Dynamic, Time-Resolved CT Imaging of Myocardial Perfusion: 320-Slice CT

Part of the Medical Radiology book series (MEDRAD)


Cardiac Computed Tomography has progressed beyond providing a purely detailed anatomical description of coronary disease, to a comprehensive demonstration of anatomic-physiological disturbance that forms the basis of a “one stop shop” for assessment of coronary disease. The 320MDCT wide area detector provides a unique capability to assess the whole heart during a single gantry rotation. This chapter outlines the scientific advances made using the 320MDCT: in animal models of cardiac ischemia followed by translational work in human subjects; initially with discussion of single centre trials followed by introduction of the Core 320 multi-centre trial.


Myocardial Perfusion Myocardial Perfusion Imaging Left Anterior Descend Myocardial Blood Flow Perfusion Defect 
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. Abadi S, Mehrez H, Ursani A, Parker M, Paul N (2011) Direct quantification of breast dose during coronary CT angiography and evaluation of dose reduction strategies AJR 196(2):152–158Google Scholar
  2. Brooks RA, Di Chiro G (1976) Beam hardening in X-ray reconstructive tomography. Phys Med Biol 21(3):390–398PubMedCrossRefGoogle Scholar
  3. Coyne EP, Belvedere DA, van de Streek PR, Weiland FL, Evans RB, Spaccavento LJ (1991) Thallium-201 scintigraphy after intravenous infusion of adenosine compared with exercise thallium testing in the diagnosis of coronary artery disease. J Am Coll Cardiol 17:1289–1294PubMedCrossRefGoogle Scholar
  4. Crossett MP, Schneider-Kolsky M, Troupis J (2011) Normal perfusion of the left ventricular myocardium using 320MDCT. JCCT 5:406–411Google Scholar
  5. George RT, Arbab-Zadeh A, Cerci RJ, Vavere AL, Kitagawa K, Dewey M, Rochitte CE, Arai AE, Paul N, Rybicki FJ, Lardo AC, Clouse ME, Lima JA (2011) 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 197(4):829–837PubMedCrossRefGoogle Scholar
  6. George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA et al (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 2:174–182PubMedCrossRefGoogle Scholar
  7. George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM, Lardo AC, Lima JA (2012) Computed tomography myocardial perfusion imaging with 320-row detector CT accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 5: 333–340Google Scholar
  8. George RT, Ichihara T, Lima JAC, Lardo AC (2010) A method for reconstructing the arterial input function during helical CT: implications for myocardial perfusion distribution imaging. Radiology 255(2):396–404PubMedCrossRefGoogle Scholar
  9. George RT, Jerosch-Herold M, Silva C, Kitagawa K, Bluemke DA, Lima JA et al (2007) Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol 42:815–822PubMedCrossRefGoogle Scholar
  10. George RT, Silva C, Cordeiro MA, di Paula A, Thompson DR, McCarthy WF et al (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48:153–160PubMedCrossRefGoogle Scholar
  11. Gupta NC, Esterbrooks DJ, Hilleman DE, Mohiuddin SM (1992) Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. The GE SPECT Multicenter Adenosine Study Group. J Am Coll Cardiol 19:248–257PubMedCrossRefGoogle Scholar
  12. Hacker M, Jakobs T, Matthiesen F et al (2005) Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences. J Nucl Med 46:1294–1300PubMedGoogle Scholar
  13. Kitagawa K, George RT, Arbab-Zadeh A, Lima JAC, Lardo AC (2010) Characterization and correction of beam-hardening artifacts during dynamic volume CT assessment of myocardial perfusion. Radiology 256(1):111–118PubMedCrossRefGoogle Scholar
  14. Klocke FJ, Baird MG, Lorell BH et al (2003) ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASNC Committee to revise the 1995 guidelines for the clinical use of cardiac radionuclide imaging). J Am Coll Cardiol 42:1318–1333PubMedCrossRefGoogle Scholar
  15. Ko B, Cameron J, Defrance T, Seneviratne S (2011) CT stress myocardial perfusion imaging using Multidetector CT—a review. JCCT 5(6):345–356Google Scholar
  16. Ko B, Cameron J, Meredith I, Leung M, Antonis P, Nasis A, Crossett M, Hope S, Lehman S, Troupis J, DeFrance T, Seneviratne S (2012) Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 33:67–77PubMedCrossRefGoogle Scholar
