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Updated: Jan 23, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
The role of computed tomography myocardial perfusion imaging in clinical practice
Amita Singh1, Victor Mor-Avi1, Amit R Patel1
1University of Chicago Medical Center, Chicago, IL, USA.
Insights
Computed tomography coronary angiography (CTCA) detects coronary artery disease (CAD) but struggles with lesion significance. Stress CT myocardial perfusion (CTP) imaging adds functional assessment, improving CAD diagnosis and management when combined with CTCA.
Area of Science:
- Cardiovascular imaging
- Radiology
- Diagnostic cardiology
Background:
- Computed tomography coronary angiography (CTCA) accurately detects coronary artery disease (CAD) but has limitations in assessing the physiologic significance of coronary stenosis.
- This limitation often necessitates further testing to determine the presence of ischemia, increasing healthcare costs and patient burden.
Purpose of the Study:
- To review the clinical applications, methodology, strengths, weaknesses, and unresolved issues of stress CT myocardial perfusion (CTP) imaging.
- To highlight the complementary role of CTP in conjunction with CTCA for a comprehensive assessment of CAD.
Main Methods:
- The review synthesizes current literature on CTP imaging, comparing its accuracy against established diagnostic standards.
- Methodology discusses acquisition protocols and interpretation strategies for CTP.
Main Results:
- CTP imaging provides crucial functional assessment of coronary stenosis, complementing the anatomical data from CTCA.
- The combination of CTCA and CTP allows for simultaneous detection of CAD and evaluation of its hemodynamic significance within a single examination.
- CTP demonstrates well-described accuracy compared to reference standards like SPECT, CMR, and invasive angiography with FFR.
Conclusions:
- Stress CTP imaging is a valuable tool for functional assessment in patients with suspected or known CAD.
- Integrating CTP with CTCA offers a powerful strategy for improving the detection and management of coronary artery disease.
- Further standardization of CTP protocols is needed, but growing evidence supports its clinical integration.
Abstract:
Computed tomography coronary angiography (CTCA) is a widely accepted non-invasive technique for the accurate detection of coronary artery disease (CAD), but comes with a notable limitation stemming from its limited capacity to define the physiologic significance of a given lesion This hampered ability for functional assessment of coronary stenosis may lead to additional testing in an effort to delineate whether ischemia is truly present. An important technique that can overcome this pitfall of CTCA has emerged in the form of stress CT myocardial perfusion (CTP) imaging, which provides the functional assessment necessary, thereby complementing the anatomic information provided by CTCA. The combination of CTCA and CTP permits a single exam to simultaneously detect coronary stenosis and categorize its hemodynamic significance. The accuracy of CTP is now well-described in comparison to a number of reference standards for the diagnosis of CAD, including single photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve (FFR) measurements. While there is not yet a consensus for a single protocol regarding the optimal mode of acquisition and interpretation of CTP, there is a growing body of data to support its integration into clinical use with CTCA as a strategy to improve the detection and management of coronary disease. This review article is aimed to discuss the current clinical applications and methodology of CTP imaging, its strengths and weaknesses as well as some of the debated issues that remain to be resolved in the future.
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