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Dynamic Myocardial CT Perfusion Imaging for Evaluation of Myocardial Ischemia as Determined by MR Imaging.

Authors :
Bamberg, Fabian
Marcus, Roy P.
Becker, Alexander
Hildebrandt, Kristof
Bauner, Kerstin
Schwarz, Florian
Greif, Martin
von Ziegler, Franz
Bischoff, Bernhard
Becker, Hans-Christoph
Johnson, Thorsten R.
Reiser, Maximilian F.
Nikolaou, Konstantin
Theisen, Daniel
Source :
JACC: Cardiovascular Imaging; Mar2014, Vol. 7 Issue 3, p267-277, 11p
Publication Year :
2014

Abstract

Objectives: The aim of this study was to determine the feasibility of computed tomography (CT)-based dynamic myocardial perfusion imaging for the assessment of myocardial ischemia and infarction compared with cardiac magnetic resonance (CMR). Background: Sequential myocardial CT perfusion imaging has emerged as a novel imaging technique for the assessment of myocardial hypoperfusion. Methods: We prospectively enrolled subjects with known coronary artery disease who underwent adenosine-mediated stress dynamic dual-source CT (100 kV, 320 mAs/rot) and CMR (3-T). Estimated myocardial blood flow (eMBF) and estimated myocardial blood volume (eMBV) were derived from CT images, using a model-based parametric deconvolution technique. The values were independently related to perfusion defects (ischemic and/or infarcted myocardial segments) as visually assessed during rest/stress and late gadolinium enhancement CMR. Conventional measures of diagnostic accuracy and differences in eMBF/eMBV were determined. Results: Of 38 enrolled subjects, 31 (mean age 70.4 ± 9.3 years; 77% men) completed both CT and CMR protocols. The prevalence of ischemic and infarcted myocardial segments detected by CMR was moderate (11.6%, n = 56 and 12.6%, n = 61, respectively, of 484 analyzed segments, with 8.4% being transmural). The diagnostic accuracy of CT for the detection of any perfusion defect was good (eMBF threshold, 88 ml/mg/min; sensitivity, 77.8% [95% confidence interval (CI): 69% to 85%]; negative predictive value, 91.3% [95% CI: 86% to 94%]) with moderate positive predictive value (50.6% [95% CI: 43% to 58%] and specificity (75.41% [95% CI: 70% to 79%]). Higher diagnostic accuracy was observed for transmural perfusion defects (sensitivity 87.8%; 95% CI: 74% to 96%) and infarcted segments (sensitivity 85.3%; 95% CI: 74% to 93%). Although eMBF in high-quality examinations was lower but not different between ischemic and infarcted segments (72.3 ± 18.7 ml/100 ml/min vs. 73.1 ± 31.9 ml/100 ml/min, respectively, p > 0.05), eMBV was significantly lower in infarcted segments compared with ischemic segments (11.3 ± 3.3 ml/100 ml vs. 18.4 ± 2.8 ml/100 ml, respectively; p < 0.01). Conclusions: Compared with CMR, dynamic stress CT provides good diagnostic accuracy for the detection of myocardial perfusion defects and may differentiate ischemic and infarcted myocardium. [Copyright &y& Elsevier]

Details

Language :
English
ISSN :
1936878X
Volume :
7
Issue :
3
Database :
Supplemental Index
Journal :
JACC: Cardiovascular Imaging
Publication Type :
Academic Journal
Accession number :
95017117
Full Text :
https://doi.org/10.1016/j.jcmg.2013.06.008