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Magalhães TA, Cury RC, Cerci RJ, Parga Filho JR, Gottlieb I, Nacif MS, Pinto IM, Rochitte CE, Vilas-Boas F, Schvartzman PR. Evaluation of Myocardial Perfusion by Computed Tomography - Principles, Technical Background and Recommendations. Arq Bras Cardiol 2019; 113:758-767. [PMID: 31691758 PMCID: PMC7020871 DOI: 10.5935/abc.20190217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/20/2019] [Indexed: 11/20/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) has gained a prominent role in the evaluation of coronary artery disease. However, its anatomical nature does not allow the evaluation of the functional repercussion of coronary obstructions. It has been made possible to evaluate Myocardial computed tomography perfusion (Myocardial CTP) recently, based on myocardial contrast changes related to coronary stenoses. Several studies have validated this technique against the anatomical reference method (cardiac catheterization) and other functional methods, including myocardial perfusion scintigraphy and fractional flow reserve. The Myocardial CTP is performed in conjunction with the CCTA, a combined analysis of anatomy and function. The stress phase (with assessment of myocardial perfusion) can be performed before or after the resting phase (assessment of resting perfusion and coronary arteries), and different acquisition parameters are proposed according to the protocol and type of equipment used. Stressors used are based on coronary vasodilation (e.g. dipyridamole, adenosine). Image interpretation, similar to other perfusion assessment methods, is based on the identification and quantification of myocardial perfusion defects. The integration of both perfusion and anatomical findings is fundamental for the examination interpretation algorithm, allowing to define if the stenoses identified are hemodynamically significant and may be related to myocardial ischemia.
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Affiliation(s)
- Tiago Augusto Magalhães
- Universidade Federal do Paraná - Complexo Hospital de Clínicas (CHC) -Universidade Federal do Paraná, Curitiba, PR - Brazil.,Hospital do Coração (HCor) - Division of cardiovascular CT/MR, São Paulo, SP - Brazil
| | | | | | - José Rodrigues Parga Filho
- Instituto do Coração (InCor) - Universidade de São Paulo - Division of Cardiovascular CT/MR, São Paulo, SP - Brazil
| | - Ilan Gottlieb
- Casa de Saúde São José - Division of Radiology, Rio de Janeiro, RJ - Brazil
| | - Marcelo Souto Nacif
- Complexo Hospitalar de Niterói - Division of Radiology, Niterói, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Universidade de São Paulo - Division of Cardiovascular CT/MR, São Paulo, SP - Brazil
| | | | - Paulo R Schvartzman
- Hospital Moinhos de Vento - Division of Cardiovascular CT/MR, Porto Alegre, RS - Brazil
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FFR CT and CT perfusion: A review on the evaluation of functional impact of coronary artery stenosis by cardiac CT. Int J Cardiol 2019; 300:289-296. [PMID: 31466886 DOI: 10.1016/j.ijcard.2019.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/14/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
Coronary computed tomography angiography (CCTA) is at the frontline of the diagnostic strategies to detect coronary artery disease (CAD). Anatomical information have proven to be insufficient to detect hemodynamic significant epicardial stenosis. In the present invited review we discuss on FFRCT and stress CTP, emerging technologies for an accurate and comprehensive evaluation of patients with suspected CAD, offering both anatomical (i.e. luminal and plaque) and functional assessment in one single technique.
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Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT. J Cardiovasc Comput Tomogr 2019; 13:55-61. [DOI: 10.1016/j.jcct.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/17/2018] [Accepted: 10/01/2018] [Indexed: 11/15/2022]
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Ramsey BC, Fentanes E, Choi AD, Branch KR, Thomas DM. Myocardial Assessment with Cardiac CT: Ischemic Heart Disease and Beyond. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018; 11:16. [PMID: 29963220 PMCID: PMC5984644 DOI: 10.1007/s12410-018-9456-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent advancements, current trends, and the expanding role for cardiac CT (CCT) in the evaluation of ischemic heart disease, nonischemic cardiomyopathies, and some specific congenital myocardial disease states. RECENT FINDINGS CCT is a highly versatile imaging modality for the assessment of numerous cardiovascular disease states. Coronary CT angiography (CCTA) is now a well-established first-line imaging modality for the exclusion of significant coronary artery disease (CAD); however, CCTA has modest positive predictive value and specificity for diagnosing obstructive CAD in addition to limited capability to evaluate myocardial tissue characteristics. SUMMARY CTP, when combined with CCTA, presents the potential for full functional and anatomic assessment with a single modality. CCT is a useful adjunct in select patients to both TTE and CMR in the evaluation of ventricular volumes and systolic function. Newer applications, such as dynamic CTP and DECT, are promising diagnostic tools offering the possibility of more quantitative assessment of ischemia. The superior spatial resolution and volumetric acquisition of CCT has an important role in the diagnosis of other nonischemic causes of cardiomyopathies.
