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The International Journal of Cardiovascular Imaging

Published in:

01-06-2016 | Original Paper

CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve

Authors: Hyun Jung Koo, Dong Hyun Yang, Young-Hak Kim, Joon-Won Kang, Soo-Jin Kang, Jihoon Kweon, Hyun Jung Kim, Tae-Hwan Lim

Published in: The International Journal of Cardiovascular Imaging | Special Issue 1/2016

Abstract

The detection of hemodynamically significant stenosis is important because ischemia-guided revascularization improves overall patient outcomes. Fractional flow reserve (FFR), which is measured during invasive coronary angiography, is regarded as the gold standard for determining hemodynamically significant coronary stenosis. Although coronary computed tomography angiography (CCTA) has been widely used to exclude significant coronary artery disease in patients with low to intermediate pretest probability, anatomic assessment by CCTA using diameter stenosis ≥50 % does not correlate well with the functional assessment of FFR. To overcome the weaknesses of conventional CCTA, such as its low specificity and positive predictive value, especially in patients with a small-diameter artery, poor image quality, or high calcium score, more sophisticated CCTA analysis methods have been developed to detect hemodynamically significant coronary stenosis. Studies that use the quantification of coronary plaque, transluminal attenuation gradient (TAG), CT myocardial perfusion (CTP), and CT-derived FFR have been conducted to validate their diagnostic performances, though each method has its pros and cons. This review provides details on the quantification of coronary plaque, TAG, CTP, and CT-derived FFR, including a definition of each, how to gather and interpret data, and the strengths and limitations of each. Further, we provide an overview of recent clinical studies.

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Kim YH, Ahn JM, Park DW, Song HG, Lee JY, Kim WJ, Yun SC, Kang SJ, Lee SW, Lee CW, Moon DH, Chung CH, Lee JW, Park SW, Park SJ (2012) Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol 60(3):181–190CrossRefPubMed

Melikian N, De Bondt P, Tonino P, De Winter O, Wyffels E, Bartunek J, Heyndrickx GR, Fearon WF, Pijls NH, Wijns W, De Bruyne B (2010) Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv 3(3):307–314CrossRefPubMed

Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, Nieman K, van Werkhoven JM, Pundziute G, Weustink AC, de Vos AM, Pugliese F, Rensing B, Jukema JW, Bax JJ, Prokop M, Doevendans PA, Hunink MG, Krestin GP, de Feyter PJ (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52(25):2135–2144CrossRefPubMed

Wong DT, Ko BS, Cameron JD, Leong DP, Leung MC, Malaiapan Y, Nerlekar N, Crossett M, Troupis J, Meredith IT, Seneviratne SK (2014) 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. J Am Coll Cardiol 63(18):1904–1912CrossRefPubMed

Halpern EJ, Savage MP, Fischman DL, Levin DC (2010) Cost-effectiveness of coronary CT angiography in evaluation of patients without symptoms who have positive stress test results. AJR Am J Roentgenol 194(5):1257–1262CrossRefPubMed

Pijls NH, Fearon WF, Tonino PA, Siebert U, Ikeno F, Bornschein B, van’t Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, De Bruyne B; FAME Study Investigators (2010) Fractional 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. J Am Coll Cardiol 56(3):177–184CrossRef

Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, Bar F, Hoorntje J, Koolen J, Wijns W, de Bruyne B (2007) Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol 49(21):2105–2111CrossRefPubMed

Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, Maccarthy PA, Van’t Veer M, Pijls NH (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55(25):2816–2821CrossRefPubMed

Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107(23):2900–2907CrossRefPubMed

10.

Shaw LJ, Weintraub WS, Maron DJ, Hartigan PM, Hachamovitch R, Min JK, Dada M, Mancini GB, Hayes SW, O’Rourke RA, Spertus JA, Kostuk W, Gosselin G, Chaitman BR, Knudtson M, Friedman J, Slomka P, Germano G, Bates ER, Teo KK, Boden WE, Berman DS (2012) Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J 164(2):243–250CrossRefPubMed

11.

Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GJ, Nieman K, Pontone G, Raff GL (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8(5):342–358CrossRefPubMed

12.

Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, Boersma E, Regar E, van Geuns RJ, de Jaegere PJ, Serruys PW, Krestin GP, de Feyter PJ (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 52(8):636–643CrossRefPubMed

13.

Rossi A, Papadopoulou SL, Pugliese F, Russo B, Dharampal AS, Dedic A, Kitslaar PH, Broersen A, Meijboom WB, van Geuns RJ, Wragg A, Ligthart J, Schultz C, Petersen SE, Nieman K, Krestin GP, de Feyter PJ (2014) Quantitative computed tomographic coronary angiography: does it predict functionally significant coronary stenoses? Circ Cardiovasc Imaging 7(1):43–51CrossRefPubMed

14.

Kristensen TS, Engstrom T, Kelbaek H, von der Recke P, Nielsen MB, Kofoed KF (2010) Correlation between coronary computed tomographic angiography and fractional flow reserve. Int J Cardiol 144(2):200–205CrossRefPubMed

15.

Ko BS, Wong DT, Cameron JD, Leong DP, Soh S, Nerlekar N, Meredith IT, Seneviratne SK (2015) The ASLA Score: A CT angiographic index to predict functionally significant coronary stenoses in lesions with intermediate severity-diagnostic accuracy. Radiology 276(1):91–101CrossRefPubMed

16.

Li M, Zhang J, Pan J, Lu Z (2013) Coronary stenosis: Morphologic index characterized by using CT angiography correlates with fractional flow reserve and is associated with hemodynamic status. Radiology 269(3):713–721CrossRefPubMed

17.

Voros S, Rinehart S, Vazquez-Figueroa JG, Kalynych A, Karmpaliotis D, Qian Z, Joshi PH, Anderson H, Murrieta L, Wilmer C, Carlson H, Ballard W, Brown C (2014) Prospective, head-to-head comparison of quantitative coronary angiography, quantitative computed tomography angiography, and intravascular ultrasound for the prediction of hemodynamic significance in intermediate and severe lesions, using fractional flow reserve as reference standard (from the ATLANTA I and II Study). Am J Cardiol 113(1):23–29CrossRefPubMed

18.

Nakazato R, Shalev A, Doh JH, Koo BK, Gransar H, Gomez MJ, Leipsic J, Park HB, Berman DS, Min JK (2013) Aggregate plaque volume by coronary computed tomography angiography is superior and incremental to luminal narrowing for diagnosis of ischemic lesions of intermediate stenosis severity. J Am Coll Cardiol 62(5):460–467CrossRefPubMed

19.

Choi JH, Min JK, Labounty TM, Lin FY, Mendoza DD, Shin DH, Ariaratnam NS, Koduru S, Granada JF, Gerber TC, Oh JK, Gwon HC, Choe YH (2011) Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC Cardiovasc Imaging 4(11):1149–1157CrossRefPubMed

20.

Choi JH, Koo BK, Yoon YE, Min JK, Song YB, Hahn JY, Choi SH, Gwon HC, Choe YH (2012) Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve. Eur Heart J Cardiovasc Imaging 13(12):1001–1007CrossRefPubMed

21.

Chow BJ, Kass M, Gagne O, Chen L, Yam Y, Dick A, Wells GA (2011) Can differences in corrected coronary opacification measured with computed tomography predict resting coronary artery flow? J Am Coll Cardiol 57(11):1280–1288CrossRefPubMed

22.

Wong DT, Ko BS, Cameron JD, Nerlekar N, Leung MC, Malaiapan Y, Crossett M, Leong DP, Worthley SG, Troupis J, Meredith IT, Seneviratne SK (2013) Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: a comparison with fractional flow reserve. J Am Coll Cardiol 61(12):1271–1279CrossRefPubMed

23.

Yoon YE, Choi JH, Kim JH, Park KW, Doh JH, Kim YJ, Koo BK, Min JK, Erglis A, Gwon HC, Choe YH, Choi DJ, Kim HS, Oh BH, Park YB (2012) Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve. JACC Cardiovasc Imaging 5(11):1088–1096CrossRefPubMed

24.

