CT myocardial perfusion imaging: current status and future directions.

Computed tomography (CT) imaging of the heart has advanced rapidly, and it is now possible to perform a comprehensive assessment at a low radiation dose. CT myocardial perfusion imaging can provide additive information to CT coronary angiography, and is particularly useful in patients with heavily calcified coronary arteries or coronary artery stents. A number of protocols are now available for CT myocardial perfusion including static, dynamic, and dual-energy techniques. This review will discuss the current status of CT myocardial perfusion imaging, its clinical application, and future directions for this technology.

[1]  P. Schlattmann,et al.  Computed tomography angiography and myocardial computed tomography perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography. , 2013, Journal of the American College of Cardiology.

[2]  Samuel Chang,et al.  Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI. , 2013, The British journal of radiology.

[3]  Christopher M. Kramer,et al.  Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis. , 2013, Journal of the American College of Cardiology.

[4]  R. Cury,et al.  Comparison of myocardial perfusion evaluation with single versus dual-energy CT and effect of beam-hardening artifacts. , 2015, Academic radiology.

[5]  S. Kim,et al.  Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT: optimization of the CT protocol to reduce the radiation dose , 2013, The International Journal of Cardiovascular Imaging.

[6]  S. Ko,et al.  Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect , 2014, The International Journal of Cardiovascular Imaging.

[7]  U. Schoepf,et al.  First-arterial-pass dual-energy CT for assessment of myocardial blood supply: do we need rest, stress, and delayed acquisition? Comparison with SPECT. , 2014, Radiology.

[8]  M. Laule,et al.  Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents—Intraindividual Comparison , 2015, PloS one.

[9]  E. Yow,et al.  A selection of recent, original research papers , 2015, Journal of Nuclear Cardiology.

[10]  J. Lima,et al.  A stepwise approach to the visual interpretation of CT-based myocardial perfusion. , 2011, Journal of cardiovascular computed tomography.

[11]  T. Flohr,et al.  Accuracy of dual-energy computed tomography for the measurement of iodine concentration using cardiac CT protocols: validation in a phantom model , 2014, European Radiology.

[12]  C. Rochitte,et al.  Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents. , 2011, Journal of cardiovascular computed tomography.

[13]  Manesh R. Patel,et al.  Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography: PLATFORM. , 2015, Journal of the American College of Cardiology.

[14]  U. Schoepf,et al.  Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging. , 2015, European journal of radiology.

[15]  R. Gibbons,et al.  Should extensive myocardial ischaemia prompt revascularization to improve outcomes in chronic coronary artery disease? , 2015, European heart journal.

[16]  Janet M. Busey,et al.  Diagnostic performance of resting CT myocardial perfusion in patients with possible acute coronary syndrome. , 2013, AJR. American journal of roentgenology.

[17]  F. Rybicki,et al.  Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. , 2014, European heart journal.

[18]  G. Beller,et al.  Stress myocardial perfusion imaging for assessing prognosis: an update. , 2011, JACC. Cardiovascular imaging.

[19]  Nuno Bettencourt,et al.  Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease. , 2011, Journal of cardiovascular computed tomography.

[20]  E. Klotz,et al.  Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve. , 2013, European heart journal cardiovascular Imaging.

[21]  C. Becker,et al.  CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR , 2013, Heart.

[22]  E. Nagel,et al.  Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. , 2013, Journal of the American College of Cardiology.

[23]  H. Ong,et al.  Dynamic CT myocardial perfusion measurements of resting and hyperaemic blood flow in low-risk subjects with 128-slice dual-source CT. , 2015, European heart journal cardiovascular Imaging.

[24]  J. Lima,et al.  Multidetector computed tomography myocardial perfusion imaging during adenosine stress. , 2006, Journal of the American College of Cardiology.

[25]  J. Lima,et al.  Computed Tomography Myocardial Perfusion Imaging With 320-Row Detector Computed Tomography Accurately Detects Myocardial Ischemia in Patients With Obstructive Coronary Artery Disease , 2012, Circulation. Cardiovascular imaging.

