Stress myocardial CT perfusion: an update and future perspective

Coronary computed tomography angiography (CTA) has been shown by several multicenter trials to have excellent diagnostic accuracy in the detection and exclusion of significant coronary stenosis. However, a major limitation of coronary CTA is that the physiological significance of stenotic lesions identified is often unknown. Stress myocardial computed tomography perfusion (CTP) is a novel examination that provides both anatomic and physiological information (i.e., myocardial perfusion). Multiple single-center studies have established the feasibility of stress myocardial CTP. Furthermore, it has been illustrated that a combined CTA/CTP protocol improves the diagnostic accuracy to detect hemodynamic significant stenosis as compared with CTA alone; this combined protocol can also be accomplished at a radiation dose comparable to nuclear myocardial perfusion imaging exams. Although initial results hold some promise, stress myocardial CTP is a modality in its infancy. Further research is required to define, validate, and optimize this new technique. However, it is a modality with significant potential, particularly in the evaluation of chest pain patients, given the advantages of short exam time and comprehensive data acquisition. This review highlights how to perform and interpret stress myocardial CTP, summarizes the current literature, and discusses some future directions.