Related Experiment Video
Updated: Jun 4, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Diagnostic Accuracy of Dynamic Stress Myocardial CT Perfusion Compared with Invasive Physiology in Patients with
Daniele Andreini1, Saima Mushtaq1, Daniela Trabattoni1
1From the Centro Cardiologico Monzino, IRCCS, Via C. Belgioioso 173, Milan, Italy (D.A., S.M., D.T., E.C., G.L., S. Galli, G.M., L.G., G.T., S.T., S. Gili, P.M., P.O., V.M., D.M., M.S., C.G., E.M., A.B., M.E.M., A.A., A F., G.P., A.L.B.); Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy (D.A.); IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy (E.C., G.M., L.G., V.M., D.M., M.S., E.G., P.P., E.M., A.L.B.); Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (J.S., M.B., E.G., P.P., K.S., T.M., C.C.); Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (K.S., T.M.); Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy (G.P.); and Department of Radiology, Azienda Ospedaliera di Padova, Padua, Italy (L.Z.).
Abstract:
Background The detection of in-stent restenosis (ISR) with coronary CT angiography (CCTA) is challenging, but CT perfusion (CTP) has demonstrated improved diagnostic accuracy over CCTA in patients with stents. However, there are limited data on the performance of dynamic CTP, which allows noninvasive adjudication of regional myocardial blood flow. Purpose To compare the diagnostic performance of regadenoson-stress dynamic CTP with that of CCTA, using fractional flow reserve (FFR) and the index of microvascular resistance (IMR) as reference standards for epicardial coronary circulation and coronary microcirculation, respectively. Materials and Methods Between January 2021 and June 2022, this prospective study enrolled patients with stents with indication for invasive coronary angiography due to suspicion of ISR or coronary artery disease progression. Participants underwent dynamic stress myocardial CTP and rest CTP plus CCTA. A wide coverage (z-axis coverage, 16 cm) and fast (gantry rotation time, 0.28 second) scanner was used. During invasive coronary angiography, FFR and IMR were obtained. The diagnostic rate (number of interpretable territories divided by number of evaluated territories) and accuracy of CCTA and CTP were evaluated in a territory-based analysis and compared with FFR and IMR (primary end points of the study). Results The study included 156 consecutive patients (136 men [87%]; mean age, 63.1 years ± 8.2 [SD]) with 504 stents. The diagnostic rate was higher for CTP than for CCTA (98.7% [789 of 799 territories] vs 95.6% [764 of 799 territories], P < .001). With use of FFR as the reference standard, sensitivity, specificity, and diagnostic accuracy were higher for CTP than for CCTA (89.0%, 82.8%, and 84.7%, respectively, vs 60.0%, 61.9%, and 61.5%; P < .001). With use of IMR as the reference standard, sensitivity, specificity, and diagnostic accuracy were higher with CTP than with CCTA (76.5%, 85.9%, and 82.9%, respectively, vs 48.2%, 63.5%, and 59.3%; P < .01). The mean effective dose of stress CTP plus CCTA was 10.4 mSv ± 2.7. Conclusion In patients with coronary stents, dynamic CTP improves the diagnostic performance of CCTA in the detection of territory-based ischemia. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Williams in this issue.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes