Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Abstract

During the last decade coronary computed tomography angiography (CTA) has become the preeminent noninvasive imaging modality to detect coronary artery disease (CAD) with high accuracy.However, CTA has a limited value in assessing the hemodynamic significance of a given stenosis due to a modest specificity and positive predictive value. In recent years, different CT techniques for detecting myocardial ischemia have emerged, such as CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and myocardial CT perfusion (CTP) imaging. Myocardial CTP imaging can be performed with a single static scan during first pass of the contrast agent, with monoenergetic or dualenergy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson). A number of CTP techniques are available, which can assess myocardial perfusion in both a qualitative, semi-quantitative or quantitative manner. Once used primarily as research tools, these modalities are increasingly being used in routine clinical practice. All these techniques offer the substantial advantage of combining anatomical and functional evaluation of flow-limiting coronary stenosis in the same examination that would be beneficial for clinical decision-making. This review focuses on the state-of the-art and future trends of these evolving imaging modalities in the field of cardiology for the physiologic assessments of CAD.

Application of double low dose combined low flow injection in coronary dual‐source coronary computed tomography angiography

“…It had the advantage of high sensitivity and specificity as well as negative predictive value in comparison with invasive CCTA which was served as the standard of reference for the detection of CAD due to its high temporal resolution and spatial resolution. 3,4 Abundant clinical studies have provided evidences that retrospective ECG-triggered CCTA has the capability of ventricle and aortic valve motion assessment along with systolic-phase information acquisition, 5,6 but retrospective ECG-triggered CCTA indeed lead to a relatively high effective radiation dose caused by the low pitch values. For example, Ko et al 7 reported that the average radiation dose for retrospective ECG-triggering was 10.7 ± 2.70 mSv, while the mean radiation dose was 3.83 ± 0.84 mSv for prospective ECG-gating, suggesting that CCTA performed with prospective ECG-triggering had less effective radiation dose as compared to retrospective ECG-triggering.…”

Computational assessment of blood flow heterogeneity in dialysis patients’ cardiac ventricles

“…The main conclusions of this study are: CT is now an advanced field of imaging that provides a wide spectrum of BF data in 546 the heart (Cademartiri et al, 2017;Schindler, 2016). In this study, the patient hearts 547 were imaged using a rest/stress protocol.…”

Anatomy and physiology in coronary artery disease imaging

“…Anyway, today CCT is one of the most studied and well-validated cardiac imaging techniques we can conceive and is ready to play a significant and growing role in cardiovascular medicine. [2][3][4][5][6][7][8][9] THE NEW LANDSCAPE AFTER UPDATED NICE GUIDELINES 2017…”