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Updated: Apr 1, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block
Estêvan Vieira Cabeda1, Andréa Maria Gomes Falcão2, José Soares2
1Departamento de Tomografia e Ressonância Cardiovascular, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
Dipyridamole-stress myocardial computed tomography perfusion (CTP) shows good accuracy for detecting myocardial ischemia in patients with left bundle branch block (LBBB). Adding CTP to coronary computed tomography angiography (CTA) improves diagnostic performance over single photon emission computed tomography (SPECT).
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Functional tests have limited accuracy for diagnosing myocardial ischemia in patients with left bundle branch block (LBBB).
- Accurate diagnosis of coronary artery disease in LBBB patients is challenging.
Purpose of the Study:
- To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) using 320-detector CT in LBBB patients.
- To compare CTP's diagnostic performance with invasive coronary angiography (QCA) and single photon emission computed tomography (SPECT).
- To evaluate the added value of CTP to coronary computed tomography angiography (CTA).
Main Methods:
- Thirty LBBB patients who underwent SPECT were included.
- Dipyridamole-stress CTP was performed using a 320-detector CT scanner.
- Assessments were conducted per-patient and per-coronary territory, with QCA (stenosis ≥ 70%) as the reference standard.
Main Results:
- CTP demonstrated good diagnostic accuracy: per-patient (83%) and per-territory (79%).
- Per-patient sensitivity was 86% and specificity was 81%.
- The combination of CTP and CTA showed significantly higher diagnostic accuracy than SPECT for detecting myocardial ischemia.
Conclusions:
- Dipyridamole-stress CTP is a feasible technique for assessing myocardial ischemia in LBBB patients.
- CTP offers good diagnostic accuracy in this challenging patient group.
- CTP, especially when combined with CTA, represents an advancement over SPECT for diagnosing coronary artery disease in LBBB.
Background:
Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB).
Objective:
To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy.
Methods:
Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution's ethics committee.
Results:
The patients' mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001).
Conclusion:
The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.
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