Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived

Pontone, Gianluca; Baggiano, Andrea; Andreini, Daniele; Guaricci, Andrea Igoren; Guglielmo, Marco; Muscogiuri, Giuseppe; Fusini, Laura; Soldi, Margherita; Torto, Alberico Del; Mushtaq, Saima; Conte, Edoardo; Calligaris, Giuseppe; Martini, Stefano De; Ferrari, Cristina; Galli, Stefano; Grancini, Luca; Olivares, Paolo; Ravagnani, Paolo; Teruzzi, Giovanni; Trabattoni, Daniela; Fabbiocchi, Franco; Montorsi, Piero; Rabbat, Mark; Bartorelli, Antonio L.; Pepi, Mauro

doi:10.1016/j.jcmg.2019.02.015

Cited by 87 publications

(77 citation statements)

References 36 publications

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“…3b). Unlike static CTP, the diagnostic performance of this technique is independent of the optimal scan timing and it also allows quantification of myocardial perfusion [30]. The prospective ECG-triggered acquisition in the systolic phase (40% R-R interval) is advantageous because this phase is less affected by motion artifact and the hypoenhancement is more visible than in the diastolic phase [31].…”

Section: Dynamic Ctp Imagingmentioning

confidence: 99%

“…Although the dynamic acquisitions are performed every third or more heartbeat, dynamic CTP with dual-source CT has been reported to have good diagnostic performance for detecting a myocardial perfusion abnormality [34]. Wide-detector CT (e.g., 256 or 320 slice detectors, with 8 cm/16 cm z-coverage) enables acquisition of data in consecutive heartbeats, providing whole-heart perfusion without temporal gaps [30,35]. Dynamic CTP imaging by wide-detector CT can accurately quantify myocardial perfusion and is comparable to positron emission tomography (PET) with 15 O-labelled water, which is the gold standard tracer because it uses a freely diffusible tracer with a 100% extraction fraction even at high blood flow [36].…”

Section: Dynamic Ctp Imagingmentioning

confidence: 99%

“…CTP is useful for assessment of the hemodynamic significance and effective classification of coronary lesions, allowing integrated evaluation of CAD when combined with CTA ( Fig. 8) [30,79]. Moreover, myocardial perfusion can be quantified and the effect of treatment after revascularization can be evaluated [35,80].…”

Section: Advantages Of Ctpmentioning

confidence: 99%

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Computed tomographic evaluation of myocardial ischemia

et al. 2020

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Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CTfractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.

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Section: Dynamic Ctp Imagingmentioning

confidence: 99%

Section: Dynamic Ctp Imagingmentioning

confidence: 99%

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Computed tomographic evaluation of myocardial ischemia

et al. 2020

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“…Using the same reference standard, Coenen et al used dual energy scanners to show an increase in the diagnostic accuracy of a combined cCTA and Dynamic Stress-CTP approach compared to anatomical assessment alone (AUC 0.78 vs. 0.70) [ 16 ]. Finally, Pontone et al used a last generation whole-heart scanner and showed that an integrated approach (cCTA+Static or Dynamic CTP) had better diagnostic accuracy in the assessment of patients with intermediate-to-high pre-test likelihood of CAD evaluated, again, using invasive FFR as the reference standard [ 15 , 27 ]. Importantly, it was possible to achieve acceptable radiation exposure (<6 mSv for cCTA+Static Stress-CTP and <9 mSv for cCTA+Dynamic Stress-CTP) as well as high diagnostic accuracy (AUC of 0.92 for cCTA+Static Stress-CTP and 0.88 for cCTA+Dynamic Stress-CTP in a per-vessel analysis).…”

Section: Discussionmentioning

confidence: 99%

Sequential Strategy Including FFRCT Plus Stress-CTP Impacts on Management of Patients with Stable Chest Pain: The Stress-CTP RIPCORD Study

Baggiano

Fusini

Torto

et al. 2020

JCM

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Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.

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“…4,[14][15][16] In single center studies, myocardial CTP imaging has demonstrated high accuracy when compared with single photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), invasive coronary angiography (ICA), positron emission tomography (PET), and invasive fractional flow reserve (FFR). 4,14,[17][18][19][20][21][22][23][24][25] Multicenter studies have also established the accuracy of myocardial CTP with coronary CTA. 26,27 These studies suggest that CTP is particularly accurate when interpreted in the context of coronary CTA findings.…”

Section: Introductionmentioning

confidence: 99%