Detection of Myocardial Ischemia Using 64-Slice MDCT

Abstract

Background:The purpose is to investigate the ability of 64-slice multidetector computed tomography (MDCT) at rest in detecting myocardial ischemia, conventionally depicted by myocardial perfusion scintigraphy (MPS). Methods and Results:In 75 patients with suspected coronary artery disease, cardiac CE-MDCT at rest and stress/rest MPS were performed. The 2D myocardial images were reconstructed in diastolic and systolic phases using raw data from coronary computed tomography (CT) angiography. CT numbers in the myocardium were used as an estimate of myocardial enhancement. The myocardium was shown using a color scale that depicts faint low-density areas more clearly than gray scale. The variation in myocardial enhancement was evaluated at systole and diastole for those segments depicted as ischemia on MPS. A pattern of transient endocardial hypoenhancement at systole and normal enhancement at diastole as the ischemic pattern on CT myocardial image was defined. MPS diagnosed myocardial ischemia in 40 of 75 patients. Use of the ischemic pattern on CT images distinguished patients with and without ischemia with a sensitivity of 90%, specificity of 83%, positive predictive value of 86% and negative predictive value of 88%. Conclusions: CT myocardial imaging at rest demonstrates a characteristic enhancement pattern for ischemia. This has potential as a non-invasive method for detecting ischemia. (Circ J 2009; 73: 905 -911)

Three-Dimensional Quantitative Volumetry of Chronic Total Occlusion Plaque Using Coronary Multidetector Computed Tomography

“…Multidetector computed tomography (MDCT) has been used as a valuable non-invasive tool for evaluation of coronary artery atherosclerotic plaque. 8- 14 Furthermore, recent developments in MDCT technology, including increased detectors and dedicated coronary artery analysis software, have enabled sophisticated volumetric plaque analysis on intravascular ultrasound (IVUS). 15, 16 We therefore reasoned that MDCT can provide additional information beyond coronary angiography, and can predict the success of CTO PCI.…”

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

“…Our results showed that severe coronary calcification was the leading cause of nonevaluable coronary segments on CCTA, with a specificity of 69% and a PPV of 81% in the per-vessel analysis compared with ICA for detecting angiographically significant stenoses. Although the capability of resting CCTA for detecting myocardial ischemia remains debatable [35], CCTA does not reliably provide the physiological significance of coronary stenoses [36]. In our series, ICA revealed stenosis ≥50% in 168 (88%) and hemodynamically significant stenosis in 144 (75%) patients.…”

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

“…Nagao et al 69 had earlier described myocardial ischaemia as a characteristic enhancement pattern, by correlating colour-coded rest cCTA studies to SPECT images and had correctly identified myocardial ischaemia in 36 of 40 patients (90%), with a specificity of 83%, a PPV of 86% and a NPV of 88%. In a separate investigation in a population of 20 patients, the same group reported 16 perfusion defects at rest CTA that were not detected on resting SPECT, 8 of which, however, became apparent on stress SPECT.…”