Myocardial Perfusion Imaging Using Adenosine Triphosphate Stress Multi-Slice Spiral Computed Tomography Alternative to Stress Myocardial Perfusion Scintigraphy

Abstract

ontrast enhanced multislice spiral computed tomography (CE-MSCT) has been proposed as a means of evaluating coronary artery stenoses. [1][2][3] In just a few years, technological advances have progressively improved the temporal resolution. Recent studies showed that CE-MSCT allows for a noninvasive assessment of coronary artery disease (CAD) in a clinical setting. [4][5][6][7][8][9][10] In addition to coronary artery assessment, CE-MSCT can also provide information about myocardial perfusion. Koyama et al reported that CE-MSCT could describe acute myocardial infarction (AMI) as a perfusion defect after the injection of a bolus of contrast medium. 11 Their data showed myocardial viability and function after AMI.No attempt to detect myocardial ischemia using pharmacological stress MSCT has been reported previously. Adenosine triphosphate (ATP) is widely used as a coronary vasodilator to detect myocardial ischemia in the fields of magnetic resonance imaging, 12 nuclear imaging 13 and echocardiography. 14 We hypothesized that CE-MSCT can describe myocardial ischemia as a hypo-perfusion area (HPA) using the ATP provocation test. The present study was designed to: (i) to test our hypothesis; and (ii) to evaluate the potential of the ATP stress CE-MSCT in a clinical setting. Methods Study ProtocolThe study protocol necessitated that the enrolled patients underwent both ATP-provocation/non-provocation CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS), and received conventional coronary angiography (CAG) as required. All patients gave their informed consent and the protocol was approved by the hospital's ethics committee.The entry criteria were as follows: (i) de novo effort or rest stable angina (documented ST-T change on electrcardiogram (ECG), or relieved by administration of nitroglycerin); (ii) no history of coronary angiography; and (iii) asymptomatic patients with a high probability of CAD (ie, multiple coronary risk factors) or abnormal findings in exercise ECG.The exclusion criteria included: (i) acute myocardial infarction (within 3 months); (ii) unstable angina (recent onset of angina within a month, severe and worsening clinical symptom); (iii) chronic atrial fibrillation; (iv) deteriorated renal function (serum creatinine >1.5 mg/dl); (v) pregnancy, hyperthyroidism or a known allergic reaction to Background The present study was designed to: (i) detect myocardial ischemia in contrast enhanced multislice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP) pharmacological stress test; and (ii) evaluate the potential of ATP stress CE-MSCT in a clinical setting. Methods and ResultsTwelve patients underwent ATP stress CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS) and 9 of the patients received conventional coronary angiography (CAG). Dual CE-MSCT scans were performed for stress and rest images, with and without intravenous infusion of ATP (0.16 mg·kg -1 ·min -1 ) at intervals of 20 min. Myocardial perfusion and coronary artery were visually eval...

Image Fusion of Coronary Tree and Regional Cardiac Function Image Using Multislice Computed Tomography

“…[4][5][6] Coronary CTA sometimes provides not only information about coronary artery stenosis (luminal morphology), but also information about plaque of the coronary artery wall. [13][14][15] Thus, coronary CTA has the potential to be the gatekeeper for deciding the treatment strategy for coronary artery diseases.…”

Myocardial CT perfusion imaging for ischemia detection

“…A large number of clinical studies have explored the diagnostic performance of myocardial CTP, showing a good sensitivity and negative predictive value, with modest specificity and positive predictive value (34)(35)(36)(37). Most of these were single center, had small sample size, and used different reference standard modalities including ICA, SPECT, CMR perfusion, and FFR.…”

“…Many single and multicenter studies have validated the results of myocardial CTP against other modalities such as SPECT, CMR, PET, invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) (34)(35)(36)(37)(38)(39)(40)(41)(42). Most of these were performed in a limited number of patients and using different scanner generations, showing high sensitivity and negative predictive value, and moderate specificity and positive predictive value.…”

Evaluation of Myocardial Ischemia by Multiple Detector Computed Tomography

“…Todos os defeitos são analisados em múltiplas fases para determinar se é um defeito de perfusão real ou artefato 33 . 21,28,[30][31][32][33]36,41,44,[48][49][50][51] . A sensibilidade oscila entre 79% e 97%, e a especificidade, de 72% a 98%, dependendo do equipamento utilizado, padrão de referência, população estudada, e se a análise é por paciente, segmento ou território coronariano.…”

“…A sensibilidade oscila entre 79% e 97%, e a especificidade, de 72% a 98%, dependendo do equipamento utilizado, padrão de referência, população estudada, e se a análise é por paciente, segmento ou território coronariano. Estudos recentes avaliaram a acurácia da PMTC utilizando equipamentos com uma ou duas fontes de raios-x, com cobertura longitudinal limitada 21,28,32,44,48,49 .…”