Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia　– Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

Tanabe, Yuji; Kurata, Akira; Uetani, Teruyoshi; Fukuyama, Naoto; Yokoi, Takahiro; Nishiyama, Hiroki; Kido, Teruhiko; Miyagawa, Masao; Mochizuki, Takashi

doi:10.1253/circj.cj-16-0834

Cited by 17 publications

(12 citation statements)

References 24 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A bolus-tracking or timing-bolus technique can aid accurate calculation of the scan time. The optimal scan time is approximately 2-10 s from the time of peak enhancement in the ascending aorta [27,28]. Scan timing is affected by many factors, including cardiac output, injection rate, and the severity of the perfusion abnormality.…”

Section: Static Ctp Imagingmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Static Ctp Imagingmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, the CT density of the myocardium on static CT perfusion imaging is highly dependent on the contrast material bolus profile as well as on data acquisition timing. 35 A previous cardiac magnetic resonance study analyzed the transmural gradient in myocardial contrast uptake as signal intensity using dynamic magnetic resonance perfusion. 36 That study indicated that the transmural gradient of the signal intensity in the left ventricular myocardium can be affected by the timing of contrast material administration and that it varies over time.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Goto

Kitagawa

Uno

et al. 2017

Circ J

View full text Add to dashboard Cite

limited response to vasodilator stress, resulting in globally reduced hyperemic MBF. 15 Because the endocardial layer is most susceptible to ischemia, 16,17 the ratio of endocardial MBF and epicardial MBF might be a more useful indicator of flow-limiting CAD.The purpose of this study was to investigate whether the transmural ratio of absolute MBF can improve the accuracy of CTP when compared with absolute MBF for the detection of flow-limiting CAD, as defined by fractional flow reserve (FFR). We also explored the prevalence of myocardial scar in candidates for CTP and its effect on the diagnostic performance of CTP. Methods Study PopulationIn the comprehensive cardiac CT registry at Mie University C oronary computed tomography angiography (CCTA) allows noninvasive assessment of the morphology of coronary artery stenosis and is highly useful for ruling out the presence of obstructive coronary artery disease (CAD). 1,2 However, because obstructive stenosis identified by CCTA is a poor predictor of the presence of myocardial ischemia, a functional test is generally recommended to investigate the hemodynamic significance of the stenotic lesion. 3 Stress dynamic CT perfusion (CTP) with absolute quantification of myocardial blood flow (MBF) is a new noninvasive technique for the assessment of myocardial ischemia. 4,5 Previous CTP studies used absolute MBF thresholds in mL/100 g/min to discriminate flow-limiting CAD, 6-10 but the absolute MBF can vary because of factors other than the degree of coronary artery stenosis. Yoshitaka Goto, MD; Kakuya Kitagawa, MD; Mio Uno, MD; Shiro Nakamori, MD; Tatsuro Ito, MD; Naoki Nagasawa, PhD; Kaoru Dohi, MD; Hajime Sakuma, MD Background: Previous dynamic stress computed tomography perfusion (CTP) studies used absolute myocardial blood flow (MBF in mL/100 g/min) as a threshold to discriminate flow-limiting coronary artery disease (CAD), but absolute MBF can be vary because of multiple factors. The aim of this study was to compare the diagnostic performance of absolute MBF and the transmural perfusion ratio (TPR) for the detection of flow-limiting CAD, and to clarify the influence of CT delayed enhancement (CTDE) on the diagnostic performance of CTP.

show abstract

“…Since the first human report of CTP under adenosine stress by Kurata et al [10], static CTP has been evaluated by many single and multicenter studies because of its technical ease of implementation-static CTP can be performed on any CT platform that is capable of CCTA. However, success of perfusion assessment by static CTP is highly dependent on contrast material bolus timing [11][12][13][14] and motion [15,16]. In contrast, with a dynamic approach, myocardial perfusion is assessed based on myocardial enhancement at multiple time points of first-pass of the contrast material, which is robust in terms of bolus timing and allows for fully quantitative analysis of myocardial perfusion.…”

Section: Wide-detector Coveragementioning

confidence: 99%

Dynamic CT Perfusion Imaging: State of the Art

Kitagawa

Goto

Nakamura

et al. 2018

Cardiovasc Imaging Asia

View full text Add to dashboard Cite

Recent advances in computed tomography (CT) technology have enabled stress dynamic CT perfusion (CTP) imaging of the entire myocardium to be performed with high temporal resolution and reasonable radiation dose. The most important advantage of dynamic CTP is the feasibility of complete quantification of myocardial perfusion in mL/min/g. Although high diagnostic values have been reported for the detection of myocardial ischemia, standardization of acquisition method, mathematical modeling and interpretation, as well as further evaluation of its accuracy, clinical role, and cost effectiveness are required before its routine clinical implementation. The current review focuses on the state-of-the-art of dynamic CTP and outlines its current status and future directions as a new technology for the physiologic assessment of coronary artery disease.

show abstract

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia　– Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

Cited by 17 publications

References 24 publications

Computed tomographic evaluation of myocardial ischemia

Computed tomographic evaluation of myocardial ischemia

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Dynamic CT Perfusion Imaging: State of the Art

Contact Info

Product

Resources

About

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia – Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

Cited by 17 publications

References 24 publications

Computed tomographic evaluation of myocardial ischemia

Computed tomographic evaluation of myocardial ischemia

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Dynamic CT Perfusion Imaging: State of the Art

Contact Info

Product

Resources

About

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia　– Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –