Myocardial perfusion imaging by computed tomography: today and tomorrow

Cardiac perfusion along with imaging of coronary artery stenosis is an important tool in assessing the degree of coronary artery disease (CAD) and decision-making regarding further treatment. SPECT, PET, echocardiography and cardiac magnetic resonance imaging are clinically established techniques to evaluate myocardial perfusion and viability with a high diagnostic accuracy and relatively few unwanted side effects. However, none of these modalities Glose can reliably assess the extent and morphology of CAD, features which also have implications as well as for patient management. In contrast, cardiac CT has emerged over the last years as a reliable tool to visualise coronary atherosclerotic plaque and stenosis, nearly unaffected by heart rate and carrying a relatively low radiation exposure; however, without allowing an adequate assessment of myocardial perfusion. Given the great promise of a combined cardiac CT examination to assess morphology and function, much research has recently been focused on the development of CT-based myocardial perfusion imaging techniques. In this article, we review recent developments in cardiac CT with respect to myocardial perfusion imaging, especially the two main techniques, first-pass and dynamic CT acquisitions.