Adenosine Stress High-pitch 128-slice Dual Source Myocardial Computed Tomography Perfusion For Imaging Of Reversible Myocardial Ischemia: Comparison with Magnetic Resonance Imaging

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.

PMID: 21862731

Posted in Computed Tomography and tagged , , , , , , , , .

2 Comments

  1. Stress CTA may be on its way to become a practical clinical alternative. This paper presents a full protocol with low radiation exposure. Next challenge would be to find standardized ways to diagnose perfusion defects.

  2. Note that beta-blocker and sublingual nitroglycerin was not used.
    Meanwhile, regarding the patient population the mean heart rate during stress and rest imaging was 69 and 58 bpm, respectively. BMI and weight was 27.8 kg/m2 and 78 kg, respectively.

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