Skip to main content

Advertisement

Log in

CT imaging of myocardial perfusion: Possibilities and perspectives

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Functional imaging in patients with suspected or known coronary artery disease (CAD) is crucial for the identification of patients who could benefit from coronary revascularization. Several studies demonstrated the high diagnostic accuracy of Single-photon-emission computed tomography myocardial perfusion imaging, stress perfusion magnetic resonance imaging, and of invasive FFR measurements for the detection of hemodynamic relevant stenosis. Cardiac computed tomography (CT) used to be limited to coronary angiography (CTA); current guidelines recommend CTA only for the exclusion of CAD. Technological advances now offer the possibility to assess myocardial perfusion by computed tomography (CT-MPI). Though different acquisition protocols and post-processing algorithms still have to be evaluated, initial clinical studies could already show a diagnostic accuracy comparable to the established imaging modalities. Thus, cardiac CT may offer a combined approach of anatomical and functional imaging. Beside the need for further studies, especially on the prognostic value of CT-MPI to stratify future cardiovascular events, the comparatively high radiation exposure and additional administration of contrast agent has to be taken in account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation 2012;125:e2-220.

    Article  PubMed  Google Scholar 

  2. Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation 2010;122:e525-55.

    Article  PubMed  Google Scholar 

  3. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-24.

    Article  PubMed  CAS  Google Scholar 

  4. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: Results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 2008;117:1283-91.

    Article  PubMed  Google Scholar 

  5. Rocha-Filho JA, Blankstein R, Shturman LD, Bezerra HG, Okada DR, Rogers IS, et al. Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiology 2010;254:410-9.

    Article  PubMed  Google Scholar 

  6. Arbab-Zadeh A, Miller JM, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, et al. Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study. J Am Coll Cardiol 2012;59:379-87.

    Article  PubMed  Google Scholar 

  7. Hulten EA, Bittencourt MS, Ghoshhajra B, Blankenstein R. Stress CT perfusion: Coupling coronary anatomy with physiology. J Nucl Cardiol 2012;19:588-600.

    Article  PubMed  Google Scholar 

  8. Nikolaou K, Knez A, Sagmeister S, Wintersperger BJ, Boekstegers P, Steinbeck G, et al. Assessment of myocardial infarctions using multidetector-row computed tomography. J Comput Assist Tomogr 2004;28:286-92.

    Article  PubMed  Google Scholar 

  9. Krombach GA, Niendorf T, Gunther RW, Mahnken AH. Characterization of myocardial viability using MR and CT imaging. European radiology 2007;17:1433-44.

    Article  PubMed  Google Scholar 

  10. Habis M, Capderou A, Ghostine S, Daoud B, Caussin C, Riou JY, et al. Acute myocardial infarction early viability assessment by 64-slice computed tomography immediately after coronary angiography: Comparison with low-dose dobutamine echocardiography. J Am Coll Cardiol 2007;49:1178-85.

    Article  PubMed  Google Scholar 

  11. Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, et al. Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am J Cardiol 2009;104:318-26.

    Article  PubMed  Google Scholar 

  12. Mor-Avi V, Lodato JA, Kachenoura N, Chandra S, Freed BH, Newby B, et al. Quantitative three-dimensional evaluation of myocardial perfusion during regadenoson stress using multidetector computed tomography. Journal of computer assisted tomography 2012;36:443-9.

    Article  PubMed  Google Scholar 

  13. Patel AR, Lodato JA, Chandra S, Kachenoura N, Ahmad H, Freed BH, et al. Detection of myocardial perfusion abnormalities using ultra-low radiation dose regadenoson stress multidetector computed tomography. J Cardiovasc Comput Tomogr 2011;5:247-54.

    Article  PubMed  Google Scholar 

  14. Thomas GS, Tammelin BR, Schiffman GL, Marquez R, Rice DL, Milikien D, et al. Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: A randomized, double-blind, placebo-controlled trial (RegCOPD trial). J Nucl Cardiol 2008;15:319-28.

    Article  PubMed  Google Scholar 

  15. Zhao G, Zhang S, Shryock JC, Xu X, Ochoa M, Hintze TH, et al. Selective action of metoprolol to attenuate regadenoson-induced tachycardia in conscious dogs. J Nucl Cardiol 2012;19:109-17.

