Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging

Feuchtner, Gudrun; Plank, Fabian; Peña, Constantino; Battle, Juan; Min, James K.; Leipsic, Jonathon; LaBounty, Troy; Janowitz, Warren R.; Katzen, Barry T.; Ziffer, Jack A.; Cury, Ricardo C.

doi:10.1136/heartjnl-2012-302531

Cited by 53 publications

(20 citation statements)

References 40 publications

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“…The presence of a myocardial hypo-enhancement region at rest on CCT has a sensitivity and specificity of around 90% to identify patients with a MI (Figures 5-7) (89,90). Rest dual energy CT provided comprehensive CAD imaging and identified perfusion defects in 90% of cases compared to SPECT (60).…”

Section: A B and The Assessment Of MI Ischemia And Viability (88)mentioning

confidence: 99%

“…Authors retrospectively evaluated fifty-three patients who underwent stress dynamic CTP and either SPECT (n = 25) or CMR (n = 28) and found that for detecting the abnormal perfused myocardium, sensitivity and specificity were 80% (95% CI, 71-90) and 86% (95% CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82% (95% CI, 76-88) and 87% (95% CI, [80][81][82][83][84][85][86][87][88][89][90][91][92] in CMR (cut-off MBF, 1.25) (69).…”

Section: A B and The Assessment Of MI Ischemia And Viability (88)mentioning

confidence: 99%

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Infarct characterization using CT

Grutta

Toia

Maffei

et al. 2017

Cardiovasc. Diagn. Ther.

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Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination.Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.

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Section: A B and The Assessment Of MI Ischemia And Viability (88)mentioning

confidence: 99%

Section: A B and The Assessment Of MI Ischemia And Viability (88)mentioning

confidence: 99%

Infarct characterization using CT

Grutta

Toia

Maffei

et al. 2017

Cardiovasc. Diagn. Ther.

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“…100 A first evidence of CT perfusion applied in the evaluation of patients with ACP (TIMI risk score ,4) presenting at the ED has demonstrated that rest CT perfusion was highly accurate in the detection of perfusion defects, with a sensitivity of 92% and specificity of 95% as compared with SPECT. 101 Adding CT perfusion information to the cardiac CT data resulted in better PPV with reduced rates of false positives ( Figure 5). 101 Accordingly, in a subanalysis of the ROMICAT I trial, the sensitivity for ACS increased from 77% for obstructive CAD to 90% with addition of rest CT perfusion.…”

Section: Plaque Features Associated With Vulnerabilitymentioning

confidence: 99%

“…101 Adding CT perfusion information to the cardiac CT data resulted in better PPV with reduced rates of false positives ( Figure 5). 101 Accordingly, in a subanalysis of the ROMICAT I trial, the sensitivity for ACS increased from 77% for obstructive CAD to 90% with addition of rest CT perfusion. 102 Finally, a first recent prognostic study in a large cohort of patients (nearly 400 patients) showed that the extent and severity of rest myocardial hypoperfusion in addition to signs of necrotic myocardium as detected by CT prior to invasive coronary evaluation and revascularization is significantly and independently related to long-term (median 50 months) outcome in patients with NSTEMI.…”

Section: Plaque Features Associated With Vulnerabilitymentioning

confidence: 99%

Chest pain: coronary CT in the ER

Maffei¹,

Seitun²,

Guaricci³

et al. 2016

BJR

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Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection of subclinical CAD and plaque imaging offer the opportunity to improve risk stratification. Moreover, recent advances of the latest generation CT scanners allow combining both anatomical and functional imaging by stress myocardial perfusion. The role of cardiac CT in acute settings is already important and will become progressively more important in the coming years.

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“…Most of the studies to date were performed with wide-detector MDCT or DSCT for higher temporal resolution that is preferred for CTP studies; however, single-source 64-detector MDCT has shown to be feasible as well. 32,33 DECT technology also has been used for CTP to improve depiction power of perfusion defects by assessing changes in iodine distribution within the myocardium. 34 In CCTA images, ischemic and nonviable myocardium is expressed as a hypoattenuation area reflecting diminished content of contrast medium within that particular myocardium -also known as myocardial blood pool defect.…”

Section: Computed Tomography Perfusionmentioning

confidence: 99%