Myocardial perfusion imaging by computed tomography: today and tomorrow

Abstract

Summary Cardiac perfusion along with imaging of coronary artery stenosis is an important tool in assessing the degree of coronary artery disease (CAD) and decision‐making regarding further treatment. SPECT, PET, echocardiography and cardiac magnetic resonance imaging are clinically established techniques to evaluate myocardial perfusion and viability with a high diagnostic accuracy and relatively few unwanted side effects. However, none of these modalities Glose can reliably assess the extent and morphology of CAD, features which also have implications as well as for patient management. In contrast, cardiac CT has emerged over the last years as a reliable tool to visualise coronary atherosclerotic plaque and stenosis, nearly unaffected by heart rate and carrying a relatively low radiation exposure; however, without allowing an adequate assessment of myocardial perfusion. Given the great promise of a combined cardiac CT examination to assess morphology and function, much research has recently been focused on the development of CT‐based myocardial perfusion imaging techniques. In this article, we review recent developments in cardiac CT with respect to myocardial perfusion imaging, especially the two main techniques, first‐pass and dynamic CT acquisitions.

New frontiers in CT angiography: physiologic assessment of coronary artery disease by multidetector CT

“…Since then, numerous protocols for CTP have been evaluated, including whole heart coverage by 320-detector row CTP, time resolved dynamic CTP by dual source CT, and CTP by dual energy imaging 29. Each of these techniques has a number of advantages and disadvantages.…”

A computational model applied to myocardial perfusion in the human heart: From large coronaries to microvasculature

“…The direct measurement of blood perfusion is nowadays possible by means of myocardial blood flow (MBF) maps [45,12,51] or myocardial perfusion reserve [68,17,6], obtained by Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI), respectively. However, these techniques are still seldom used in the daily diagnostic practice, also because they require very expensive procedures, which are also very demanding for the patients in terms of radiological exposition and/or duration of the acquisition exam.…”

A Stationary-Sources and Rotating-Detectors Computed Tomography Architecture for Higher Temporal Resolution and Lower Radiation Dose

“…In clinical practices, it generally requires adhering to the principle of reducing radiation doses as low as reasonably achievable (ALARA). The dose concern is particularly critical for CT perfusion imaging, where a high radiation dose (∼10mSv) can be accumulated from multiple CT acquisitions [19]. The dose issue will become even more prominent if a higher spatial resolution is required.…”