Alternative technique using dual source CT imaging for assessment of myocardial perfusion

Abstract

Purpose: To elucidate the diagnostic role of multidetector DSCT for the assessment of myocardial perfusion in correlation with coronary luminal integrity in a single CT scan while both tubes were operated in single energy mode. Methods and material: Thirty-five patients were subjected to single acquisition contrast-enhanced, ECG-gated DSCT of the heart at rest. Postprocessing was performed generating two image sets: coronary CT angiographic images (cCTA) and myocardial perfusion images (CTP) for respective correlative assessment of coronary luminal integrity and myocardial perfusion. Perfusion defect was detected subjectively using gray scale images and the color coded first pass and color overlaid late enhancement (color attenuation) images were used for semi-objective evaluation and final objective and quantitative confirmation by density measurement. Results: Significant correlation and good agreement between the findings of DSCT myocardial perfusion and the findings of stenosis and its degree on cCTA on a segmental basis is noted with Cohen’s Kappa = 0.67 and prevalence and bias adjusted Kappa = 0.71 emphasizing the high diagnostic value of DSCT myocardial perfusion as compared to cCTA as the gold reference standard. Conclusion: We propose that comprehensive evaluation of coronary artery morphology and myocardial perfusion in patients with CAD could be achieved by single reproducible non-invasive contrast enhanced CT acquisition using DSCT scanners while operated in single energy mode with high sensitivity, specificity and diagnostic accuracy, it also has the potential to be the first, independent and stand out imaging choice in such field.

Keywords

• Dual source computed tomography (DSCT)
• Computed tomography perfusion (CTP)
• Coronary CT angiography (cCTA)
• Coronary artery disease (CAD)
• Myocardial infarction (MI)