The Feasibility, Tolerability, Safety, and Accuracy of Low-radiation Dynamic Computed Tomography Myocardial Perfusion Imaging With Regadenoson Compared With Single-photon Emission Computed Tomography

Assen, Marly van; Duguay, Taylor M.; Litwin, Sheldon E.; Bayer, Richard R.; Nance, John W.; Surányi, Pál; Cecco, Carlo N. De; Varga-Szemes, Ákos; Jacobs, Brian E.; Johnson, Addison A.; Tesche, Christian; Schoepf, U. Joseph

doi:10.1097/rti.0000000000000502

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…At the time of the meta-analysis by Danad et al, 59 the average radiation dose from dynamic CTP was around 10 mSv using mainly second-generation DSCT systems and higher kVp settings. Studies using contemporary CT scanners allow acquisition of dynamic CTP examinations at doses of around 5 mSv or less 46,51,61 . These radiation doses are still lower than SPECT imaging, which also has effective doses of around 12 to 15 mSv.…”

Section: Functional Vessel-specific Ct Imaging At the Myocardial Leve...mentioning

confidence: 99%

Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia

Patel

Emrich

Schoepf³

et al. 2021

Journal of Thoracic Imaging

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Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.

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Section: Functional Vessel-specific Ct Imaging At the Myocardial Leve...mentioning

confidence: 99%

Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia

Patel

Emrich

Schoepf³

et al. 2021

Journal of Thoracic Imaging

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“…Most commonly used coronary vasodilators include regadenosone, adenosine, and dipyridamole of which the first 2 seem to be superior. 25,37,38 Characteristics of the 3 coronary vasodilators are described in Table 1.…”

Section: Vasodilator Administrationmentioning

confidence: 99%

“…Coronary vasodilator agents induce hyperemia in healthy myocardium whereas ischemic regions remain normo/hypoperfused. Most commonly used coronary vasodilators include regadenosone, adenosine, and dipyridamole of which the first 2 seem to be superior 25,37,38. Characteristics of the 3 coronary vasodilators are described in Table 1.…”

Section: Ct Perfusion For Detection Of Myocardial Ischemiamentioning

confidence: 99%

Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography

Møller

Schuijf²,

Oyama‐Manabe

et al. 2022

Journal of Thoracic Imaging

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Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality.

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“…Van Assen et al reported that cardiac CT perfusion can be performed with comparable radiation doses to single-photon emission CT (SPECT) (CT perfusion with 4.4 ± 2.7 mSv and SPECT with 5.6 ± 1.7 mSv). It showed good diagnostic accuracy for the detection of ischaemia compared with SPECT [34]. Danad et al reported a mean ED of 5.31 mSv for a coronary CTA, 6.01 mSv for a technetium-99m/tetrofosmin-labelled SPECT and 3.10 mSv for [ O]H 2 O-positron emission tomography (PET).…”

Section: Radiation Doses Of Cardiac and Liver Ct Perfusion Scans Perf...mentioning

confidence: 99%

Experimental examination of radiation doses from cardiac and liver CT perfusion in a phantom study as a function of organ, age and sex

Bos

König²,

Blex

et al. 2021

J. Radiol. Prot.

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Cardiac and liver computed tomography (CT) perfusion has not been routinely implemented in the clinic and requires high radiation doses. The purpose of this study is to examine the radiation exposure and technical settings for cardiac and liver CT perfusion scans at different CT scanners. Two cardiac and three liver CT perfusion protocols were examined with the N1 LUNGMAN phantom at three multi-slice CT scanners: a single-source (I) and second- (II) and third-generation (III) dual-source CT scanners. Radiation doses were reported for the CT dose index (CTDIvol) and dose–length product (DLP) and a standardised DLP (DLP10cm) for cardiac and liver perfusion. The effective dose (ED10cm) for a standardised scan length of 10 cm was estimated using conversion factors based on the International Commission on Radiological Protection (ICRP) 110 phantoms and tissue-weighting factors from ICRP 103. The proposed total lifetime attributable risk of developing cancer was determined as a function of organ, age and sex for adults. Radiation exposure for CTDIvol, DLP/DLP10 cm and ED10 cm during CT perfusion was distributed as follows: for cardiac perfusion (II) 144 mGy, 1036 mGy·cm/1440 mGy·cm and 39 mSv, and (III) 28 mGy, 295 mGy·cm/279 mGy·cm and 8 mSv; for liver perfusion (I) 225 mGy, 3360 mGy·cm/2249 mGy·cm and 54 mSv, (II) 94 mGy, 1451 mGy·cm/937 mGy·cm and 22 mSv, and (III) 74 mGy, 1096 mGy·cm/739 mGy·cm and 18 mSv. The third-generation dual-source CT scanner applied the lowest doses. Proposed total lifetime attributable risk increased with decreasing age. Even though CT perfusion is a high-dose examination, we observed that new-generation CT scanners could achieve lower doses. There is a strong impact of organ, age and sex on lifetime attributable risk. Further investigations of the feasibility of these perfusion scans are required for clinical implementation.

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The Feasibility, Tolerability, Safety, and Accuracy of Low-radiation Dynamic Computed Tomography Myocardial Perfusion Imaging With Regadenoson Compared With Single-photon Emission Computed Tomography

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Cited by 4 publications

References 27 publications

Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia

Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia

Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography

Experimental examination of radiation doses from cardiac and liver CT perfusion in a phantom study as a function of organ, age and sex

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