Adenosine-stress dynamic myocardial CT perfusion imaging: initial clinical experience.

Abstract:

OBJECTIVE:To evaluate the feasibility of adenosine-stress dynamic myocardial volume perfusion imaging with second generation dual source computed tomography (CT) for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared with stress perfusion and viability magnetic resonance imaging (MRI). MATERIAL AND METHODS:Ten patients (8 male, 2 female, mean age 62.7 +/- 7.1 years) underwent stress/rest perfusion and delayed-enhancement MRI, and a cardiac CT protocol comprising prospectively electrocardiogram -triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a "shuttle" mode, and delayed enhancement acquisitions. Two independent observers visually assessed myocardial perfusion defects. For semi-quantitative evaluation, CT- and MRI-derived myocardial-to-left ventricular upslope indices were compared. Additionally, absolute MBF was quantified based on dynamic perfusion CT and correlated with semi quantitative CT measurements. Myocardial perfusion analysis was performed on a segmental basis. Analysis used paired t tests, Wilcoxon signed-rank test, linear correlation, and Bland-Altman statistics. RESULTS:A total of 149 segments (93.1%) were suitable for analysis. Sensitivity, specificity, positive and negative predictive values for detection of myocardial perfusion defects at CT compared with MRI were 86.1%, 98.2%, 93.9%, and 95.7%, respectively. Semiquantitative analysis of CT data showed significant differences between ischemic and nonischemic myocardium with a signal intensity upslope that was comparable with MRI-derived values (CT: 5.2 +/- 2 SI/s, MRI: 4.8 +/- 2.3 SI/s, P > 0.05). Moderate correlation was observed between absolute CT quantification of MBF and semi-quantitative CT measurements. Mean total dose length product for the entire cardiac CT protocol was 1290.4 +/- 233.3 mGy cm. CONCLUSION:Adenosine-stress volumetric first pass CT perfusion imaging is feasible and may enable the evaluation of qualitative and semi quantitative parameters of myocardial perfusion in a comparable fashion as MRI.

journal_name

Invest Radiol

journal_title

Investigative radiology

authors

Bastarrika G,Ramos-Duran L,Rosenblum MA,Kang DK,Rowe GW,Schoepf UJ

doi

10.1097/RLI.0b013e3181dfa2f2

subject

Has Abstract

pub_date

2010-06-01 00:00:00

pages

306-13

issue

6

eissn

0020-9996

issn

1536-0210

journal_volume

45

pub_type

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