CT Assessment of the Myocardial Blood Supply: Quantitative Imaging

  • Ullrich Ebersberger
  • Justin R. Silverman
  • Young Jun Cho
  • Lucas L. Geyer
Part of the Medical Radiology book series (MEDRAD)


Myocardial perfusion computed tomography (CTP) is a promising imaging technique on the verge of expanding the capabilities of CT. Especially, the capability of CTP to enable quantitative evaluations may provide a more accurate assessment of the hemodynamic significance of CAD. Two different approaches currently used are discussed in this chapter: 1. Dual energy CT 2. Dynamic, time-resolved quantitative imaging.


Single Photon Emission Compute Tomography Myocardial Perfusion Myocardial Blood Flow Fractional Flow Reserve Invasive Coronary Angiography 


  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):1168–1173. doi: 10.1007/s00330-010-1715-9 PubMedCrossRefGoogle Scholar
  2. Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, Blankstein R, Hoffmann U, Sommer WH, Hoffmann VS, Johnson TRC, Becker H-CR, Wintersperger BJ, Reiser MF, Nikolaou K (2011) Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 260(3):689–698. doi: 10.1148/radiol.11110638 PubMedCrossRefGoogle Scholar
  3. 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):306–313. doi: 10.1097/RLI.0b013e3181dfa2f2 PubMedGoogle Scholar
  4. 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. doi: 10.1007/s10554-012-0080-y Google Scholar
  5. Brooks RA, Di Chiro G (1976) Beam hardening in X-ray reconstructive tomography. Phys Med Biol 21(3):390–398PubMedCrossRefGoogle Scholar
  6. Cury RC, Nieman K, Shapiro MD, Butler J, Nomura CH, Ferencik M, Hoffmann U, Abbara S, Jassal DS, Yasuda T, Gold HK, Jang IK, Brady TJ (2008) Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT. Radiology 248(2):466–475. doi: 10.1148/radiol.2482071478 PubMedCrossRefGoogle Scholar
  7. De Bruyne B, Pijls NHJ, Kalesan B, Barbato E, Tonino PAL, Piroth Z, Jagic N, Mobius-Winckler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engstrøm T, Oldroyd KG, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Jüni P, Fearon WF (2012) Fractional flow reserve–guided PCI versus medical therapy in stable coronary disease. New Engl J Med: 120827230013003. doi: 10.1056/NEJMoa1205361
  8. 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):153–160. doi: 10.1016/j.jacc.2006.04.014 PubMedCrossRefGoogle Scholar
  9. 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):815–822. doi: 10.1097/RLI.0b013e318124a884 PubMedCrossRefGoogle Scholar
  10. Hamon M, Fau G, Née G, Ehtisham J, Morello R, Hamon M (2010) Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease. J Cardiovasc Magn Reson 12(1):29. doi: 10.1186/1532-429X-12-29 PubMedCrossRefGoogle Scholar
  11. Kang DK, Schoepf UJ, Bastarrika G, Nance JW Jr, Abro JA, Ruzsics B (2010) Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications. Semin Ultrasound CT MR 31(4):276–291. doi: 10.1053/j.sult.2010.05.004 PubMedCrossRefGoogle Scholar
  12. Leber AW, Johnson T, Becker A, von Ziegler F, Tittus J, Nikolaou K, Reiser M, Steinbeck G, Becker CR, Knez A (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 28(19):2354–2360. doi: 10.1093/eurheartj/ehm294 PubMedCrossRefGoogle Scholar
  13. Mahnken AH, Bruners P, Katoh M, Wildberger JE, Gunther RW, Buecker A (2006) Dynamic multi-section CT imaging in acute myocardial infarction: preliminary animal experience. Eur Radiol 16(3):746–752. doi: 10.1007/s00330-005-0057-5 PubMedCrossRefGoogle Scholar
  14. 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):298–305. doi: 10.1097/RLI.0b013e3181dfa3cf PubMedGoogle Scholar