    Article  PubMed  Google Scholar 

  16. Blankstein R, Shturman LD, Rogers IS, Rocha-Filho JA, Okada DR, Sarwar A, et al. Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 2009;54:1072-84.

    Article  PubMed  Google Scholar 

  17. Feuchtner G, Goetti R, Plass A, Wieser M, Scheffel H, Wyss C, et al. Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: Comparison with magnetic resonance imaging. Circ Cardiovasc Imaging 2011;4:540-9.

    Article  PubMed  Google Scholar 

  18. Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, et al. Detection of hemodynamically significant coronary artery stenosis: Incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 2011;260:689-98.

    Article  PubMed  Google Scholar 

  19. Kurata A, Mochizuki T, Koyama Y, Haraikawa T, Suzuki J, Shigematsu Y, et al. Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: Alternative to stress myocardial perfusion scintigraphy. Circ J 2005;69:550-7.

    Article  PubMed  Google Scholar 

  20. Ko SM, Choi JW, Hwang HK, Song MG, Shin JK, Chee HK. Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine-induced stress dual-energy CT for detection of significant coronary stenosis. AJR Am J Roentgenol 2012;198:512-20.

    Article  PubMed  Google Scholar 

  21. Cury RC, Magalhaes TA, Borges AC, Shiozaki AA, Lemos PA, Junior JS, et al. Dipyridamole stress and rest myocardial perfusion by 64-detector row computed tomography in patients with suspected coronary artery disease. Am J Cardiol 2010;106:310-5.

    Article  PubMed  Google Scholar 

  22. Okada DR, Ghoshhajra BB, Blankstein R, Rocha-Filho JA, Shturman LD, Rogers IS, et al. Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT. J Nucl Cardiology 2010;17:27-37.

    Article  Google Scholar 

  23. Tamarappoo BK, Dey D, Nakazato R, Shmilovich H, Smith T, Cheng VY, et al. Comparison of the extent and severity of myocardial perfusion defects measured by CT coronary angiography and SPECT myocardial perfusion imaging. JACC Cardiovasc Imaging 2010;3:1010-9.

    Article  PubMed  Google Scholar 

  24. Ho KT, Chua KC, Klotz E, Panknin C. Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT. JACC Cardiovasc Imaging 2010;3:811-20.

    Article  PubMed  Google Scholar 

  25. George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM, Lardo AC, et al. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 2012;5:333-40.

    Article  PubMed  Google Scholar 

  26. Feuchtner GM, Plank F, Pena C, Battle J, Min J, Leipsic J, et al. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: Comparison with SPECT-myocardial perfusion imaging. Heart 2012;98:1510-7.

    Article  PubMed  Google Scholar 

  27. Weininger M, Schoepf UJ, Ramachandra A, Fink C, Rowe GW, Costello P, et al. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results. Eur J Radiol 2012;81:3703-10.

    Article  PubMed  Google Scholar 

  28. Ko SM, Choi JW, Song MG, Shin JK, Chee HK, Chung HW, et al. 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 2011;21:26-35.

    Article  PubMed  Google Scholar 

  29. Ko BS, Cameron JD, Meredith IT, Leung M, Antonis PR, Nasis A, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: A comparison with fractional flow reserve. Eur Heart J 2012;33:67-77.

    Article  PubMed  Google Scholar 

  30. George RT, Arbab-Zadeh A, Cerci RJ, Vavere AL, Kitagawa K, Dewey M, et al. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320-MDCT: The CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study. AJR Am J Roentgenol 2011;197:829-37.

    Article  PubMed  Google Scholar 

  31. Shaw LJ, Hendel RC, Heller GV, Borges-Neto S, Cerqueira M, Berman DS. Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT. J Nucl Cardiol 2008;15:762-73.

    PubMed  Google Scholar 

  32. Zemrak F, Petersen SE. Late gadolinium enhancement CMR predicts adverse cardiovascular outcomes and mortality in patients with coronary artery disease: Systematic review and meta-analysis. Prog Cardiovasc Dis 2011;54:215-29.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexander Becker MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becker, A., Becker, C. CT imaging of myocardial perfusion: Possibilities and perspectives. J. Nucl. Cardiol. 20, 289–296 (2013). https://doi.org/10.1007/s12350-013-9681-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-013-9681-7

Keywords

Navigation