Value of dynamic computed tomography myocardial perfusion in CAD: a systematic review and meta-analysis

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.