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Affiliation(s)
- Bryan C. Ramsey
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
| | - Emilio Fentanes
- Cardiology Division, Department of Medicine, Tripler Army Medical Center, Honolulu, HI USA
| | - Andrew D. Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC USA
| | | | - Dustin M. Thomas
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
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The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT. Eur J Radiol 2015; 84:2411-20. [DOI: 10.1016/j.ejrad.2014.12.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/21/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
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Park KH, Park WJ. Endothelial Dysfunction: Clinical Implications in Cardiovascular Disease and Therapeutic Approaches. J Korean Med Sci 2015; 30:1213-25. [PMID: 26339159 PMCID: PMC4553666 DOI: 10.3346/jkms.2015.30.9.1213] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis is a chronic progressive vascular disease. It starts early in life, has a long asymptomatic phase, and a progression accelerated by various cardiovascular risk factors. The endothelium is an active inner layer of the blood vessel. It generates many factors that regulate vascular tone, the adhesion of circulating blood cells, smooth muscle proliferation, and inflammation, which are the key mechanisms of atherosclerosis and can contribute to the development of cardiovascular events. There is growing evidence that functional impairment of the endothelium is one of the first recognizable signs of development of atherosclerosis and is present long before the occurrence of atherosclerotic cardiovascular disease. Therefore, understanding the endothelium's central role provides not only insights into pathophysiology, but also a possible clinical opportunity to detect early disease, stratify cardiovascular risk, and assess response to treatments. In the present review, we will discuss the clinical implications of endothelial function as well as the therapeutic issues for endothelial dysfunction in cardiovascular disease as primary and secondary endothelial therapy.
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Affiliation(s)
- Kyoung-Ha Park
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Woo Jung Park
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
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Measuring myocardial perfusion: the role of PET, MRI and CT. Clin Radiol 2015; 70:576-84. [DOI: 10.1016/j.crad.2014.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
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Burnstock G, Pelleg A. Cardiac purinergic signalling in health and disease. Purinergic Signal 2015; 11:1-46. [PMID: 25527177 PMCID: PMC4336308 DOI: 10.1007/s11302-014-9436-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 01/09/2023] Open
Abstract
This review is a historical account about purinergic signalling in the heart, for readers to see how ideas and understanding have changed as new experimental results were published. Initially, the focus is on the nervous control of the heart by ATP as a cotransmitter in sympathetic, parasympathetic, and sensory nerves, as well as in intracardiac neurons. Control of the heart by centers in the brain and vagal cardiovascular reflexes involving purines are also discussed. The actions of adenine nucleotides and nucleosides on cardiomyocytes, atrioventricular and sinoatrial nodes, cardiac fibroblasts, and coronary blood vessels are described. Cardiac release and degradation of ATP are also described. Finally, the involvement of purinergic signalling and its therapeutic potential in cardiac pathophysiology is reviewed, including acute and chronic heart failure, ischemia, infarction, arrhythmias, cardiomyopathy, syncope, hypertrophy, coronary artery disease, angina, diabetic cardiomyopathy, as well as heart transplantation and coronary bypass grafts.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Analysis of myocardial perfusion from vasodilator stress computed tomography: Does improvement in image quality by iterative reconstruction lead to improved diagnostic accuracy? J Cardiovasc Comput Tomogr 2014; 8:238-45. [DOI: 10.1016/j.jcct.2014.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/18/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
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Adenosine triphosphate stress dual-source computed tomography to identify myocardial ischemia: comparison with invasive coronary angiography. SPRINGERPLUS 2014; 3:75. [PMID: 24570849 PMCID: PMC3929595 DOI: 10.1186/2193-1801-3-75] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/06/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to investigate the utility incremental diagnostic value of combined assessment with coronary CT angiography (CCTA) and myocardial CT perfusion imaging (CTP) using dual-energy technology with an Adenosine Triphosphate (ATP) load technique. MATERIALS AND METHODS Twenty-one patients underwent ATP-provocation dual-energy CT and CAG. We compared the diagnostic accuracy with CAG, for ischemic region due coronary stenosis by CCTA alone and CCTA combined with CTP (Combined CCTA/CTP). RESULTS All of 21 patients CTP images could be evaluated, however 8 CCTA images could not be evaluated by calcification and motion artifact, so assessability was 61.9% (13/21) for CCTA alone, and 100% for Combined CCTA/CTP. With CAG results as a comparison, the sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 83.3% (20/24), 74.4% (29/39), 66.7% (20/30), and 87.8% (29/33) for CCTA alone, and 66.7% (16/24), 92.3% (36/39), 84.2% (16/19), and 81.8% (36/44) for combined CCTA/CTP. The diagnostic accuracy of the two methods were 77.8% (49/63) and 82.5% (52/63). CONCLUSION Dual-energy CT may be a useful modality for perfusion assessment and correlated well with the severity of stenosis on CAG. This technique may even be of use in cases of severe calcification in the coronary artery wall.