Stuijfzand WJ, Danad I, Raijmakers PG, Marcu CB, Heymans MW, van Kuijk CC, van Rossum AC, Nieman K, Min JK, Leipsic J, van Royen N, Knaapen P (2014) Additional value of transluminal attenuation gradient in CT angiography to predict hemodynamic significance of coronary artery stenosis. JACC Cardiovasc Imaging 7(4):374–386CrossRefPubMedPubMedCentral

25.

Choi JH, Kim EK, Kim SM, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Choe YH, Oh JK (2014) Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography. Circ Cardiovasc Imaging 7(3):482–490CrossRefPubMed

26.

Takx RA, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, Hoffmann U, Leiner T (2015) Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging 8(1):e002666CrossRefPubMed

27.

Newhouse JH, Murphy RX Jr (1981) Tissue distribution of soluble contrast: effect of dose variation and changes with time. AJR Am J Roentgenol 136(3):463–467CrossRefPubMed

28.

Techasith T, Cury RC (2011) Stress myocardial CT perfusion: an update and future perspective. JACC Cardiovasc Imaging 4(8):905–916CrossRefPubMed

29.

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):467–481CrossRefPubMed

30.

Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, Blankstein R, Hoffmann U, Sommer WH, Hoffmann VS, Johnson TR, Becker HC, 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):689–698CrossRefPubMed

31.

Greif M, von Ziegler F, Bamberg F, Tittus J, Schwarz F, D’Anastasi M, Marcus RP, Schenzle J, Becker C, Nikolaou K, Becker A (2013) CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR. Heart 99(14):1004–1011CrossRefPubMed

32.

Bamberg F, Marcus RP, Becker A, Hildebrandt K, Bauner K, Schwarz F, Greif M, von Ziegler F, Bischoff B, Becker HC, Johnson TR, Reiser MF, Nikolaou K, Theisen D (2014) Dynamic myocardial CT perfusion imaging for evaluation of myocardial ischemia as determined by MR imaging. JACC Cardiovasc Imaging 7(3):267–277CrossRefPubMed

33.

Nørgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, Jensen JM, Mauri L, De Bruyne B, Bezerra H, Osawa K, Marwan M, Naber C, Erglis A, Park SJ, Christiansen EH, Kaltoft A, Lassen JF, Bøtker HE, Achenbach S, NXT Trial Study Group (2014) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 63(12):1145–1155CrossRefPubMed

34.

Bettencourt N, Chiribiri A, Schuster A, Ferreira N, Sampaio F, Pires-Morais G, Santos L, Melica B, Rodrigues A, Braga P, Azevedo L, Teixeira M, Leite-Moreira A, Silva-Cardoso J, Nagel E, Gama V (2013) Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. J Am Coll Cardiol 61(10):1099–1107CrossRefPubMed

35.

Bischoff B, Bamberg F, Marcus R, Schwarz F, Becker HC, Becker A, Reiser M, Nikolaou K (2013) Optimal timing for first-pass stress CT myocardial perfusion imaging. Int J Cardiovasc Imaging 29(2):435–442CrossRefPubMed

36.

Ko BS, Cameron JD, Meredith IT, Leung M, Antonis PR, Nasis A, Crossett M, Hope SA, Lehman SJ, Troupis J, DeFrance T, Seneviratne SK (2012) Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 33(1):67–77CrossRefPubMed

37.

George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA, Becker L, Yousuf O, Texter J, Lardo AC, Lima JA (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(3):174–182CrossRefPubMedPubMedCentral

38.

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 computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 5(3):333–340CrossRefPubMed

39.

Ko BS, Cameron JD, Leung M, Meredith IT, Leong DP, Antonis PR, Crossett M, Troupis J, Harper R, Malaiapan Y, Seneviratne SK (2012) 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. JACC Cardiovasc Imaging 5(11):1097–1111CrossRefPubMed

40.

