Top

Published in:

01-03-2018 | Cardiac

CT myocardial perfusion imaging: ready for prime time?

Authors: Richard A. P. Takx, Csilla Celeng, U. Joseph Schoepf

Published in: European Radiology | Issue 3/2018

Abstract

The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. It allows for the quantitation of myocardial blood flow and calculation of coronary flow reserve and shows good correlation with ¹⁵O-H₂O positron emission tomography and invasive fractional flow reserve. In addition, patients prefer CCTA/CT-MPI over SPECT, MRI and invasive coronary angiography. CT-MPI is ready for clinical use for detecting myocardial ischaemia caused by obstructive disease. Nevertheless, the clinical utility of CT-MPI to identify ischaemia in patients with non-obstructive/microvascular disease still has to be established.

Key Points

• CT-MPI can improve the positive predictive value of CCTA for lesion-specific ischaemia.

• CT-MPI adds incremental prognostic value over CCTA for major adverse cardiac events.

• CT-MPI correlates with ¹⁵ O-H ₂ O PET.

• CT-MPI/CCTA shows high overall patient satisfaction.

Menke J, Kowalski J (2016) Diagnostic accuracy and utility of coronary CT angiography with consideration of unevaluable results: A systematic review and multivariate Bayesian random-effects meta-analysis with intention to diagnose. Eur Radiol 26:451–458CrossRefPubMed

Dharampal AS, Papadopoulou SL, Rossi A et al (2013) Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease. Eur Radiol 23:2934–2943CrossRefPubMed

Ahmadi A, Stone GW, Leipsic J et al (2016) Association of Coronary Stenosis and Plaque Morphology With Fractional Flow Reserve and Outcomes. JAMA Cardiol 1:350–357CrossRefPubMed

Osawa K, Miyoshi T, Miki T et al (2016) Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard. PLoS One 11:e0149170CrossRefPubMedPubMedCentral

Ruzsics B, Lee H, Zwerner PL, Gebregziabher M, Costello P, Schoepf UJ (2008) Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience. Eur Radiol 18:2414–2424CrossRefPubMed

Delgado Sanchez-Gracian C, Oca Pernas R, Trinidad Lopez C et al (2016) Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience. Eur Radiol 26:3199–3207CrossRefPubMed

Takx RA, Blomberg BA, El Aidi H et al (2015) Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging 8:e002666

Bamberg F, Hinkel R, Schwarz F et al (2012) Accuracy of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model. Invest Radiol 47:71–77CrossRefPubMed

Danad I, Szymonifka J, Schulman-Marcus J, Min JK (2016) Static and dynamic assessment of myocardial perfusion by computed tomography. Eur Heart J Cardiovasc Imaging 17:836–844CrossRefPubMedPubMedCentral

10.

Cury RC, Kitt TM, Feaheny K et al (2015) A randomized, multicenter, multivendor study of myocardial perfusion imaging with regadenoson CT perfusion vs single photon emission CT. J Cardiovasc Comput Tomogr 9:e101–e102

11.

George RT, Mehra VC, Chen MY et al (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 272:407–416CrossRefPubMedPubMedCentral

12.

Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG (1994) Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 330:1782–1788CrossRefPubMed

13.

Ko BS, Cameron JD, Meredith IT et al (2012) Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 33:67–77CrossRefPubMed

14.

Ko BS, Cameron JD, Leung M et al (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 5:1097–1111CrossRefPubMed

15.

Meinel FG, Pugliese F, Schoepf UJ et al (2017) Prognostic Value of Stress Dynamic Myocardial Perfusion CT in a Multicenter Population With Known or Suspected Coronary Artery Disease. AJR Am J Roentgenol 208:761–769CrossRefPubMed

16.

Pazhenkottil AP, Nkoulou RN, Ghadri JR et al (2011) Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J 32:1465–1471CrossRefPubMed

17.

van Werkhoven JM, Schuijf JD, Gaemperli O et al (2009) Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 53:623–632CrossRefPubMed

18.

van Rosendael AR, Dimitriu-Leen AC, de Graaf MA et al (2017) Impact of computed tomography myocardial perfusion following computed tomography coronary angiography on downstream referral for invasive coronary angiography, revascularization and, outcome at 12 months. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jex055

19.

Christian TF, Frankish ML, Sisemoore JH et al (2010) Myocardial perfusion imaging with first-pass computed tomographic imaging: Measurement of coronary flow reserve in an animal model of regional hyperemia. J Nucl Cardiol 17:625–630CrossRefPubMed

20.

