Related Experiment Video
Updated: Apr 18, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT
Gert Jan Pelgrim1, Monique Dorrius1, Xueqian Xie2
1University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.
Insights
Computed tomography (CT) perfusion shows promise for detecting coronary artery disease (CAD). However, variations in CT perfusion techniques and reference standards necessitate standardization for reliable clinical use.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Accurate non-invasive diagnostic tools are crucial for timely intervention.
- Computed tomography (CT) perfusion is an emerging imaging modality for assessing myocardial blood supply.
Purpose of the Study:
- To evaluate the diagnostic performance of various CT perfusion techniques.
- To compare CT perfusion against established reference standards for CAD detection.
- To identify the strengths and limitations of CT perfusion in clinical practice.
Main Methods:
- A systematic literature search was conducted across PubMed, Web of Knowledge, and Embase.
- Articles published between January 1998 and July 2014 were screened for inclusion.
- A meta-analysis was performed on 22 studies involving 1507 subjects, pooling diagnostic parameters.
Main Results:
- CT perfusion techniques demonstrated considerable sensitivity and specificity in detecting hemodynamically relevant CAD.
- Performance varied across different CT perfusion techniques (snapshot vs. dynamic) and reference standards (ICA, SPECT, MRI).
- For instance, vessel-based sensitivity and specificity for combined CT angiography and stress CT were 84% and 93% versus ICA-based >50% stenosis.
Conclusions:
- CT perfusion shows potential as a sensitive and specific tool for evaluating coronary artery disease.
- Significant variability exists in current CT perfusion techniques and reference standards.
- Standardization of myocardial perfusion CT techniques is essential for widespread clinical adoption and reliable interpretation.
Purpose:
To determine the diagnostic performance of computed tomography (CT) perfusion techniques for the detection of functionally relevant coronary artery disease (CAD) in comparison to reference standards, including invasive coronary angiography (ICA), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI).
Materials And Methods:
PubMed, Web of Knowledge and Embase were searched from January 1, 1998 until July 1, 2014. The search yielded 9475 articles. After duplicate removal, 6041 were screened on title and abstract. The resulting 276 articles were independently analyzed in full-text by two reviewers, and included if the inclusion criteria were met. The articles reporting diagnostic parameters including true positive, true negative, false positive and false negative were subsequently evaluated for the meta-analysis. Results were pooled according to CT perfusion technique, namely snapshot techniques: single-phase rest, single-phase stress, single-phase dual-energy stress and combined coronary CT angiography [rest] and single-phase stress, as well the dynamic technique: dynamic stress CT perfusion.
Results:
Twenty-two articles were included in the meta-analysis (1507 subjects). Pooled per-patient sensitivity and specificity of single-phase rest CT compared to rest SPECT were 89% (95% confidence interval [CI], 82-94%) and 88% (95% CI, 78-94%), respectively. Vessel-based sensitivity and specificity of single-phase stress CT compared to ICA-based >70% stenosis were 82% (95% CI, 64-92%) and 78% (95% CI, 61-89%). Segment-based sensitivity and specificity of single-phase dual-energy stress CT in comparison to stress MRI were 75% (95% CI, 60-85%) and 95% (95% CI, 80-99%). Segment-based sensitivity and specificity of dynamic stress CT perfusion compared to stress SPECT were 77% (95% CI, 67-85) and 89% (95% CI, 78-95%). For combined coronary CT angiography and single-phase stress CT, vessel-based sensitivity and specificity in comparison to ICA-based >50% stenosis were 84% (95% CI, 67-93%) and 93% (95% CI, 89-96%).
Conclusion:
This meta-analysis shows considerable variation in techniques and reference standards for CT of myocardial blood supply. While CT seems sensitive and specific for evaluation of hemodynamically relevant CAD, studies so far are limited in size. Standardization of myocardial perfusion CT technique is essential.
More Related Videos
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies