Optimal timing for first-pass stress CT myocardial perfusion imaging

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• 作者：Bernhard Bischoff (1)
  Fabian Bamberg (1)
  Roy Marcus (1)
  Florian Schwarz (1)
  Hans-Christoph Becker (1)
  Alexander Becker (2)
  Maximilian Reiser (1)
  Konstantin Nikolaou (1)
  
• 关键词：Coronary artery disease ; Computed tomography ; Perfusion imaging
• 刊名：The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging)
• 出版年：2013
• 出版时间：February 2013
• 年：2013
• 卷：29
• 期：2
• 页码：435-442
• 全文大小：525KB
• 参考文献：1. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52:1724-732 CrossRef
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  13. Weininger M, Schoepf UJ, Ramachandra A, Fink C, Rowe GW, Costello P, et al. (2010) Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chestpain: initial results. Eur J Radiol. in press
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• 作者单位：Bernhard Bischoff (1)
  Fabian Bamberg (1)
  Roy Marcus (1)
  Florian Schwarz (1)
  Hans-Christoph Becker (1)
  Alexander Becker (2)
  Maximilian Reiser (1)
  Konstantin Nikolaou (1)
  
  1. Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
  2. Department of Cardiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
  
• ISSN：1573-0743

文摘

CT-based myocardial perfusion imaging (CTP) has been shown to accurately detect myocardial perfusion defects when compared to SPECT. When performing single-phase first-pass stress CTP, timing is of major importance. The aim of this study was to provide guidance for optimal timing of single-phase first-pass stress CTP acquisitions. 16 patients (12 male, age, 69?±?8?years) with known or suspected coronary artery disease underwent invasive coronary angiography with fractional flow reserve (FFR) measurements using a pressure wire as well as a time-resolved CTP protocol under adenosine stress, performed on a dual-Source CT scanner over a period of 30?s. From the CTP data, time-attenuation curves have been determined both in known ischemic myocardium with a corresponding coronary artery stenosis as proven by a FFR below 0.75 in invasive coronary angiography, as well as in non-ischemic reference myocardium during pharmacological stress. Furthermore, contrast enhancement in the ascending aorta was determined. The time point for an optimal contrast (i.e., difference in Hounsfield Units, HU) between ischemic and normal myocardium was determined. Under pharmacological stress using adenosine, a maximum mean HU difference between ischemic and non-ischemic myocardium (17.7-2.5?HU) was observed 24-2?s after injection of contrast medium. The maximal attenuation difference between normal and ischemic myocardium ranged from 15 to 77?HU in the analyzed patient cohort. When applying a bolus-tracking technique with an automatic contrast detection in the proximal ascending aorta, the optimal time frame for stress CTP was between 8 and 16?s after contrast enhancement in the aorta exceeds 100?HU, or between 7 and 15?s using a threshold of 150?HU. For first-pass CT myocardial perfusion imaging there is a time frame of approximately 8?s for optimal differentiation of ischemic and non-ischemic myocardium, which will be helpful to optimize single-phase CTP scans.