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van Werkhoven JM, Schuijf JD, Bax JJ. Myocardial perfusion imaging to assess ischemia using multislice computed tomography. Expert Rev Cardiovasc Ther 2014; 7:49-56. [DOI: 10.1586/14779072.7.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress Myocardial Perfusion: Imaging with Multidetector CT. Radiology 2014; 270:25-46. [DOI: 10.1148/radiol.13112739] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kurata A, Kawaguchi N, Kido T, Inoue K, Suzuki J, Ogimoto A, Funada JI, Higaki J, Miyagawa M, Vembar M, Mochizuki T. Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography. PLoS One 2013; 8:e83950. [PMID: 24376774 PMCID: PMC3871670 DOI: 10.1371/journal.pone.0083950] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to investigate the correlation of the qualitative transmural extent of hypoperfusion areas (HPA) using stress dynamic whole-heart computed tomography perfusion (CTP) imaging by 256-slice CT with CTP-derived myocardial blood flow (MBF) for the estimation of the severity of coronary artery stenosis. Methods and Results Eleven patients underwent adenosine triphosphate (0.16 mg/kg/min, 5 min) stress dynamic CTP by 256-slice CT (coverage: 8 cm, 0.27 s/rotation), and 9 of the 11 patients underwent coronary angiography (CAG). Stress dynamic CTP (whole–heart datasets over 30 consecutive heart beats in systole without spatial and temporal gaps) was acquired with prospective ECG gating (effective radiation dose: 10.4 mSv). The extent of HPAs was visually graded using a 3-point score (normal, subendocardial, transmural). MBF (ml/100g/min) was measured by deconvolution. Differences in MBF (mean ± standard error) according to HPA and CAG results were evaluated. In 27 regions (3 major coronary territories in 9 patients), 11 coronary stenoses (> 50% reduction in diameter) were observed. In 353 myocardial segments, HPA was significantly related to MBF (P < 0.05; normal 295 ± 94; subendocardial 186 ± 67; and transmural 80 ± 53). Coronary territory analysis revealed a significant relationship between coronary stenosis severity and MBF (P < 0.05; non-significant stenosis [< 50%], 284 ± 97; moderate stenosis [50–70%], 184 ± 74; and severe stenosis [> 70%], 119 ± 69). Conclusion The qualitative transmural extent of HPA using stress whole-heart dynamic CTP imaging by 256-slice CT exhibits a good correlation with quantitative CTP-derived MBF and may aid in assessing the hemodynamic significance of coronary artery disease.
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Affiliation(s)
- Akira Kurata
- Department of Diagnostic and Therapeutic Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
- * E-mail:
| | - Naoto Kawaguchi
- Department of Diagnostic and Therapeutic Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Teruhito Kido
- Department of Diagnostic and Therapeutic Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Katsuji Inoue
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jun Suzuki
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akiyoshi Ogimoto
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jun-ichi Funada
- Department of Cardiology, National Hospital Organization, Ehime National Hospital, Ehime, Japan
| | - Jitsuo Higaki
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masao Miyagawa
- Department of Diagnostic and Therapeutic Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mani Vembar
- CT Clinical Science, Philips Healthcare, Cleveland, Ohio, United States of America
| | - Teruhito Mochizuki
- Department of Diagnostic and Therapeutic Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
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Adenaw N, Salerno M. PET/MRI: current state of the art and future potential for cardiovascular applications. J Nucl Cardiol 2013; 20:976-89. [PMID: 23996656 DOI: 10.1007/s12350-013-9780-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Positron emission tomography-magnetic resonance imaging (PET/MRI) is emerging as a novel diagnostic modality with exciting potential for a role in multiple cardiovascular applications. The combination of the high sensitivity of PET tracers with the excellent spatial resolution and tissue characterization of cardiac MRI will provide complementary information in a variety of cardiac pathologies. While initial efforts have focused on the combination of MRI and PET for assessment of coronary artery disease, cardiomyopathy, viability, and inflammation, this new technology holds enormous potential for molecular cardiovascular imaging. This article will review the development of PET/MRI, review the current research, and discuss potential future applications.
