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Updated: May 6, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Value of dynamic computed tomography myocardial perfusion in CAD: a systematic review and meta-analysis
Yuma Kawaguchi1, Shingo Kato1, Nobuyuki Horita2
1Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 236-0004, Japan.
Insights
Dynamic CT perfusion accurately detects myocardial ischemia, aiding in coronary artery disease assessment. This non-invasive method shows high diagnostic performance and prognostic value for adverse events in patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Diagnostic Accuracy
Background:
- Myocardial ischemia quantification is crucial for diagnosing coronary artery disease (CAD).
- Dynamic computed tomography (CT) perfusion offers a non-invasive approach to assess myocardial blood flow (MBF).
Purpose of the Study:
- To evaluate the diagnostic accuracy of dynamic CT perfusion for detecting significant CAD.
- To assess the prognostic value of dynamic CT perfusion in risk stratification of CAD patients.
Main Methods:
- Systematic literature search of PubMed, Embase, Web of Science, and Cochrane Library.
- Meta-analysis of 23 studies comparing dynamic CT perfusion with invasive fractional flow reserve (FFR).
- Evaluation of diagnostic performance using summary receiver operating characteristic (sROC) curves and pooled hazard ratios.
Main Results:
- Dynamic CT perfusion demonstrated high diagnostic accuracy (AUC=0.92, sensitivity=0.82, specificity=0.86) for detecting myocardial ischemia.
- MBF was significantly lower in ischemic regions (0.92 mL/min/g) compared to non-ischemic regions (1.39 mL/min/g).
- The method showed prognostic value, with a pooled hazard ratio of 4.98 for predicting adverse events.
Conclusions:
- Dynamic CT perfusion is a highly accurate non-invasive tool for quantifying myocardial ischemia and detecting functional significance.
- The technique shows potential for risk stratification in patients with coronary artery disease.
- Diagnostic performance was consistent across different CT scanner types and patient body mass indices.
Aims:
Dynamic stress computed tomography (CT) perfusion is a non-invasive method for quantifying myocardial ischaemia by assessing myocardial blood flow (MBF). In this meta-analysis, we evaluated the diagnostic accuracy of dynamic CT perfusion for the detection of significant coronary artery disease (CAD) across various CT scanners, obese patients, and its prognostic value.
Methods And Results:
We systematically searched PubMed, Embase, Web of Science, and Cochrane library for published studies evaluating the accuracy of CT myocardial perfusion in diagnosing functional significant ischaemia by invasive fractional flow reserve. The diagnostic performance of dynamic CT perfusion in detecting ischaemia was evaluated using a summary receiver operating characteristic (sROC) curve. A total of 23 studies underwent meta-analysis. In myocardial region without ischaemia, MBF was measured at 1.39 mL/min/g [95% confidence interval (CI) 1.25-1.54], while in region with ischaemia, it was 0.92 mL/min/g (95% CI 0.83-1.01) (P < 0.001). On the patient-based analysis, the area under the sROC curve of CT-MBF was 0.92, with a sensitivity of 0.82 and specificity of 0.86. Differences in CT type (dual source vs. single source), and body mass index did not significantly affect the diagnostic performance. The pooled hazard ratio of dynamic CT perfusion for predicting adverse events was 4.98 (95% CI 2.08-11.93, P ≤ 0.001, I2 = 61%, P for heterogeneity = 0.07).
Conclusion:
Dynamic CT perfusion has high diagnostic performance in the quantitative assessment of ischaemia and detection of functional myocardial ischaemia as defined by invasive FFR and may be useful in risk stratification of CAD patients.
