CT Evaluation of the Myocardial Blood Supply: Ultra-Low Radiation Dose CT Techniques

Beyond Structure and Function: CT Imaging of Myocardial Perfusion and Viability
  • Christoph BeckerEmail author
  • Bernhard Bischoff
Part of the Medical Radiology book series (MEDRAD)


An ECG triggered high pitch (3.2) spiral CT scan acquired 8-16 seconds after the administration of contrast media and achievement of 100 HU in the ascending aorta best displays the difference in enhancement between ischemic/infarcted and remote myocardium. If this CT scan is been performed under pharmacological stress and repeated at rest, reversible ischemia may be distinguished agains infarcted myocardium. In our experience, regadenoson is superior to adenosine to provoce stress induced ischemia. The rest scan with beta blockage may be performed before the stress scan to avoid image distorsion by motion artifacts when diagnosing the coronary arteries. This scan protocol is associated with much less radiation compared to dynamic CTA. The total amount of radiation for a stress and rest scan is in the range of 2 mSv and may be sufficient to diagnose clinically relevant ischemia myocardial ischemia. However, this approach does not allow for quantitate assessment of myocardial blood flow and is therefore not suited to follow for changes in myocardial perfusion under treatment.


Myocardial Blood Flow Remote Myocardium Detector Width Myocardial Blood Volume Case Coronary Artery Disease 
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.


  1. Bamberg F, Klotz E, Flohr T et al (2010) Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience. Eur Radiol 20:1168–1173PubMedCrossRefGoogle Scholar
  2. Blankstein R, Shturman LD, Rogers IS et al (2009) Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 54:1072–1084PubMedCrossRefGoogle Scholar
  3. Feuchtner G, Goetti R, Plass A et al (2011) 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 4:540–549PubMedCrossRefGoogle Scholar
  4. Patel AR, Lodato JA, Chandra S et al (2011) Detection of myocardial perfusion abnormalities using ultra-low radiation dose regadenoson stress multidetector computed tomography. J Cardiovasc Comput Tomogr 5:247–254PubMedCrossRefGoogle Scholar
  5. Rocha-Filho JA, Blankstein R, Shturman LD et al (2010) Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiol 254:410–419PubMedCrossRefGoogle Scholar
  6. Thomas GS, Tammelin BR, Schiffman GL et al (2008) 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 Off Publ Am Soc Nucl Cardiol 15:319–328CrossRefGoogle Scholar
  7. Zhao G, Zhang S, Shryock JC et al (2012) Selective action of metoprolol to attenuate regadenoson-induced tachycardia in conscious dogs. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 19:109–117CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Clinical RadiologyLudwig-Maximilians UniversityMunichGermany

Personalised recommendations