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Affiliation(s)
- Nebiyu Adenaw
- Departments of Medicine and Cardiology, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA
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Evaluación de la isquemia miocárdica con tomografía computarizada de doble fuente: comparación con la resonancia magnética. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hamirani YS, Kramer CM. Advances in stress cardiac MRI and computed tomography. Future Cardiol 2013; 9:681-95. [PMID: 24020670 DOI: 10.2217/fca.13.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Stress cardiac MRI and stress computed tomography (CT) perfusion are relatively new, noninvasive cardiovascular stress-testing modalities. Both of these tests have undergone rapid technical improvements. Data from randomized controlled trials in stress cardiac MRI are becoming gradually incorporated into cardiovascular clinical practice, not only to assess physiological significance of coronary artery disease, but also to provide prognostic information. As CT perfusion protocols become more uniform with adequate handling of artifacts and decreasing radiation exposure with combined CT coronary angiography/CT perfusion imaging, it has the potential to become a comprehensive diagnostic test.
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Affiliation(s)
- Yasmin S Hamirani
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
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Delgado C, Vázquez M, Oca R, Vilar M, Trinidad C, Sanmartin M. Myocardial ischemia evaluation with dual-source computed tomography: comparison with magnetic resonance imaging. ACTA ACUST UNITED AC 2013; 66:864-70. [PMID: 24773993 DOI: 10.1016/j.rec.2013.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/31/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVES Computed tomography does not accurately determine which coronary lesions lead to myocardial ischemia and consequently further tests are required to evaluate ischemia induction. The aim of this study was to compare diagnostic accuracy between dual-energy computed tomography and magnetic resonance imaging in the assessment of myocardial perfusion and viability in patients suspected of coronary artery disease. METHODS A prospective study was performed in 56 consecutive patients (39 men [69.6%]; mean age [standard deviation], 63 [10]; range, 23-81). Computed tomography was performed with the following protocol: 1, adenosine stress perfusion; 2, coronary angiography; and 3, delayed enhancement. Magnetic resonance imaging for the evaluation of stress perfusion and delayed enhancement was performed within 30 days. Two observers in consensus analyzed the perfusion and delayed enhancement images. RESULTS We studied 952 myocardial segments and 168 vascular territories. In a per-segment analysis, the sensitivity, specificity, and positive and negative predictive values of computed tomography compared with magnetic resonance were 76%, 99%, 89%, and 98% for perfusion defects, and 64%, 99%, 82%, and 99% for delayed enhancement, respectively. In a per-vascular territory analysis, the same measures were 78%, 97%, 86%, and 95% for perfusion defects, and 72%, 99%, 93%, and 97% for delayed enhancement, respectively. The mean radiation dose was 8.2 (2) mSv. CONCLUSIONS Dual-source computed tomography may allow accurate and concomitant evaluation of perfusion defects and myocardial viability and analysis of coronary anatomy.
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Affiliation(s)
- Carlos Delgado
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain.
