Top

Current Cardiovascular Imaging Reports

Published in:

01-01-2021 | CT Angiography | Molecular Imaging (J.C. Wu and P.K.P. Nguyen, Section Editor)

From Inception to 2020: a Review of Dynamic Myocardial CT Perfusion Imaging

Authors: Sujana Balla, M.B.B.S, Koen Nieman, MD Ph.D

Published in: Current Cardiovascular Imaging Reports | Issue 1/2021

Abstract

Purpose of Review

Dynamic myocardial CT perfusion imaging (CTP) is an emerging new approach to establish the hemodynamic severity of coronary artery obstructions. Literature and consensus documents on its practical applicability are limited.

Recent Findings

Despite significant amount of literature supporting the diagnostic accuracy of dynamic CTP and its incremental value over CTA in the last decade, its use has been relatively limited.

Summary

Obstacles to its broader clinical use may include knowledge gaps associated with dynamic CTP imaging. We review patient preparation, scanning protocols, scanner requirements, optimization of the scan and image reconstruction, interpretation of the results, and the reported diagnostic performance of dynamic CTP.

Patel AR, Bamberg F, Branch K, Carrascosa P, Chen M, Cury RC, et al. Society of cardiovascular computed tomography expert consensus document on myocardial computed tomography perfusion imaging. J Cardiovasc Comput Tomogr. 2020;14(1):87–100.CrossRef

Robb RA, Ritman EL. High speed synchronous volume computed tomography of the heart. Radiology. 1979;133(3 Pt 1):655–61.CrossRef

Rossi A, Dharampal A, Wragg A, Davies LC, van Geuns RJ, Anagnostopoulos C, et al. 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. 2014;15(1):85–94.CrossRef

Yokoi T, Tanabe Y, Kido T, Kurata A, Kido T, Uetani T, et al. Impact of the sampling rate of dynamic myocardial computed tomography perfusion on the quantitative assessment of myocardial blood flow. Clin Imaging. 2019;56:93–101.CrossRef

van Assen M, De Cecco CN, Eid M, von Knebel Doeberitz P, Scarabello M, Lavra F, Bauer MJ, Mastrodicasa D, Duguay TM, Zaki B, Lo GG, Choe YH, Wang Y, Sahbaee P, Tesche C, Oudkerk M, Vliegenthart R, Schoepf UJ. Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease. J Cardiovasc Comput Tomogr. 2019 May-Jun;13(3):26–33. https://doi.org/10.1016/j.jcct.2019.02.005.

Rossi A, Wragg A, Klotz E, Pirro F, Moon JC, Nieman K, Pugliese F. Dynamic computed tomography myocardial perfusion imaging: comparison of clinical analysis methods for the detection of vessel-specific ischemia. Circ Cardiovasc Imaging. 2017 Apr;10(4):e005505. https://doi.org/10.1161/CIRCIMAGING.116.005505.

Kono AK, Coenen A, Lubbers M, Kurata A, Rossi A, Dharampal A, et al. Relative myocardial blood flow by dynamic computed tomographic perfusion imaging predicts hemodynamic significance of coronary stenosis better than absolute blood flow. Investig Radiol. 2014;49(12):801–7.CrossRef

Coenen A, et al. Integrating CT myocardial perfusion and CT-FFR in the work-up of coronary artery disease. JACC Cardiovasc Imaging. 2017;10(7):760–70.CrossRef

Nieman K, Cury RC, Ferencik M, Nomura CH, Abbara S, Hoffmann U, et al. Differentiation of recent and chronic myocardial infarction by cardiac computed tomography. Am J Cardiol. 2006;98(3):303–8.CrossRef

10.

Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, et al. Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol. 2005;45(12):2042–7.CrossRef

11.

Lardo AC, Cordeiro MAS, Silva C, Amado LC, George RT, Saliaris AP, et al. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation. 2006;113(3):394–404.CrossRef

12.

Kurobe Y, Kitagawa K, Ito T, Kurita Y, Shiraishi Y, Nakamori S, et al. Myocardial delayed enhancement with dual-source CT: advantages of targeted spatial frequency filtration and image averaging over half-scan reconstruction. J Cardiovasc Comput Tomogr. 2014;8(4):289–98.CrossRef

13.

Alessio AM, et al. Accuracy of myocardial blood flow estimation from dynamic contrast-enhanced cardiac CT compared with PET. Circ Cardiovasc Imaging. 2019;12(6):e008323.CrossRef

14.

Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, et al. Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology. 2011;260(3):689–98.CrossRef

15.

Wang Y, Qin L, Shi X, Zeng Y, Jing H, Schoepf UJ, et al. Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging. AJR Am J Roentgenol. 2012;198(3):521–9.CrossRef

16.

Weininger M, Schoepf UJ, Ramachandra A, Fink C, Rowe GW, Costello P, et al. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results. Eur J Radiol. 2012;81(12):3703–10.CrossRef

17.

Huber AM, Leber V, Gramer BM, Muenzel D, Leber A, Rieber J, et al. Myocardium: dynamic versus single-shot CT perfusion imaging. Radiology. 2013;269(2):378–86.CrossRef

18.

