Ko SM, Choi JW, Song MG, et al 2011 Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol
To evaluate the feasibility and diagnostic accuracy of adenosine-stress dual-energy computed tomography (DECT) for detecting haemodynamically significant stenosis causing reversible myocardial perfusion defect (PD) compared with stress perfusion magnetic resonance imaging (SP-MRI) and conventional coronary angiography (CCA).
Fifty patients with known coronary artery disease (CAD) detected by dual-source CT (DSCT) were investigated by contrast-enhanced, stress DECT with high- and low-energy x-ray spectra settings during adenosine infusion. A colour-coded iodine map was used for evaluation of myocardial PDs compared with rest DSCT perfusion images. Reversible myocardial PDs according to the stress DECT/rest DSCT were compared with SP-MRI on a segmental basis and CCA on a vascular territorial basis.
A total of 697 myocardial segments and 123 vascular territories of 41 patients were analysed. Three hundred one segments and 72 vascular territories in 38 patients showed reversible PDs on stress DECT. Stress DECT had 89% sensitivity, 78% specificity and 82% accuracy for detecting segments with reversible PDs seen on SP-MRI (n=28). Compared with CCA (n=41), stress DECT had 89% sensitivity, 76% specificity and 83% accuracy for the detection of vascular territories with reversible myocardial PDs that had haemodynamically relevant CAD.
Adenosine stress DECT can identify stress-induced myocardial PD in patients with CAD.
"Contrast enhanced coronary CT-angiography (CTA) is a well-established method for the detection of coronary artery disease (1-4). The clinical value of myocardial CT perfusion (CTP) alone (5) or in combination with CTA are the subject of current research (6-8). Due to its excellent safety profile, adenosine is a favored substance for stress induction in cardiac imaging (9, 10). "
[Show abstract][Hide abstract] ABSTRACT: We aimed to evaluate the time efficiency and diagnostic accuracy of automated myocardial computed tomography perfusion (CTP) image analysis software.
320-row CTP was performed in 30 patients, and analyses were conducted independently by three different blinded readers by the use of two recent software releases (version 4.6 and novel version 4.71GR001, Toshiba, Tokyo, Japan). Analysis times were compared, and automated epi- and endocardial contour detection was subjectively rated in five categories (excellent, good, fair, poor and very poor). As semi-quantitative perfusion parameters, myocardial attenuation and transmural perfusion ratio (TPR) were calculated for each myocardial segment and agreement was tested by using the intraclass correlation coefficient (ICC). Conventional coronary angiography served as reference standard.
The analysis time was significantly reduced with the novel automated software version as compared with the former release (Reader 1: 43:08 ± 11:39 min vs. 09:47 ± 04:51 min, Reader 2: 42:07 ± 06:44 min vs. 09:42 ± 02:50 min and Reader 3: 21:38 ± 3:44 min vs. 07:34 ± 02:12 min; p < 0.001 for all). Epi- and endocardial contour detection for the novel software was rated to be significantly better (p < 0.001) than with the former software. ICCs demonstrated strong agreement (≥ 0.75) for myocardial attenuation in 93% and for TPR in 82%. Diagnostic accuracy for the two software versions was not significantly different (p = 0.169) as compared with conventional coronary angiography.
The novel automated CTP analysis software offers enhanced time efficiency with an improvement by a factor of about four, while maintaining diagnostic accuracy.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(1):21-9. DOI:10.3348/kjr.2013.14.1.21 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several approaches in the past have aimed to combine anatomical and functional information about the myocardium in an effort to identify significant coronary artery disease and characterize ischemic heart disease. Recent developments in CT-technology have permitted the expansion of cardiac CT into new territories beyond coronary artery visualization. Introduction of dual-energy CT has demonstrated the ability to evaluate coronary anatomy, myocardial ischemia, and viability. It now appears possible to provide a comprehensive evaluation of ischemic heart disease through a single, stand-alone imaging modality. The presented review emphasizes the promising potential of cardiac dual-energy CT in clinical practice.
Current Cardiovascular Imaging Reports 06/2013; 6(3). DOI:10.1007/s12410-013-9197-1
[Show abstract][Hide abstract] ABSTRACT: Coronary computed tomographic angiography (CCTA) has emerged as a novel noninvasive method for the evaluation of coronary artery stenosis, arterial wall, and plaque features. Recent developments in CCTA technology, CT perfusion imaging, and fractional flow reserve CT (FFRCT) have emerged which combine anatomy and physiology by identifying obstructive lesions that are ischemia-causing. These techniques are currently at an early stage, and future studies are needed to further establish their clinical utility. The aim of this review is to compare these modalities.
Current Cardiovascular Imaging Reports 10/2012; 5(5). DOI:10.1007/s12410-012-9159-z
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