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CT-based myocardial perfusion imaging-practical considerations: acquisition, image analysis, interpretation, and
Vishal C Mehra1, Marietta Ambrose, Carolina Valdiviezo-Schlomp
1Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N. Wolfe Street, Carnegie Building 565C, Baltimore, MD 21287, USA.
Insights
New CT-based myocardial perfusion imaging (CTP), combined with CT angiography (CTA), offers a comprehensive, non-invasive cardiac risk assessment strategy. This approach integrates anatomical and functional data for improved patient stratification.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Non-invasive cardiac risk assessment traditionally uses exercise or pharmacological stress testing.
- CT angiography (CTA) effectively differentiates coronary artery disease risk.
- Advancements in CT technology enable CT-based myocardial perfusion imaging (CTP) for functional assessment.
Purpose of the Study:
- To review the research, implementation, and analysis methods for CT-based myocardial perfusion imaging (CTP).
- To discuss the current technological state and challenges of CTP.
- To highlight the integration of CTA and CTP in multicenter studies like CORE320 for comprehensive risk assessment.
Main Methods:
- Review of existing literature on CT-based cardiac risk assessment modalities.
- Discussion of quantitative, semiquantitative, and qualitative image analysis techniques for CTP.
- Examination of the CORE320 study evaluating combined CTA and CTP against reference standards.
Main Results:
- CTP provides functional information complementing anatomical data from CTA.
- Combined CTA and CTP strategies show promise for comprehensive cardiac risk assessment.
- The CORE320 study investigates this combined approach against established methods.
Conclusions:
- CT-based myocardial perfusion imaging (CTP) represents a significant advancement in non-invasive cardiac risk assessment.
- Integrating CTA and CTP offers a powerful, comprehensive strategy for evaluating coronary artery disease.
- Further research and validation, such as through the CORE320 study, are crucial for widespread clinical adoption.
Abstract:
Methods for non-invasive, cardiac risk assessment have historically relied on exercise stress testing with or without echocardiography or radionuclide imaging and pharmacological stress testing when appropriate. More recently, CT-based modalities like CT angiography (CTA) have been shown to reliably differentiate low from high-risk coronary disease. The advent of newer CT technology now allows for CT-based myocardial perfusion imaging (CTP) that provides functional information, that when analyzed with anatomic data from CTA, can provide a comprehensive risk assessment strategy. In this review, we discuss the research and implementation; as well as the quantitative, semiquantitative, and qualitative methods of image analysis of CT-based perfusion. We also discuss the present state of technology and challenges associated with the methodology. In each section, when appropriate, we provide some information regarding the translation of these methods being utilized in the international, multicenter CORE320 study that is evaluating the combined CT-based imaging (CTA and CTP) strategy of risk assessment in comparison to the combined reference standard of radionuclide myocardial perfusion imaging and invasive angiography.
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