| | - María Vázquez
- Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Roque Oca
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Manuel Vilar
- Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Carmen Trinidad
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain
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Patel AR, Bhave NM, Mor-Avi V. Myocardial perfusion imaging with cardiac computed tomography: state of the art. J Cardiovasc Transl Res 2013; 6:695-707. [PMID: 23963959 DOI: 10.1007/s12265-013-9499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
Cardiac computed tomography (CCT) has become an important tool for the anatomic assessment of patients with suspected coronary disease. Its diagnostic accuracy for detecting the presence of underlying coronary artery disease and ability to risk stratify patients are well documented. However, the role of CCT for the physiologic assessment of myocardial perfusion during resting and stress conditions is only now emerging. With the addition of myocardial perfusion imaging to coronary imaging, CCT has the potential to assess both coronary anatomy and its functional significance with a single non-invasive test. In this review, we discuss the current state of CCT myocardial perfusion imaging for the detection of myocardial ischemia and myocardial infarction and examine its complementary role to CCT coronary imaging.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, Section of Cardiology, Cardiac Imaging Center, University of Chicago, Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, IL, 60637, USA,
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Comparison of MR and CT for the Assessment of the Significance of Coronary Artery Disease: a Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9186-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quantitative three-dimensional evaluation of myocardial perfusion during regadenoson stress using multidetector computed tomography. J Comput Assist Tomogr 2012; 36:443-9. [PMID: 22805675 DOI: 10.1097/rct.0b013e31825833a3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The ability of multidetector computed tomography (MDCT) to detect stress-induced myocardial perfusion abnormalities is of great clinical interest as a potential tool for the combined evaluation of coronary stenosis and its hemodynamic significance. We tested the hypothesis that quantitative 3-dimensional (3D) analysis of myocardial perfusion from MDCT images obtained during regadenoson stress would more accurately detect the presence of significant coronary artery disease (CAD) than identical analysis when performed on resting MDCT images. METHODS We prospectively studied 50 consecutive patients referred for CT coronary angiography (CTCA) who agreed to undergo additional imaging with regadenoson (0.4 mg; Astellas). Images were acquired using prospective gating (256-channel; Philips). Custom analysis software was used to define 3D myocardial segments, and calculate for each segment an index of severity and extent of perfusion abnormality, Qh, which was compared with perfusion defects predicted by the presence and severity of coronary stenosis on CTCA. RESULTS Three patients were excluded because of image artifacts. In the remaining 47 patients, CTCA depicted stenosis more than 50% in 23 patients in 37 of 141 coronary arteries. In segments supplied by the obstructed arteries, myocardial attenuation was slightly reduced compared with normally perfused segments at rest (mean [SD], 91 [21] vs 93 [26] Hounsfield units, not significant) and, to a larger extent, at peak stress (102 [21] vs 112 [20] Hounsfield units, P < 0.05). In contrast, index Qh was significantly increased at rest (0.40 [0.48] vs 0.26 [0.41], P < 0.05) and reached a nearly 3-fold difference at peak stress (0.66 [0.74] vs 0.28 [0.51], P < 0.05). The addition of regadenoson improved the diagnosis of CAD, as reflected by an increase in sensitivity (from 0.57 to 0.91) and improvement in accuracy (from 0.65 to 0.77). CONCLUSIONS Quantitative 3D analysis of MDCT images allows objective detection of CAD, the accuracy of which is improved by regadenoson stress.
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Tashakkor AY, Nicolaou S, Leipsic J, Mancini GJ. The Emerging Role of Cardiac Computed Tomography for the Assessment of Coronary Perfusion: A Systematic Review and Meta-analysis. Can J Cardiol 2012; 28:413-22. [DOI: 10.1016/j.cjca.2012.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 12/12/2022] Open
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Adenosine-Stress Dynamic Myocardial Perfusion Imaging With Second-Generation Dual-Source CT: Comparison With Conventional Catheter Coronary Angiography and SPECT Nuclear Myocardial Perfusion Imaging. AJR Am J Roentgenol 2012; 198:521-9. [PMID: 22357991 DOI: 10.2214/ajr.11.7830] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Dwivedi G, Dowsley TF, Chow BJW. Assessment of cardiac computed tomography-myocardial perfusion imaging - promise and challenges - . Circ J 2012; 76:544-52. [PMID: 22327029 DOI: 10.1253/circj.cj-11-1427] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiac computed tomography (CT) has evolved rapidly over the last decade into a reliable imaging modality for the non-invasive assessment of coronary artery disease. With the advancement in multi-detector CT technology, there has developed an increasing body of evidence that suggests that the role of cardiac CT can be extended to include functional assessment of the myocardium not only at rest but also during stress. Simultaneous anatomical and functional assessment approaches will have a number of advantages such as evaluation of the transmural extent of myocardial perfusion defects (including small subendocardial perfusion defects), reduced risk associated with multiple sources of radiation, and short image acquisition time. Although initial results hold some promise, CT myocardial perfusion imaging is a modality in the early stages of development and further work and studies are required to define, validate, and optimize this technique. This review will provide an overview of this novel perfusion imaging method, its underlying principles, evolution, limitations and future directions.