  17. Kühl T, Linde J, Fuchs A, Kristensen T, Kelbæk H, George R, Hove J, Kofoed KF (2012) Patterns of myocardial perfusion in humans evaluated with contrast-enhanced 320 multi detector computed tomography. Int J Cardiovasc Imaging 28(7):1739–1747Google Scholar
  18. Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S, Halperin HR, Wu KC, Hare JH, Lima JAC (2006) Contrast enhanced multidetector computed tomography viability imaging following myocardial infarction: characterization of myocyte death, microvascular obstruction and chronic scar. Circulation 113:394–404PubMedCrossRefGoogle Scholar
  19. Mehra V, Ambrose M, Valdiviezo-Schlomp C, Schuleri K, Lardo AC, Lima JA, George RT (2011a) CT-based myocardial perfusion imaging-practical considerations: acquisition, image analysis, interpretation, and challenges. J Cardiovasc Transl Res 4(4):437–448PubMedCrossRefGoogle Scholar
  20. Mehra V, Valdiviezo C, Arbab-Zadeh A, Ko B, Seneviratne S, Cerci R, Lima J, George R (2011b) A stepwise approach to the visual interpretation of CT-based myocardial perfusion. JCCT 5(6):357–369Google Scholar
  21. Nasis A, Seneviratne S, DeFrance T (2010) Advances in contrast-enhanced cardiovascular CT for the evaluation of myocardial perfusion. Curr Cardiovasc Imaging Rep 3:372–381CrossRefGoogle Scholar
  22. Nguyen T, Heo J, Ogilby JD, Iskandrian AS (1990) Single photon emission computed tomography with thallium-201 during adenosine-induced coronary hyperemia: correlation with coronary arteriography, exercise thallium imaging and two-dimensional echocardiography. J Am Coll Cardiol 16:1375–1383PubMedCrossRefGoogle Scholar
  23. Nishimura S, Mahmarian JJ, Boyce TM, Verani MS (1992) Equivalence between adenosine and exercise thallium-201 myocardial tomography: a multicenter, prospective, crossover trial. J Am Coll Cardiol 20:265–275PubMedCrossRefGoogle Scholar
  24. Olson EA, Han KS, Pisano DJ (1981) CT reprojection polychromaticity correction for three attenuators. IEEE Trans Nucl Sci 28(4):3628–3640CrossRefGoogle Scholar
  25. Parodi O, Marcassa C, Casucci R et al (1991) Accuracy and safety of technetium-99 m hexakis 2-methoxy-2-isobutyl isonitrile (sestamibi) myocardial scintigraphy with high dose dipyridamole test in patients with effort angina pectoris: a multicenter study. Italian Group of Nuclear Cardiology. J Am Coll Cardiol 18:1439–1444PubMedCrossRefGoogle Scholar
  26. Pijls NH, de Bruyne B, Peels K, van der Voort PH, Bonnier HJ, Bartunek JKJJ, Koolen JJ (1996) Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334:1703–1708PubMedCrossRefGoogle Scholar
  27. Rumberger JA, Bell MR (1992) Measurement of myocardial perfusion and cardiac output using intravenous injection methods by ultrafast (cine) computed tomography. Invest Radiol 27:S40–S46PubMedCrossRefGoogle Scholar
  28. 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 9:59–69PubMedCrossRefGoogle Scholar
  29. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, Stokkel MPM, 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
  30. Torres F, Crean A, Nguyen ET, Doyle D, Menezes R, Ayyappan AP, Abadi S, Paul N (2010) Abolition of respiratory motion artifact in CT coronary angiography with ultrafast examinations: a comparison between 64-row and 320-row multidetector scanners. Can Assoc Radiol J 61:5–12PubMedCrossRefGoogle Scholar
  31. Valdiviezo C, Ambrose M, Mehra V, Lardo AC, Lima JAC, George RT (2010) Quantitative and qualitative analysis and interpretation of CT perfusion imaging. J Nucl Cardiol 17:1091–1100PubMedCrossRefGoogle Scholar
  32. Vavere AL, Simon GG, Lima JAC (2011) Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. JCCT 5:370–381Google Scholar
  33. Williams M, Reid J, McKillop G, Weir N, van Beek E, Uren N, Newby D (2011) Cardiac and coronary CT. Comprehensive imaging approach in the assessment of coronary heart disease. Heart 97:1198–1205PubMedCrossRefGoogle Scholar
  34. Zatz LM, Alvarez RE (1977) An inaccuracy in computed tomography: the energy dependence of CT values. Radiology 124(1):91–97PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Joint Department of Medical Imaging and the Peter Munk Cardiac CentreToronto General Hospital, University of TorontoTorontoCanada

Personalised recommendations