Advertisement

CT Evaluation of the Myocardial Blood Supply: Single-Source, Single-Energy CT

  • Konstantin Nikolaou
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Cardiac CT has evolved into a useful clinical tool assessing the morphology of the coronary arteries noninvasively. However, the diagnostic accuracy can still be limited. Especially in stenoses with unclear hemodynamic significance, morphological assessment of the CT coronary angiography tends to overestimate disease, leading to false-positive results. Recent technical developments offer the opportunity to assess myocardial perfusion, combining morphological with functional information. In this chapter, single-source CT techniques providing perfusion information on the myocardium, i.e., both single-shot and dynamic multiphasic acquisition techniques, will be explained and discussed.

Keywords

Myocardial Perfusion Myocardial Perfusion Imaging Perfusion Imaging Myocardial Blood Flow Fractional Flow Reserve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Bamberg F, Klotz E, Flohr T, Becker A, Becker CR, Schmidt B, Wintersperger BJ, Reiser MF, Nikolaou K (2010) Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience. Eur Radiol 20(5):1168–1173Google Scholar
  2. Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, Blankstein R, Hoffmann U, Sommer WH, Hoffmann VS, Johnson TR, Becker HC, Wintersperger BJ, Reiser MF (2011) Nikolaou K Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 260(3):689–698Google Scholar
  3. Bamberg F, Hinkel R, Schwarz F, Sandner TA, Baloch E, Marcus R, Becker A, Kupatt C, Wintersperger BJ, Johnson TR, Theisen D, Klotz E, Reiser MF, Nikolaou K (2012) Accuracy of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model. Invest Radiol 47(1):71–77Google Scholar
  4. Bastarrika G, Ramos-Duran L, Rosenblum MA, Kang DK, Rowe GW, Schoepf UJ (2010) Adenosine-stress dynamic myocardial CT perfusion imaging: initial clinical experience. Invest Radiol 45(6):306–313Google Scholar
  5. Bischoff B, Bamberg F, Marcus R, Schwarz F, Becker HC, Becker A, Reiser M, Nikolaou K (2012) Optimal timing for first-pass stress CT myocardial perfusion imaging. Int J Cardiovasc Imaging. [Epub ahead of print]Google Scholar
  6. Blankstein R, Di Carli MF (2010) Integration of coronary anatomy and myocardial perfusion imaging. Nat Rev Cardiol 7(4):226–236Google Scholar
  7. Blankstein R, Shturman LD, Rogers IS, Rocha-Filho JA, Okada DR, Sarwar A, Soni AV, Bezerra H, Ghoshhajra BB, Petranovic M, Loureiro R, Feuchtner G, Gewirtz H, Hoffmann U, Mamuya WS, Brady TJ, Cury RC (2009) Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 54(12):1072–1084PubMedCrossRefGoogle Scholar
  8. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and committee on cardiac imaging council on clinical cardiology. Circulation 114(16):1761–1791PubMedCrossRefGoogle Scholar
  9. De Bruyne B, Hersbach F, Pijls NH, Bartunek J, Bech JW, Heyndrickx GR, Gould KL, Wijns W (2001) Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but “Normal” coronary angiography. Circulation 104(20):2401–2406PubMedCrossRefGoogle Scholar
  10. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116(11):1290–1305PubMedCrossRefGoogle Scholar
  11. George RT, Silva C, Cordeiro MA, DiPaula A, Thompson DR, McCarthy WF, Ichihara T, Lima JA, Lardo AC (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48(1):153–160PubMedCrossRefGoogle Scholar
  12. George RT, Jerosch-Herold M, Silva C, Kitagawa K, Bluemke DA, Lima JA, Lardo AC (2007) Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol 42(12):815–822PubMedCrossRefGoogle Scholar
  13. George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA, Becker L, Yousuf O, Texter J, Lardo AC, Lima JA (2009) Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging 2(3):174–182PubMedCrossRefGoogle Scholar
  14. Gramer BM, Muenzel D, Leber V, von Thaden AK, Feussner H, Schneider A, Vembar M, Soni N, Rummeny EJ, Huber AM (2012) Impact of iterative reconstruction on CNR and SNR in dynamic myocardial perfusion imaging in an animal model. Eur Radiol. [Epub ahead of print]Google Scholar
  15. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, McCollough C, Martinoff S, Kastrati A, Schomig A, Achenbach S (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301(5):500–507PubMedCrossRefGoogle Scholar