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Affiliation(s)
- Girish Dwivedi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Canada
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26
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Kurata A, Higashino H, Mochizuki T. Coronary endothelial dysfunction and non-contrast multidetector computed tomography. Circ J 2011; 76:45-6. [PMID: 22156315 DOI: 10.1253/circj.cj-11-1342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Patel AR, Lodato JA, Chandra S, Kachenoura N, Ahmad H, Freed BH, Newby B, Lang RM, Mor-Avi V. Detection of myocardial perfusion abnormalities using ultra-low radiation dose regadenoson stress multidetector computed tomography. J Cardiovasc Comput Tomogr 2011; 5:247-54. [PMID: 21723516 DOI: 10.1016/j.jcct.2011.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/03/2011] [Accepted: 06/04/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ability of multidetector computed tomography (MDCT) to detect stress-induced myocardial perfusion abnormalities is of great clinical interest as a potential tool for the combined evaluation of coronary stenosis and its significance. However, stress testing requires repeated scanning that is associated with additional radiation exposure and iodine contrast. OBJECTIVE Our goal was to determine the effects of reduced tube voltage and contrast dose on the ability to detect perfusion abnormalities. METHODS We studied 40 patients referred for coronary CT angiography (CTA) who agreed to undergo additional imaging after administration of an A(2A)-agonist (regadenoson 0.4 mg). Images were acquired at rest and during hyperemia with prospective gating with 120 kV tube voltage with 80-90 mL of contrast in 20 patients (group 1) and 100 kV with 55-70 mL of contrast in the remaining 20 patients (group 2). Custom 3D analysis software was used to define 3D myocardial segments and measure x-ray attenuation in each segment. In each group of patients, myocardial attenuation was averaged for segments supplied by coronary arteries with stenosis causing >50% luminal narrowing on coronary CTA and separately for segments supplied by arteries without significant stenosis. RESULTS Coronary CTA detected stenosis >50% in 23 of 120 coronary arteries in 16 of 40 patients. In all patients combined, myocardial attenuation increased from 86 ± 9 at rest to 110 ± 17 HU with stress, reflecting an increase in tissue blood flow, despite the decrease in left ventricular cavity attenuation (347 ± 72 to 281 ± 55 HU), reflecting an increase in cardiac output. Importantly, in both groups, myocardial attenuation was equally reduced in segments supplied by diseased arteries (group 1: 119 ± 19 vs 103 ± 14 HU, P < 0.05; group 2: 108 ± 20 vs 97 ± 16 HU, P < 0.05), despite the 74% reduction in radiation (from 7.4 ± 2.8 to 1.9 ± 0.45 mSv) and the 28% reduction in contrast dose (from 84 ± 7 to 60 ±7 mL) (both P < 0.05). CONCLUSIONS Regadenoson stress MDCT imaging can detect hypoperfused myocardium even when imaging settings are optimized to provide a significant reduction in radiation and contrast doses.
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Affiliation(s)
- Amit R Patel
- University of Chicago, MC5084, 5841 S Maryland Ave, Chicago, IL 60637, USA
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Wang Q, Qin J, Gai LY, Chen YD, Dong W, Guan ZW, Wang ZG, Sun ZJ, Tian JH. A pilot study on diagnosis of coronary artery disease using computed tomography first-pass myocardial perfusion imaging at rest. J Zhejiang Univ Sci B 2011; 12:485-91. [PMID: 21634042 DOI: 10.1631/jzus.b1000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although computed tomography coronary angiography (CTCA) can identify coronary stenosis, little data exists on the ability of multislice computed tomography (MSCT) to detect myocardial perfusion defects at rest. METHODS In 33 patients with diagnosed or suspected coronary artery disease (CAD), CTCA using retrospective electrocardiography (ECG) gating at rest and invasive coronary angiography (ICA) was performed. The 2D myocardial images were reconstructed in diastolic and systolic phases using the same raw data for CTCA. CT values of the myocardium were used as an estimate of myocardial enhancement, which were shown by color mapping. Myocardial ischemia was defined as a pattern of transient endocardial hypo-enhancement at systole and normal enhancement at diastole. The results of ICA were taken as the reference standard. RESULTS When a diameter reduction of more than 50% in ICA was used as diagnostic criteria of CAD, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT first-pass myocardial perfusion imaging (MPI) at rest were 0.85, 0.67, 0.92, and 0.50 per patient, respectively, and 0.58, 0.93, 0.85, and 0.76 per vessel, respectively. CONCLUSIONS CT first-pass MPI at rest could detect CAD patients, which could become a practical and convenient way to detect ischemia, consequently offering the ability for MSCT to act as a "one stop shop" for the diagnosis of CAD.