Kikuchi Y, Oyama-Manabe N, Naya M, Manabe O, Tomiyama Y, Sasaki T, et al. Quantification of myocardial blood flow using dynamic 320-row multi-detector CT as compared with (1)(5)O-H(2)O PET. Eur Radiol. 2014;24(7):1547–56.CrossRef

19.

Tanabe Y, Kido T, Uetani T, Kurata A, Kono T, Ogimoto A, et al. Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography. Eur Radiol. 2016;26(11):3790–801.CrossRef

20.

Nishiyama H, Tanabe Y, Kido T, Kurata A, Uetani T, Kido T, et al. Incremental diagnostic value of whole-heart dynamic computed tomography perfusion imaging for detecting obstructive coronary artery disease. J Cardiol. 2019;73(5):425–31.CrossRef

21.

Tomizawa N, Chou S, Fujino Y, Kamitani M, Yamamoto K, Inoh S, et al. Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT. J Cardiovasc Comput Tomogr. 2019;13(1):55–61.CrossRef

22.

Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Soldi M, Del Torto A, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Olivares P, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M. Dynamic stress computed tomography perfusion with a whole-heart coverage scanner in addition to coronary computed tomography angiography and fractional flow reserve computed tomography derived. JACC Cardiovasc Imaging. 2019 Dec;12(12):2460–71. https://doi.org/10.1016/j.jcmg.2019.02.015.

23.

Kurata A, Kawaguchi N, Kido T, Inoue K, Suzuki J, Ogimoto A, et al. Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography. PLoS One. 2013;8(12):e83950.CrossRef

24.

Kim SM, Choi JH, Chang SA, Choe YH. 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. Br J Radiol. 2013;86(1032):20130481.CrossRef

25.

Ho KT, et al. Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT. JACC Cardiovasc Imaging. 2010;3(8):811–20.CrossRef

26.

Ebersberger U, Marcus RP, Schoepf UJ, Lo GG, Wang Y, Blanke P, et al. Dynamic CT myocardial perfusion imaging: performance of 3D semi-automated evaluation software. Eur Radiol. 2014;24(1):191–9.CrossRef

27.

Bastarrika G, Ramos-Duran L, Rosenblum MA, Kang DK, Rowe GW, Schoepf UJ. Adenosine-stress dynamic myocardial CT perfusion imaging: initial clinical experience. Investig Radiol. 2010;45(6):306–13.CrossRef

28.

Greif M, von Ziegler F, Bamberg F, Tittus J, Schwarz F, D'Anastasi M, et al. CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR. Heart. 2013;99(14):1004–11.CrossRef

29.

Lu M, Wang S, Sirajuddin A, Arai AE, Zhao S. Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: a systematic review and meta-analysis. Int J Cardiol. 2018;258:325–31.CrossRef

30.

Takx RA, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, Hoffmann U, Leiner T. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging. 2015 Jan;8(1):e002666. https://doi.org/10.1161/CIRCIMAGING.114.002666.

31.

Lubbers M, Coenen A, Kofflard M, Bruning T, Kietselaer B, Galema T, et al. Comprehensive cardiac CT with myocardial perfusion imaging versus functional testing in suspected coronary artery disease: the multicenter, Randomized CRESCENT-II Trial. JACC Cardiovasc Imaging. 2018;11(11):1625–36.CrossRef

32.

Danad I, Szymonifka J, Schulman-Marcus J, Min JK. Static and dynamic assessment of myocardial perfusion by computed tomography. Eur Heart J Cardiovasc Imaging. 2016;17(8):836–44.CrossRef

33.

Pan J, Yuan M, Yu M, Gao Y, Shen C, Wang Y, et al. Myocardial blood flow quantified by low-dose dynamic CT myocardial perfusion imaging is associated with peak troponin level and impaired left ventricle function in patients with ST-elevated myocardial infarction. Korean J Radiol. 2019;20(5):709–18.CrossRef

34.

Nakamura S, Kitagawa K, Goto Y, Omori T, Kurita T, Yamada A, Takafuji M, Uno M, Dohi K, Sakuma H. Incremental prognostic value of myocardial blood flow quantified with stress dynamic computed tomography perfusion imaging. JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 2):1379–87. https://doi.org/10.1016/j.jcmg.2018.05.021.

35.

Pugliese F, Mollet NR, Hunink MGM, Cademartiri F, Nieman K, van Domburg RT, et al. Diagnostic performance of coronary CT angiography by using different generations of multisection scanners: single-center experience. Radiology. 2008;246(2):384–93.CrossRef

Title: From Inception to 2020: a Review of Dynamic Myocardial CT Perfusion Imaging
Authors: Sujana Balla, M.B.B.S
Koen Nieman, MD Ph.D
Publication date: 01-01-2021
Publisher: Springer US
Keywords: CT Angiography
Arterial Diseases
Published in: Current Cardiovascular Imaging Reports / Issue 1/2021
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI: https://doi.org/10.1007/s12410-020-09551-1

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

From Inception to 2020: a Review of Dynamic Myocardial CT Perfusion Imaging

Abstract

Purpose of Review

Recent Findings

Summary

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page