OBJECTIVES: Coronary computed tomography angiography (CTA) enables accurate anatomic evaluation of coronary artery stenosis, however lacking information about hemodynamical significance. The aim of this study was to evaluate 128-slice myocardial CT perfusion (CTP) imaging with adenosine stress using a high-pitch mode, in comparison with cardiac magnetic resonance imaging (CMR).
METHODS: 39 patients with intermediate-to-high coronary risk profile underwent adenosine stress 128-slice dual source CTP (128×0.6mm, 0.28s). Among those, 30 patients (64±10y, 6% females) also underwent adenosine stress CMR (1.5T). The 2-steps CTP protocol consisted of: 1) Adenosine stress-CTP using a high-pitch factor (3.4) ECG-synchronized spiral mode and 2) rest-CTP/coronary-CTA using either high-pitch (HR<63bpm) or prospective ECG-triggering (HR>63bpm). Results were compared to CMR and to invasive angiography (IA) in 25 patients.
RESULTS: The performance of stress-CTP for detection of myocardial perfusion defects compared to CMR was: sens. 96%, spec. 88%, PPV 93%, NPV 94% (per vessel), and sens. 78%, spec. 87%, PPV 83%, NPV 84% (per segment). The accuracy of stress-CTP for imaging of reversible ischemia compared to CMR was: sens 95%, spec 96%, PPV 95%, NPV 96% (per vessel). In 25 patients who underwent IA, the accuracy of CTA for detection of stenosis >70% was (per segment): sens. 96%, spec. 88%, PPV 67%, NPV 98.9%. The accuracy improved from 84% to 95% after adding stress CTP to CTA. Radiation exposure of the entire stress/rest CT protocol was only 2.5mSv.
CONCLUSIONS: Adenosine-induced stress 128-slice dual source high-pitch myocardial CTP allows for simultaneously assessment of reversible myocardial ischemia and coronary stenosis with good diagnostic accuracy as compared to CMR and IA, at a very low radiation exposure.
Lady Davis Carmel Medical Center
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