  16. Hendel RC, Budoff MJ, Cardella JF, Chambers CE, Dent JM, Fitzgerald DM, Hodgson JM, Klodas E, Kramer CM, Stillman AE, Tilkemeier PL, Ward RP, Weigold WG, White RD, Woodard PK (2009) ACC/AHA/ACR/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR/SIR 2008 key data elements and definitions for cardiac imaging: a report of the American college of cardiology/American heart association task force on clinical data standards (writing committee to develop clinical data standards for cardiac imaging). Circulation 119(1):154–186PubMedCrossRefGoogle Scholar
  17. Hsiao EM, Rybicki FJ, Steigner M (2010) CT coronary angiography: 256-slice and 320-detector row scanners. Curr Cardiol Rep 12(1):68–75Google Scholar
  18. Kido T, Kurata A, Higashino H, Inoue Y, Kanza RE, Okayama H, Higaki J, Murase K, Mochizuki T (2008) Quantification of regional myocardial blood flow using first-pass multidetector-row computed tomography and adenosine triphosphate in coronary artery disease. Circ J 72(7):1086–1091PubMedCrossRefGoogle Scholar
  19. Ko BS, Cameron JD, Meredith IT, Leung M, Antonis PR, Nasis A, Crossett M, Hope SA, Lehman SJ, Troupis J, DeFrance T, Seneviratne SK (2012a) Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 33(1):67–77Google Scholar
  20. Ko SM, Choi JW, Hwang HK, Song MG, Shin JK, Chee HK (2012b) 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 198(3):512–520Google Scholar
  21. Koyama Y, Mochizuki T, Higaki J (2004) Computed tomography assessment of myocardial perfusion, viability, and function. J Magn Reson Imaging 19(6):800–815PubMedCrossRefGoogle Scholar
  22. Mahnken AH, Klotz E, Pietsch H, Schmidt B, Allmendinger T, Haberland U, Kalender WA, Flohr T (2010) Quantitative whole heart stress perfusion CT imaging as noninvasive assessment of hemodynamics in coronary artery stenosis: preliminary animal experience. Invest Radiol 45(6):298–305Google Scholar
  23. Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, Boersma E, Regar E, van Geuns RJ, de Jaegere PJ, Serruys PW, Krestin GP, de Feyter PJ (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 52(8):636–643PubMedCrossRefGoogle Scholar
  24. Orrison WW Jr, Snyder KV, Hopkins LN, Roach CJ, Ringdahl EN, Nazir R, Hanson EH (2011) Whole-brain dynamic CT angiography and perfusion imaging. Clin Radiol 66(6):566–574Google Scholar
  25. Patel AR, Antkowiak PF, Nandalur KR, West AM, Salerno M, Arora V, Christopher J, Epstein FH, Kramer CM (2010) Assessment of advanced coronary artery disease: advantages of quantitative cardiac magnetic resonance perfusion analysis. J Am Coll Cardiol 56(7):561–569Google Scholar
  26. Ruzsics B, Chiaramida SA, Schoepf UJ (2009a) Images in cardiology: dual-energy computed tomography imaging of myocardial infarction. Heart 95(3):180PubMedCrossRefGoogle Scholar
  27. Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, Costello P, Zwerner PL (2009b) 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 104(3):318–326PubMedCrossRefGoogle Scholar
  28. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, Stokkel MP, Dibbets-Schneider P, Decramer I, De Bondt P, van der Wall EE, Vanhoenacker PK, Bax JJ (2006) Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 48(12):2508–2514PubMedCrossRefGoogle Scholar
  29. Serruys PW, di Mario C, Piek J, Schroeder E, Vrints C, Probst P, de Bruyne B, Hanet C, Fleck E, Haude M, Verna E, Voudris V, Geschwind H, Emanuelsson H, Muhlberger V, Danzi G, Peels HO, Ford AJ Jr, Boersma E (1997) Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE study (Doppler Endpoints Balloon Angioplasty Trial Europe). Circulation 96(10):3369–3377PubMedCrossRefGoogle Scholar
  30. Shaw LJ, Hachamovitch R, Berman DS, Marwick TH, Lauer MS, Heller GV, Iskandrian AE, Kesler KL, Travin MI, Lewin HC, Hendel RC, Borges-Neto S, Miller DD (1999) The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of noninvasive diagnosis (END) multicenter study group. J Am Coll Cardiol 33(3):661–669PubMedCrossRefGoogle Scholar
  31. Swindle MM, Smith AC, Hepburn BJ (1988) Swine as models in experimental surgery. J Invest Surg 1(1):65–79PubMedCrossRefGoogle Scholar
  32. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, Van’t Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360(3):213–224PubMedCrossRefGoogle Scholar
  33. Vliegenthart R, Henzler T, Moscariello A, Ruzsics B, Bastarrika G, Oudkerk M, Schoepf UJ (2012) CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability. AJR Am J Roentgenol 198(3):531–547Google Scholar
  34. Wang Y, Qin L, Shi X, Zeng Y, Jing H, Schoepf UJ, Jin Z (2012) 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 198(3):521–529Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2012

Authors and Affiliations

  1. 1.Department of Clinical RadiologyUniversity Hospitals Munich - Grosshadern CampusMunichGermany

Personalised recommendations