Integrative computed tomography imaging of ischemic heart disease

The introduction of coronary computed tomography (CT) angiography has reinvigorated the debate regarding whether management of patients with suspected coronary artery disease should be based primarily on physiologic versus anatomic testing. Recent advances in multidetector row CT (MDCT) technology have created new opportunities in integrative medical imaging and provided new insight into a variety of disease states. Anatomic testing (ie, invasive catheterization) enables direct visualization and grading of coronary artery stenoses, but it has problems in gauging the hemodynamic significance of lesions for myocardial perfusion. Conversely, stress/rest myocardial perfusion imaging has been extensively validated for assessing the clinical significance of coronary artery disease. This imaging shows fixed or reversible perfusion defects but has only limited anatomic information. Although the evaluation of coronary artery stenosis will remain the primary clinical indication for cardiac CT, simultaneous assessment of ventricular function, plaque formation, myocardial perfusion, and viability becomes feasible with a single modality. Newer generations of MDCT scanners with a dual-energy mode may effectively combine anatomic and functional information and create a new frontier for integrative imaging. The purpose of this study is to describe the practical application of MDCT technology for the comprehensive diagnosis of ischemic heart disease.