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Affiliation(s)
- Qi Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
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Valdiviezo C, Ambrose M, Mehra V, Lardo AC, Lima JAC, George RT. Quantitative and qualitative analysis and interpretation of CT perfusion imaging. J Nucl Cardiol 2010; 17:1091-100. [PMID: 20924735 DOI: 10.1007/s12350-010-9291-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Coronary artery disease (CAD) remains the leading cause of death in the United States. Rest and stress myocardial perfusion imaging has an important role in the non-invasive risk stratification of patients with CAD. However, diagnostic accuracies have been limited, which has led to the development of several myocardial perfusion imaging techniques. Among them, myocardial computed tomography perfusion imaging (CTP) is especially interesting as it has the unique capability of providing anatomic- as well as coronary stenosis-related functional data when combined with computed tomography angiography (CTA). The primary aim of this article is to review the qualitative, semi-quantitative, and quantitative analysis approaches to CTP imaging. In doing so, we will describe the image data required for each analysis and discuss the advantages and disadvantages of each approach.
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Affiliation(s)
- Carolina Valdiviezo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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30
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Shikata F, Imagawa H, Kawachi K, Kido T, Kurata A, Inoue Y, Hosokawa K, Nagao M, Higashino H, Mochizuki T, Ryugo M, Nagashima M. Regional myocardial blood flow measured by stress multidetector computed tomography as a predictor of recovery of left ventricular function after coronary artery bypass grafting. Am Heart J 2010; 160:528-34. [PMID: 20826263 DOI: 10.1016/j.ahj.2010.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/16/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multidetector-row computed tomography (MDCT) applications have expanded to evaluation of myocardial blood flow (MBF) and viability. We quantified regional MBF pre- and post-coronary artery bypass grafting (CABG) using adenosine stress and cardiac 64-MDCT, and investigated whether the results predict MBF and left ventricular (LV) function recovery after CABG. METHODS We studied 321 regions in 19 CABG patients who underwent adenosine stress 64-row MDCT perfusion imaging and cine magnetic resonance imaging pre- and post-CABG. Myocardial blood flow was estimated from linear regression equation slopes using Patlak plot analyses and compared with LV function by measuring wall thickening (%WT) using cine magnetic resonance imaging. RESULTS Overall mean MBFs were 1.39 +/- 0.49 and 1.95 +/- 0.49 mL/(g min) pre- and post-CABG (P < .0001). Myocardial blood flow in revascularized areas increased significantly (pre-CABG 1.18 +/- 0.45, post-CABG 1.99 +/- 0.66 mL/[g min], P < .001), whereas nonischemic areas showed no difference (1.79 +/- 0.70 and 1.97 +/- 0.46 mL/[g min], P = .14). Revascularized areas with preoperative MBF > or = 0.9 mL/(g min) showed significantly greater MBF improvement than those with preoperative MBF <0.9 mL/(g min) (P = .04). In patients with preoperative LV dysfunction (ejection fraction <40%), %WT in revascularized areas with pre-CABG MBF > or = 0.9 mL/(g min) improved significantly after CABG (pre-%WT 40.9 +/- 22.9, post-%WT 52.8 +/- 20.6, P = .03) versus those with pre-CABG MBF <0.9 mL/(g min) (pre-%WT 53.2 +/- 35.5, post-%WT 42.5 +/- 17.0, P = .40). CONCLUSIONS Our results demonstrated more significantly increased MBF post-CABG than pre-CABG, particularly in revascularized areas. Regional MBF before CABG may predict MBF and LV function recovery, in the short term, after CABG.
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Shikata F, Nagashima M, Kawachi K, Kido T, Watanabe K, Ryugo M, Imagawa H, Mochizuki T. Images in cardiovascular medicine. Dual-source computed tomography for visualization of the abnormal motion of the aortic cusp after re-replacement of the mitral valve. Circ J 2010; 74:2241-3. [PMID: 20668348 DOI: 10.1253/circj.cj-10-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumiaki Shikata
- Department of Cardiovascular Surgery, Ehime University Hospital, Toon, Japan
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Ko SM, Choi JW, Song MG, Shin JK, Chee HK, Chung HW, Kim DH. Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol 2010; 21:26-35. [PMID: 20658242 DOI: 10.1007/s00330-010-1897-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility and diagnostic accuracy of adenosine-stress dual-energy computed tomography (DECT) for detecting haemodynamically significant stenosis causing reversible myocardial perfusion defect (PD) compared with stress perfusion magnetic resonance imaging (SP-MRI) and conventional coronary angiography (CCA). METHODS Fifty patients with known coronary artery disease (CAD) detected by dual-source CT (DSCT) were investigated by contrast-enhanced, stress DECT with high- and low-energy x-ray spectra settings during adenosine infusion. A colour-coded iodine map was used for evaluation of myocardial PDs compared with rest DSCT perfusion