Coenen A, Lubbers MM, Kurata A et al (2017) Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis. Eur Radiol 27:2309–2316CrossRefPubMed

21.

van de Hoef TP, Siebes M, Spaan JA, Piek JJ (2015) Fundamentals in clinical coronary physiology: why coronary flow is more important than coronary pressure. Eur Heart J 36:3312–3319aCrossRefPubMed

22.

Reis SE, Holubkov R, Lee JS et al (1999) Coronary flow velocity response to adenosine characterizes coronary microvascular function in women with chest pain and no obstructive coronary disease. Results from the pilot phase of the Women's Ischemia Syndrome Evaluation (WISE) study. J Am Coll Cardiol 33:1469–1475CrossRefPubMed

23.

Graf S, Khorsand A, Gwechenberger M et al (2007) Typical chest pain and normal coronary angiogram: cardiac risk factor analysis versus PET for detection of microvascular disease. J Nucl Med 48:175–181PubMed

24.

Murthy VL, Naya M, Foster CR et al (2011) Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 124:2215–2224CrossRefPubMedPubMedCentral

25.

Marinescu MA, Loffler AI, Ouellette M, Smith L, Kramer CM, Bourque JM (2015) Coronary microvascular dysfunction, microvascular angina, and treatment strategies. JACC Cardiovasc Imaging 8:210–220CrossRefPubMedPubMedCentral

26.

Williams MC, Mirsadraee S, Dweck MR et al (2016) Computed tomography myocardial perfusion vs 15O-water positron emission tomography and fractional flow reserve. Eur Radiol. https://doi.org/10.1007/s00330-016-4404-5

27.

Klein R, Beanlands RS, deKemp RA (2010) Quantification of myocardial blood flow and flow reserve: Technical aspects. J Nucl Cardiol 17:555–570CrossRefPubMed

28.

Kikuchi Y, Oyama-Manabe N, Naya M et al (2014) Quantification of myocardial blood flow using dynamic 320-row multi-detector CT as compared with (1)(5)O-H(2)O PET. Eur Radiol 24:1547–1556CrossRefPubMed

29.

Pepine CJ, Anderson RD, Sharaf BL et al (2010) Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. J Am Coll Cardiol 55:2825–2832CrossRefPubMedPubMedCentral

30.

Sharaf B, Wood T, Shaw L et al (2013) Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) angiographic core laboratory. Am Heart J 166:134–141CrossRefPubMedPubMedCentral

31.

Feger S, Rief M, Zimmermann E et al (2015) Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography. Eur Radiol 25:2115–2124CrossRefPubMed

32.

Ebersberger U, Marcus RP, Schoepf UJ et al (2014) Dynamic CT myocardial perfusion imaging: performance of 3D semi-automated evaluation software. Eur Radiol 24:191–199CrossRefPubMed

33.

Kim SM, Kim YN, Choe YH (2013) Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT: optimization of the CT protocol to reduce the radiation dose. Int J Cardiovasc Imaging 29:875–884CrossRefPubMed

34.

Fujita M, Kitagawa K, Ito T et al (2014) Dose reduction in dynamic CT stress myocardial perfusion imaging: comparison of 80-kV/370-mAs and 100-kV/300-mAs protocols. Eur Radiol 24:748–755CrossRefPubMed

35.

Botvinick EH (2009) Current methods of pharmacologic stress testing and the potential advantages of new agents. J Nucl Med Technol 37:14–25CrossRefPubMed

36.

Pelgrim GJ, van Hamersvelt RW, Willemink MJ et al (2017) Accuracy of iodine quantification using dual energy CT in latest generation dual source and dual layer CT. Eur Radiol. https://doi.org/10.1007/s00330-017-4752-9

Title: CT myocardial perfusion imaging: ready for prime time?
Authors: Richard A. P. Takx
Csilla Celeng
U. Joseph Schoepf
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 3/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5057-8

At a glance: The STEP trials

Springer Medicine

CT myocardial perfusion imaging: ready for prime time?

Abstract

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Key Points

Please log in to get access to this content

Other articles of this Issue 3/2018

Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction

Association of weight change with progression of meniscal intrasubstance degeneration over 48 months: Data from the Osteoarthritis Initiative

Assessment of CT dose to the fetus and pregnant female patient using patient-specific computational models

Optimising preoperative risk stratification tools for prostate cancer using mpMRI

Biphasic and protracted anaphylaxis to iodinated contrast media

Serial automated quantitative CT analysis in idiopathic pulmonary fibrosis: functional correlations and comparison with changes in visual CT scores