Yang DH, Kim YH, Roh JH, Kang JW, Han D, Jung J, Kim N, Lee JB, Ahn JM, Lee JY, Park DW, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ, Lim TH (2015) Stress myocardial perfusion CT in patients suspected of having coronary artery disease: visual and quantitative analysis-validation by using fractional flow reserve. Radiology 276(3):715–723CrossRefPubMed

41.

Huber AM, Leber V, Gramer BM, Muenzel D, Leber A, Rieber J, Schmidt M, Vembar M, Hoffmann E, Rummeny E (2013) Myocardium: dynamic versus single-shot CT perfusion imaging. Radiology 269(2):378–386CrossRefPubMed

42.

Arnoldi E, Lee YS, Ruzsics B, Weininger M, Spears JR, Rowley CP, Chiaramida SA, Costello P, Reiser MF, Schoepf UJ (2011) CT detection of myocardial blood volume deficits: dual-energy CT compared with single-energy CT spectra. J Cardiovasc Comput Tomogr 5(6):421–429CrossRefPubMed

43.

Ko SM, Park JH, Hwang HK, Song MG (2014) Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect. Int J Cardiovasc Imaging 30(Suppl 1):41–53CrossRefPubMed

44.

Meinel FG, De Cecco CN, Schoepf UJ, Nance JW Jr, Silverman JR, Flowers BA, Henzler T (2014) First-arterial-pass dual-energy CT for assessment of myocardial blood supply: do we need rest, stress, and delayed acquisition? Radiology 270(3):708–716CrossRefPubMed

45.

Zoghbi GJ, Dorfman TA, Iskandrian AE (2008) The effects of medications on myocardial perfusion. J Am Coll Cardiol 52(6):401–416CrossRefPubMed

46.

Taillefer R, Ahlberg AW, Masood Y, White CM, Lamargese I, Mather JF, McGill CC, Heller GV (2003) Acute beta-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99 m sestamibi SPECT imaging. J Am Coll Cardiol 42(8):1475–1483CrossRefPubMed

47.

Rochitte CE, George RT, Chen MY, Arbab-Zadeh A, Dewey M, Miller JM, Niinuma H, Yoshioka K, Kitagawa K, Nakamori S, Laham R, Vavere AL, Cerci RJ, Mehra VC, Nomura C, Kofoed KF, Jinzaki M, Kuribayashi S, de Roos A, Laule M, Tan SY, Hoe J, Paul N, Rybicki FJ, Brinker JA, Arai AE, Cox C, Clouse ME, Di Carli MF, Lima JA (2014) Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J 35(17):1120–1130CrossRefPubMed

48.

George RT, Mehra VC, Chen MY, Kitagawa K, Arbab-Zadeh A, Miller JM, Matheson MB, Vavere AL, Kofoed KF, Rochitte CE, Dewey M, Yaw TS, Niinuma H, Brenner W, Cox C, Clouse ME, Lima JA, Di Carli M (2014) Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study. Radiology 272(2):407–416CrossRefPubMedPubMedCentral

49.

Okada DR, Ghoshhajra BB, Blankstein R, Rocha-Filho JA, Shturman LD, Rogers IS, Bezerra HG, Sarwar A, Gewirtz H, Hoffmann U, Mamuya WS, Brady TJ, Cury RC (2010) Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT. J Nucl Cardiol 17(1):27–37CrossRefPubMedPubMedCentral

50.

Ko SM, Choi JW, Song MG, Shin JK, Chee HK, Chung HW, Kim DH (2011) Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol 21(1):26–35CrossRefPubMed

51.

Kim YH, Park SJ (2013) Ischemia-guided percutaneous coronary intervention for patients with stable coronary artery disease. Circ J 77(8):1967–1974CrossRefPubMed

52.

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF, FAME Study Investigators (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360(3):213–224CrossRefPubMed

53.

De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, Jagic N, Möbius-Winkler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engstrom T, Oldroyd KG, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Juni P, Fearon WF, FAME 2 Trial Investigators (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 367(11):991–1001CrossRefPubMed

54.