images. Reversible myocardial PDs according to the stress DECT/rest DSCT were compared with SP-MRI on a segmental basis and CCA on a vascular territorial basis. RESULTS A total of 697 myocardial segments and 123 vascular territories of 41 patients were analysed. Three hundred one segments and 72 vascular territories in 38 patients showed reversible PDs on stress DECT. Stress DECT had 89% sensitivity, 78% specificity and 82% accuracy for detecting segments with reversible PDs seen on SP-MRI (n=28). Compared with CCA (n=41), stress DECT had 89% sensitivity, 76% specificity and 83% accuracy for the detection of vascular territories with reversible myocardial PDs that had haemodynamically relevant CAD. CONCLUSION Adenosine stress DECT can identify stress-induced myocardial PD in patients with CAD.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
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34
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de Graaf F, Schuijf J, Delgado V, van Velzen J, Kroft L, de Roos A, Jukema J, van der Wall E, Bax J. Clinical Application of CT Coronary Angiography: State of the Art. Heart Lung Circ 2010; 19:107-16. [DOI: 10.1016/j.hlc.2009.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 11/24/2009] [Indexed: 01/17/2023]
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Min JK, Shaw LJ. Noninvasive diagnostic and prognostic assessment of individuals with suspected coronary artery disease: coronary computed tomographic angiography perspective. Circ Cardiovasc Imaging 2009; 1:270-81; discussion 281. [PMID: 19808551 DOI: 10.1161/circimaging.108.823807] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James K Min
- Department of Medicine, Weill Medical College of Cornell University and the New York Presbyterian Hospital, New York, NY 10021, USA.
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Affiliation(s)
- Michael Salerno
- From the University of Virginia Health System, Charlottesville, Va
| | - George A. Beller
- From the University of Virginia Health System, Charlottesville, Va
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Kachenoura N, Veronesi F, Lodato JA, Corsi C, Mehta R, Newby B, Lang RM, Mor-Avi V. Volumetric quantification of myocardial perfusion using analysis of multi-detector computed tomography 3D datasets: comparison with nuclear perfusion imaging. Eur Radiol 2009; 20:337-47. [PMID: 19711083 DOI: 10.1007/s00330-009-1552-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 06/25/2009] [Accepted: 07/05/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although the ability of multi-detector computed tomography (MDCT) to detect perfusion abnormalities associated with acute and chronic myocardial infarction (MI) has been demonstrated, this methodology is based on visual interpretation of selected 2D slices. OBJECTIVES We sought to develop a new technique for quantitative volumetric analysis of myocardial perfusion from 3D datasets and test it against resting nuclear myocardial perfusion imaging (NMPI) reference. METHODS We studied 44 patients undergoing CTCA: a control group of 15 patients and a study group of 29 patients. MDCT datasets acquired for CTCA were analyzed using custom software designed to: (1) generate bull's eye display of myocardial perfusion and (2) calculate a quantitative index of extent and severity of perfusion abnormality, Q(H), for 16 volumetric myocardial segments. Visual interpretation of MDCT-derived bull's eyes was compared with rest NMPI scores using kappa statistics of agreement on a coronary territory and patient basis. Quantitative MDCT perfusion data were correlated with rest NMPI summed scores and used for objective detection of perfusion defects. RESULTS Visual analysis of MDCT-derived bull's eyes accurately detected perfusion defects in agreement with NMPI (kappa = 0.70 by territory; 0.79 by patient). Quantitative data were in good agreement with NMPI, as reflected by: (1) correlation of 0.87 (territory) and 0.84 (patient) between summed Q(H) and NMPI scores, (2) area under ROC curve 0.87 with sensitivity of 0.79-0.92, specificity 0.83-0.91, and accuracy 0.83-0.89 for objective detection of abnormalities. CONCLUSIONS Our new technique for volumetric analysis of 3D MDCT images allows accurate objective detection of perfusion defects. This perfusion information can be obtained without additional radiation or contrast load, and may aid in elucidating the significance of coronary lesions.
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Nagao M, Matsuoka H, Kawakami H, Higashino H, Mochizuki T, Ohshita A, Kohno T, Shigemi S. Detection of Myocardial Ischemia Using 64-Slice MDCT. Circ J 2009; 73:905-11. [PMID: 19325193 DOI: 10.1253/circj.cj-08-0940] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michinobu Nagao
- Department of Radiology, Ehime University Graduate School of Medicine
| | | | - Hideo Kawakami
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
| | - Hiroshi Higashino
- Department of Radiology, Ehime University Graduate School of Medicine
| | | | - Akira Ohshita
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
| | - Tamami Kohno
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
| | - Susumu Shigemi
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
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