Historically, myocardial perfusion scintigraphy (MPS) has been used to assess myocardial perfusion. Magnetic resonance imaging (MRI) has been used to assess both myocardial perfusion and delayed enhancement (viability). However, computed tomography (CT) has advantages over MPS and MRI in terms of spatial resolution, availability, simplicity, and shorter test time. CT can assess myocardial perfusion as increased myocardial contrast density. Adenosine triphosphate (ATP) or adenosine stress perfusion CT is comparable to MPS and MRI for the assessment of myocardial perfusion reserve (ischemia). When dynamic (first-pass) data are acquired, absolute myocardial blood flow (MBF, ml g −1min−1) can be measured by analyzing the time–density curve of myocardium and blood pool. Using wide-range multislice CT (256- to 320-slice CT) for dynamic acquisition, whole-heart regional MBF can be measured. In this chapter, the potential of 256-slice CT in the assessment of myocardial perfusion and viability is illustrated.
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