[26]  M. Budoff,et al.  A randomized, multicenter, multivendor study of myocardial perfusion imaging with regadenoson CT perfusion vs single photon emission CT. , 2015, Journal of cardiovascular computed tomography.

[27]  G. Rodriguez-Granillo,et al.  Signal density of left ventricular myocardial segments and impact of beam hardening artifact: implications for myocardial perfusion assessment by multidetector CT coronary angiography , 2010, The International Journal of Cardiovascular Imaging.

[28]  B. Prenner,et al.  A randomized, double-blind, placebo-controlled study assessing the safety and tolerability of regadenoson in subjects with asthma or chronic obstructive pulmonary disease , 2012, Journal of Nuclear Cardiology.

[29]  A. Iskandrian,et al.  The effects of medications on myocardial perfusion. , 2008, Journal of the American College of Cardiology.

[30]  Paulo Donato,et al.  Correspondence between left ventricular 17 myocardial segments and coronary anatomy obtained by multi-detector computed tomography: an ex vivo contribution , 2012, Surgical and Radiologic Anatomy.

[31]  G. Feuchtner,et al.  Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI. , 2014, AJR. American journal of roentgenology.

[32]  S. Ko,et al.  Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography , 2010, European Radiology.

[33]  R. Cury,et al.  Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. , 2010, Radiology.

[34]  Uwe Siebert,et al.  Clinical ResearchInterventional CardiologyFractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease: 2-Year Follow-Up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) Study , 2010 .

[35]  B. Ko,et al.  Myocardial density analysis utilizing automated myocardial defect analysis software on resting 320-detector MDCT , 2013, The International Journal of Cardiovascular Imaging.

[36]  M. Oudkerk,et al.  The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT. , 2015, European journal of radiology.

[37]  C. Caussin,et al.  Late defect on delayed contrast-enhanced multi-detector row CT scans in the prediction of SPECT infarct size after reperfused acute myocardial infarction: initial experience. , 2005, Radiology.

[38]  M. Budoff,et al.  Myocardial hypo-enhancement on resting computed tomography angiography images accurately identifies myocardial hypoperfusion. , 2011, Journal of cardiovascular computed tomography.

[39]  R. Cury,et al.  Beam hardening artifact reduction using dual energy computed tomography: implications for myocardial perfusion studies. , 2015, Cardiovascular diagnosis and therapy.

[40]  Richard D. White,et al.  ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. , 2010, Circulation.

[41]  K. Choo,et al.  Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve , 2013, Acta radiologica.

[42]  Albert C. Lardo,et al.  Quantitative and qualitative analysis and interpretation of CT perfusion imaging , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[43]  H. Shirato,et al.  Quantification of myocardial blood flow using dynamic 320-row multi-detector CT as compared with 15O-H2O PET , 2014, European Radiology.

[44]  G. Rodriguez-Granillo,et al.  Early assessment of myocardial viability by the use of delayed enhancement computed tomography after primary percutaneous coronary intervention. , 2009, JACC. Cardiovascular imaging.

[45]  M. Rief,et al.  Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography , 2015, European Radiology.

[46]  J. Leipsic,et al.  The emerging role of cardiac computed tomography for the assessment of coronary perfusion: a systematic review and meta-analysis. , 2012, The Canadian journal of cardiology.

[47]  H. Morita,et al.  Additional diagnostic value of first-pass myocardial perfusion imaging without stress when combined with 64-row detector coronary CT angiography in patients with coronary artery disease , 2014, Heart.

[48]  N. Paul,et al.  Perioperative β-Blockers : Use With Caution Perioperative β Blockers in Patients Having Non-Cardiac Surgery : A Meta-Analysis , 2010 .

[49]  Harlan M Krumholz,et al.  Exposure to low-dose ionizing radiation from medical imaging procedures. , 2009, The New England journal of medicine.

[50]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Circulation.

