Related Experiment Video
Updated: May 11, 2026
Dynamic Assessments of Coronary Flow Reserve after Myocardial Ischemia Reperfusion in Mice
Published on: August 25, 2023
CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR
Martin Greif1, Franz von Ziegler, Fabian Bamberg
1Department of Cardiology, University Hospital of Munich, Bayern, Germany. martin.greif@med.uni-muenchen.de
Insights
CT-myocardial perfusion imaging (CT-MPI) accurately detects hemodynamically relevant coronary artery stenoses. This CT-MPI approach offers a moderate diagnostic accuracy, improving upon CT angiography alone for assessing coronary artery disease.
Area of Science:
- Cardiovascular imaging
- Radiology
- Diagnostic accuracy studies
Background:
- Coronary artery disease (CAD) diagnosis relies on assessing stenosis severity.
- Hemodynamic relevance of coronary stenoses is crucial for guiding treatment decisions.
- CT angiography (CTA) visualizes coronary anatomy, but functional significance requires further assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of CT-myocardial perfusion imaging (CT-MPI) and combined CTA/CT-MPI for detecting hemodynamically relevant coronary stenoses.
- To compare the performance of CT-MPI with CTA alone in patients with suspected or known CAD.
Main Methods:
- Prospective diagnostic study involving 65 patients with chest pain.
- Coronary CT angiography (CTA) and adenosine stress CT-myocardial perfusion imaging (CT-MPI) were performed.
- Invasive fractional flow reserve (FFR) measurement was used as the gold standard to define hemodynamically relevant stenoses (FFR < 0.80).
Main Results:
- CTA alone had high sensitivity (100%) but low specificity (43.8%) for hemodynamically significant stenoses.
- CT-MPI significantly improved specificity (65.6%), positive predictive value (74.4%), and diagnostic accuracy (81.5%) compared to CTA alone.
- CT-MPI maintained high sensitivity (97%) and negative predictive value (95.5%) for ruling out significant stenoses.
Conclusions:
- CT-MPI demonstrates moderate diagnostic accuracy for detecting hemodynamically relevant coronary artery stenoses.
- CT-MPI offers a valuable tool for assessing both coronary artery morphology and function simultaneously.
- The combination of CTA and CT-MPI did not further improve the detection of significant stenoses beyond CT-MPI alone.
Objectives:
To evaluate the diagnostic accuracy (DA) of CT-myocardial perfusion imaging (CT-MPI) and a combined approach with CT angiography (CTA) for the detection of haemodynamically relevant coronary stenoses in patients with both suspected and known coronary artery disease.
Design:
Prospective, non-randomised, diagnostic study.
Setting:
Academic hospital-based study.
Patients:
65 patients (42 men age 70.4±9) with typical or atypical chest pain.
Interventions:
CTA and CT-MPI with adenosine stress using a fast dual-source CT system. At subsequent invasive angiography, FFR measurement was performed in coronary arteries to define haemodynamic relevance of stenosis.
Main Outcome Measures:
We tried to correlate haemodynamically relevant stenosis (FFR < 0.80) to a reduced myocardial blood flow (MBF) as assessed by CT-MPI and determined the DA of CT-MPI for the detection of haemodynamically relevant stenosis.
Results:
Sensitivity and negative predictive value (NPV) of CTA alone were very high (100% respectively) for ruling out haemodynamically significant stenoses, specificity, Positive predictive value (PPV) and DA were low (43.8, 67.3 and 72%, respectively). CT-MPI showed a significant increase in specificity, PPV and DA for the detection of haemodynamically relevant stenoses (65.6, 74.4 and 81.5%, respectively) with persisting high sensitivity and NPV for ruling out haemodynamically relevant stenoses (97% and 95.5% respectively). The combination of CTA and CT-MPI showed no further increase in detection of haemodynamically significant stenosis compared with CT-MPI alone.
Conclusions:
Our data suggest that CT-MPI permits the detection of haemodynamically relevant coronary artery stenoses with a moderate DA. CT may, therefore, allow the simultaneous assessment of both coronary morphology and function.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this principle...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes