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Updated: Mar 26, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Relation between quantitative coronary CTA and myocardial ischemia by adenosine stress myocardial CT perfusion
Alexander R van Rosendael1,2, Lucia J Kroft3, Alexander Broersen4
1Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands.
Insights
Coronary computed tomography angiography (CTA) and CT myocardial perfusion (CTP) can assess coronary artery disease. Stenosis severity and lesion length are key indicators of myocardial ischemia, even with other plaque characteristics considered.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary computed tomography angiography (CTA) has limitations in predicting myocardial ischemia.
- Plaque morphology and composition may offer additional insights beyond luminal stenosis.
- Integrating coronary CTA with adenosine stress CT myocardial perfusion (CTP) provides comprehensive anatomical and functional data.
Purpose of the Study:
- To investigate the association between coronary stenosis severity, plaque characteristics, and myocardial ischemia.
- To determine the predictive value of quantitative CTA parameters and plaque morphology for ischemia.
Main Methods:
- Analysis of 84 patients undergoing sequential coronary CTA and adenosine stress CTP.
- Automated quantitative CTA for stenosis assessment.
- Visual assessment of CTP for downstream myocardial ischemia (summed difference score ≥1).
Main Results:
- 21% of coronary plaques were associated with downstream ischemia.
- Ischemia prevalence increased with stenosis severity: 9% (<50%), 18% (50%-70%), and 57% (>70%).
- Stenosis percentage (OR 1.06) and lesion length (OR 1.26) were independent predictors of ischemia.
Conclusions:
- Quantitative CTA stenosis percentage correlates with myocardial ischemia, but is a moderate determinant.
- Lumen area stenosis and lesion length are independently associated with ischemia.
- These findings highlight the importance of stenosis severity and lesion length in assessing ischemia with combined CTA and CTP.
Background:
Coronary-computed tomography angiography (CTA) has limited accuracy to predict myocardial ischemia. Besides luminal area stenosis, other coronary plaque morphology and composition parameters may help to assess ischemia. With the integration of coronary CTA and adenosine stress CT myocardial perfusion (CTP), reliable information regarding coronary anatomy and function can be derived in one procedure. This analysis aimed to investigate the association between coronary stenosis severity, plaque composition and morphology and the presence of ischemia measured with adenosine stress myocardial CTP.
Methods And Results:
84 patients (age, 62 ± 10 years; 48% men) who underwent sequential coronary CTA and adenosine stress myocardial CT perfusion were analyzed. Automated quantification was performed in all coronary lesions (quantitative CTA). Downstream myocardial ischemia was assessed by visual analysis of the rest and stress CTP images and defined as a summed difference score of ≥1. One or more coronary plaques were present in 146 coronary arteries of which 31 (21%) were ischemia-related. Of the lesions with a stenosis percentage <50%, 50%-70%, and >70%, respectively, 9% (6/67), 18% (9/51), and 57% (16/28) demonstrated downstream ischemia. Furthermore, mean plaque burden, plaque volume, lesion length, maximal plaque thickness, and dense calcium volume were significantly higher in ischemia-related lesions, but only stenosis severity (%) (OR 1.06; 95% CI 1.02-1.10; P = .006) and lesion length (mm) (OR 1.26; 95% CI 1.02-1.55; P = .029) were independent correlates.
Conclusions:
Increasing stenosis percentage by quantitative CTA is positively correlated to myocardial ischemia measured with adenosine stress myocardial CTP. However, stenosis percentage remains a moderate determinant. Lumen area stenosis and lesion length were independently associated with ischemia, adjusted for coronary plaque volume, mean plaque burden, maximal lesion thickness, and dense calcium volume.
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