[51]  K. Kofoed,et al.  Patterns of myocardial perfusion in humans evaluated with contrast-enhanced 320 multidetector computed tomography , 2012, The International Journal of Cardiovascular Imaging.

[52]  M. Reiser,et al.  Optimal timing for first-pass stress CT myocardial perfusion imaging , 2013, The International Journal of Cardiovascular Imaging.

[53]  Samuel Chang,et al.  Additional value of adenosine-stress dynamic CT myocardial perfusion imaging in the reclassification of severity of coronary artery stenosis at coronary CT angiography. , 2013, Clinical radiology.

[54]  M. Budoff,et al.  Detection and quantification of myocardial perfusion defects by resting single-phase 64-slice cardiac computed tomography angiography compared with SPECT myocardial perfusion imaging , 2013, Coronary artery disease.

[55]  Amit R. Patel,et al.  Analysis of myocardial perfusion from vasodilator stress computed tomography: does improvement in image quality by iterative reconstruction lead to improved diagnostic accuracy? , 2014, Journal of cardiovascular computed tomography.

[56]  M. Reiser,et al.  Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. , 2011, Radiology.

[57]  Dongjin Han,et al.  Stress Myocardial Perfusion CT in Patients Suspected of Having Coronary Artery Disease: Visual and Quantitative Analysis-Validation by Using Fractional Flow Reserve. , 2015, Radiology.

[58]  Hyuk-Jae Chang,et al.  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 , 2009, Circulation. Cardiovascular imaging.

[59]  M. Pencina,et al.  Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. , 2013, Journal of the American College of Cardiology.

[60]  Bettina M. Gramer,et al.  Myocardium: dynamic versus single-shot CT perfusion imaging. , 2013, Radiology.

[61]  W. Burchert,et al.  The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging , 2014, Journal of Nuclear Cardiology.

[62]  R. Cury,et al.  Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography. , 2011, Journal of cardiovascular computed tomography.

[63]  I. Meredith,et al.  Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion + computed tomography angiography with transluminal attenuation gradient + computed tomography angiography against invasive fractional flow reserve. , 2014, Journal of the American College of Cardiology.

[64]  G. Rodriguez-Granillo,et al.  Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease. , 2015, European journal of radiology.

[65]  J. Troupis,et al.  Normal perfusion of the left ventricular myocardium using 320 MDCT. , 2011, Journal of cardiovascular computed tomography.

[66]  Frank J Rybicki,et al.  Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study: An integrated analysis of CT coronary angiography and myocardial perfusion. , 2015, Journal of cardiovascular computed tomography.

[67]  Henry R. Halperin,et al.  Contrast-Enhanced Multidetector Computed Tomography Viability Imaging After Myocardial Infarction: Characterization of Myocyte Death, Microvascular Obstruction, and Chronic Scar , 2006, Circulation.

[68]  I. Meredith,et al.  Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease: a comparison with fractional flow reserve. , 2012, JACC. Cardiovascular imaging.

[69]  Y. Shiraishi,et al.  Dose reduction in dynamic CT stress myocardial perfusion imaging: comparison of 80-kV/370-mAs and 100-kV/300-mAs protocols , 2014, European Radiology.

[70]  J. Paul,et al.  Diagnosis of functionally significant coronary stenosis with exercise CT myocardial perfusion imaging. , 2015, Radiology.

[71]  Kakuya Kitagawa,et al.  Characterization and correction of beam-hardening artifacts during dynamic volume CT assessment of myocardial perfusion. , 2010, Radiology.

[72]  Robert C. Hendel,et al.  Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial , 2007, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[73]  S. Achenbach,et al.  Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. , 2010, European heart journal.

[74]  J. Calvin,et al.  Attenuation of the side effect profile of regadenoson: A randomized double-blinded placebo-controlled study with aminophylline in patients undergoing myocardial perfusion imaging. “The ASSUAGE trial” , 2012, Journal of Nuclear Cardiology.

[75]  Scot-Heart Investigators,et al.  CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial , 2015, The Lancet.