  15. Nagao M, Matsuoka H, Kawakami H, Higashino H, Mochizuki T, Murase K, Uemura M (2008) Quantification of myocardial perfusion by contrast-enhanced 64-MDCT: characterization of ischemic myocardium. Am J Roentgenol 191(1):19–25. doi: 10.2214/AJR.07.2929 CrossRefGoogle Scholar
  16. Nance JW Jr, Bastarrika G, Kang DK, Ruzsics B, Vogt S, Schmidt B, Raupach R, Flohr TG, Schoepf UJ (2011) High-temporal resolution dual-energy computed tomography of the heart using a novel hybrid image reconstruction algorithm: initial experience. J Comput Assist Tomogr 35(1):119–125. doi: 10.1097/RCT.0b013e3181f87475 PubMedCrossRefGoogle Scholar
  17. Nesto RW, Kowalchuk GJ (1987) The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 59(7):23C–30CPubMedCrossRefGoogle Scholar
  18. Nikolaou K, Sanz J, Poon M, Wintersperger BJ, Ohnesorge B, Rius T, Fayad ZA, Reiser MF, Becker CR (2005) Assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detector-row computed tomography of the heart: preliminary results. Eur Radiol 15(5):864–871. doi: 10.1007/s00330-005-2672-6 PubMedCrossRefGoogle Scholar
  19. Rumberger JA, Feiring AJ, Lipton MJ, Higgins CB, Ell SR, Marcus ML (1987) Use of ultrafast computed tomography to quantitate regional myocardial perfusion: a preliminary report. J Am Coll Cardiol 9(1):59–69PubMedCrossRefGoogle Scholar
  20. Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, Costello P, Zwerner PL (2009) 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):318–326. doi: 10.1016/j.amjcard.2009.03.051 PubMedCrossRefGoogle Scholar
  21. So A, Lee TY (2011) Quantitative myocardial CT perfusion: a pictorial review and the current state of technology development. J Cardiovasc Comput Tomogr 5(6):467–481. doi: 10.1016/j.jcct.2011.11.002 PubMedCrossRefGoogle Scholar
  22. So A, Lee TY, Imai Y, Narayanan S, Hsieh J, Kramer J, Procknow K, Leipsic J, Labounty T, Min J (2011) Quantitative myocardial perfusion imaging using rapid kVp switch dual-energy CT: preliminary experience. J Cardiovasc Comput Tomogr 5(6):430–442. doi: 10.1016/j.jcct.2011.10.008 PubMedCrossRefGoogle Scholar
  23. So A, Hsieh J, Imai Y, Narayanan S, Kramer J, Procknow K, Dutta S, Leipsic J, Min JK, Labounty T, Lee TY (2012) Prospectively ECG-triggered rapid kV-switching dual-energy CT for quantitative imaging of myocardial perfusion. JACC Cardiovasc Imaging 5(8):829–836. doi: 10.1016/j.jcmg.2011.12.026 PubMedCrossRefGoogle Scholar
  24. Taylor AJ, Cerqueira M, Hodgson JMB, Mark D, Min J, O’gara P, Rubin GD (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. JAC 56(22):1864–1894. doi: 10.1016/j.jacc.2010.07.005 Google Scholar
  25. Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, Van t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF, Investigators FS (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. New Engl J Med 360(3):213–224. doi: 10.1056/NEJMoa0807611 PubMedCrossRefGoogle Scholar
  26. 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. Am J Roentgenol 198(3):521–529. doi: 10.2214/AJR.11.7830 CrossRefGoogle Scholar
  27. Wolfkiel CJ, Ferguson JL, Chomka EV, Law WR, Labin IN, Tenzer ML, Booker M, Brundage BH (1987) Measurement of myocardial blood flow by ultrafast computed tomography. Circulation 76(6):1262–1273PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ullrich Ebersberger
    • 2
  • Justin R. Silverman
    • 1
  • Young Jun Cho
    • 3
  • Lucas L. Geyer
    • 4
  1. 1.Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Cardiology and Intensive Care MedicineHeart Center Munich-BogenhausenMunichGermany
  3. 3.Department of RadiologyKonyang University College of MedicineDaejeonKorea
  4. 4.Department of Clinical RadiologyUniversity Hospitals LMU MunichMunichGermany

Personalised recommendations