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Updated: Mar 12, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardial ischemia detection with single-phase CT perfusion in symptomatic patients using high-pitch helical image
Bernhard Bischoff1,2, Simon Deseive3, Martin Rampp4
1Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany. bernhard.bischoff@med.uni-muenchen.de.
Insights
Coronary CT angiography (CCTA) has limited accuracy in patients with calcified arteries or prior revascularization. Combining CCTA with CT myocardial perfusion imaging (CTMPI) significantly improves diagnostic accuracy for detecting coronary artery stenosis.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Coronary CT angiography (CCTA) accuracy is limited by calcifications and stent artifacts in certain patient groups.
- CT myocardial perfusion imaging (CTMPI) shows promise for detecting myocardial ischemia and overcoming CCTA limitations.
Purpose of the Study:
- To evaluate the diagnostic accuracy of CCTA combined with CTMPI in patients with prior myocardial revascularization.
- To compare the diagnostic performance of combined CCTA and CTMPI versus CCTA alone.
Main Methods:
- Prospective study of 36 patients with prior myocardial revascularization undergoing CCTA and CTMPI.
- High-pitch helical acquisition for stress CTMPI, sequential CT for rest imaging.
- MP-SPECT and invasive coronary angiography served as the reference standard.
Main Results:
- CCTA alone had low diagnostic accuracy (31% per patient, 60% per vessel).
- Combined CCTA and CTMPI significantly improved accuracy (78% per patient, 92% per vessel; p < 0.001).
- Mean radiation dose was 0.9 mSv for stress and 5.0 mSv for rest CT scans.
Conclusions:
- Combining CCTA with CTMPI significantly enhances diagnostic accuracy for hemodynamically significant coronary artery stenosis in patients with prior revascularization.
- CTMPI is a valuable tool to improve the diagnostic performance of CCTA in complex coronary artery disease cases.
- This combined approach offers improved detection of significant coronary artery stenosis compared to CCTA alone.
Abstract:
Coronary CT angiography (CCTA) suffers from a reduced diagnostic accuracy in patients with heavily calcified coronary arteries or prior myocardial revascularisation due to artefacts caused by calcifications and stent material. CT myocardial perfusion imaging (CTMPI) yields high potential for the detection of myocardial ischemia and might help to overcome the above mentioned limitations. We analysed CT single-phase perfusion using high-pitch helical image acquisition technique in patients with prior myocardial revascularisation. Thirty-six patients with an indication for invasive coronary angiography (28 with coronary stents, 2 with coronary artery bypass grafts and 6 with both) were included in this prospective study at two study sites. All patients were examined on a 2nd generation dual-source CT system. Stress CT images were obtained using a prospectively ECG-triggered single-phase high-pitch helical image acquisition technique. During stress the tracer for myocardial perfusion (MP) SPECT imaging was administered. Rest CT images were acquired using prospectively ECG-triggered sequential CT. MP-SPECT imaging and invasive coronary angiography served as standard of reference. In this heavily diseased patient cohort CCTA alone showed a low overall diagnostic accuracy for detection of hemodynamically relevant coronary artery stenosis of only 31% on a per-patient base and 60% on a per-vessel base. Combining CCTA and CTMPI allowed for a significantly higher overall diagnostic accuracy of 78% on a per-patient base and 92% on a per-vessel base (p < 0.001). Mean radiation dose for stress CT scans was 0.9 mSv, mean radiation dose for rest CT scans was 5.0 mSv. In symptomatic patients with known coronary artery disease and prior myocardial revascularization combining CCTA and CTMPI showed significantly higher diagnostic accuracy in detection of hemodynamically significant coronary artery stenosis when compared to CCTA alone.
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