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Japanese Journal of Radiology
Published in: Japanese Journal of Radiology 5/2020

Open Access 01-05-2020 | Computed Tomography | Invited Review

Computed tomographic evaluation of myocardial ischemia

Authors: Yuki Tanabe, Akira Kurata, Takuya Matsuda, Kazuki Yoshida, Dhiraj Baruah, Teruhito Kido, Teruhito Mochizuki, Prabhakar Rajiah

Published in: Japanese Journal of Radiology | Issue 5/2020

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Abstract

Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CT-fractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.
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Metadata
Title
Computed tomographic evaluation of myocardial ischemia
Authors
Yuki Tanabe
Akira Kurata
Takuya Matsuda
Kazuki Yoshida
Dhiraj Baruah
Teruhito Kido
Teruhito Mochizuki
Prabhakar Rajiah
Publication date
01-05-2020
Publisher
Springer Singapore
Published in
Japanese Journal of Radiology / Issue 5/2020
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-020-00922-8

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