Myocardial perfusion is an important prognostic marker in the management of patients with suspected coronary artery disease as it demonstrates the hemodynamic consequences of coronary artery stenosis. The traditional diagnostic algorithm is based on a combination of physiological and anatomical testing using different modalities. Physiological testing, such as nuclear imaging, has been extensively validated for determining the effect of stenoses on the myocardial perfusion but provides only limited anatomical information. Conversely, anatomical testing, such as invasive coronary angiography, can directly visualize and grade coronary artery stenosis but has limitations for gauging their hemodynamic effect on the myocardial perfusion.
Accordingly, a single test allowing the comprehensive evaluation of all aspects of coronary artery disease is clinically desirable. There is early evidence that cardiac computed tomography (CT) performed in single- or dual-energy mode has the potential for an integrative evaluation of both, coronary artery anatomy as well as changes in the myocardial blood supply. Cardiac dual-energy CT is based on the more recent technology of dual-source CT, and exploits the fact that iodine-based contrast medium has unique spectral characteristics when penetrated with different X-ray energy levels, enabling mapping of the iodine (and thus blood) distribution within the myocardium.
This chapter provides an overview about the role and current state of dual-energy CT in the evaluation of the myocardial perfusion.
KeywordsSingle Photon Emission Compute Tomography Myocardial Perfusion Myocardial Perfusion Imaging Coronary Artery Stenosis Invasive Coronary Angiography
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