Kim HJ, Vignon-Clementel IE, Coogan JS, Figueroa CA, Jansen KE, Taylor CA (2010) Patient-specific modeling of blood flow and pressure in human coronary arteries. Ann Biomed Eng 38(10):3195–3209CrossRefPubMed

55.

Sharma P, Itu L, Zheng X, Kamen A, Bernhardt D, Suciu C, Comaniciu D (2012) A framework for personalization of coronary flow computations during rest and hyperemia. Conf Proc IEEE Eng Med Biol Soc 2012:6665–6668PubMed

56.

Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, Dunning A, DeFrance T, Lansky A, Leipsic J, Min JK (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 58(19):1989–1997CrossRefPubMed

57.

Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, Erglis A, Lin FY, Dunning AM, Apruzzese P, Budoff MJ, Cole JH, Jaffer FA, Leon MB, Malpeso J, Mancini GB, Park SJ, Schwartz RS, Shaw LJ, Mauri L (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308(12):1237–1245CrossRefPubMedPubMedCentral

58.

Leipsic J, Yang TH, Thompson A, Koo BK, Mancini GB, Taylor C, Budoff MJ, Park HB, Berman DS, Min JK (2014) CT angiography (CTA) and diagnostic performance of noninvasive fractional flow reserve: results from the Determination of Fractional Flow Reserve by Anatomic CTA (DeFACTO) study. AJR Am J Roentgenol 202(5):989–994CrossRefPubMed

59.

Coenen A, Lubbers MM, Kurata A, Kono A, Dedic A, Chelu RG, Dijkshoorn ML, Gijsen FJ, Ouhlous M, van Geuns RJ, Nieman K (2015) Fractional flow reserve computed from noninvasive CT angiography data: diagnostic performance of an on-site clinician-operated computational fluid dynamics algorithm. Radiology 274(3):674–683CrossRefPubMed

60.

Litt HI, Gatsonis C, Snyder B, Singh H, Miller CD, Entrikin DW, Leaming JM, Gavin LJ, Pacella CB, Hollander JE (2012) CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 366(15):1393–1403CrossRefPubMed

61.

Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52(21):1724–1732CrossRefPubMed

62.

Arbab-Zadeh A, Hoe J (2011) Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography methods, caveats, and implications. JACC Cardiovasc Imaging 4(2):191–202CrossRefPubMed

63.

Renker M, Nance JW Jr, Schoepf UJ, O’Brien TX, Zwerner PL, Meyer M, Kerl JM, Bauer RW, Fink C, Vogl TJ, Henzler T (2011) Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction. Radiology 260(2):390–399CrossRefPubMed

64.

Feuchtner G, Goetti R, Plass A, Wieser M, Scheffel H, Wyss C, Stolzmann P, Donati O, Schnabl J, Falk V, Alkadhi H, Leschka S, Cury RC (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(5):540–549CrossRefPubMed

65.

Kim SM, Cho YK, Choe YH (2014) Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT in patients with normal body mass indices: effect of tube voltage, tube current, and iodine concentration on image quality and radiation dose. Int J Cardiovasc Imaging 30(Suppl 2):95–103CrossRefPubMed

66.

Choo KS, Hwangbo L, Kim JH, Park YH, Kim JS, Kim J, Chun KJ, Jeong DW, Lim SJ (2013) Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve. Acta Radiol 54(4):389–395CrossRefPubMed

67.

Rossi A, Dharampal A, Wragg A, Davies LC, van Geuns RJ, Anagnostopoulos C, Klotz E, Kitslaar P, Broersen A, Mathur A, Nieman K, Hunink MG, de Feyter PJ, Petersen SE, Pugliese F (2014) Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it predict functionally significant coronary lesions? Eur Heart J Cardiovasc Imaging 15(1):85–94CrossRefPubMed

Title: CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve
Authors: Hyun Jung Koo
Dong Hyun Yang
Young-Hak Kim
Joon-Won Kang
Soo-Jin Kang
Jihoon Kweon
Hyun Jung Kim
Tae-Hwan Lim
Publication date: 01-06-2016
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue Special Issue 1/2016
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-015-0825-5

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