Preliminary experience with dynamic CT myocardial perfusion imaging: a single-centre perspective

This study aimed to optimise the dynamic coronary computed tomography perfusion (CTP) protocol, focusing on patient preparation, scanning parameters, and image acquisition, reconstruction, and interpretation. Future phases will evaluate the diagnostic accuracy of dynamic CTP in detecting haemodynamically significant coronary artery disease (CAD), using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as reference standards.

Thirty-six symptomatic patients with confirmed or suspected CAD underwent dynamic CTP using a whole-heart coverage CT scanner (Revolution Apex CT, GE Healthcare). Two patients were excluded due to non-diagnostic CTP results. Of the remaining 34 patients, 24 underwent both cardiac CT angiography (CCTA) and CTP, while 19 underwent CCTA, CTP, and ICA. Preliminary data were analysed by comparing CTP findings with CCTA and ICA/FFR when available.

Among 578 myocardial segments, 424 (73.3%) showed normal perfusion and 154 (26.6%) exhibited hypoperfusion. Of the 17 cases with perfusion deficits, ICA confirmed significant stenosis in 10, resulting in 100% sensitivity and 22% specificity for detecting haemodynamically significant stenosis. FFR assessment in 10 patients demonstrated 60% concordance between CTP, ICA, and FFR. Incorporating CTP into the diagnostic pathway led to a 29.4% reclassification in management strategies.

The low specificity observed for detecting significant CAD underscores the need for further refinement of the CTP protocol. Future research should aim to optimise myocardial blood flow thresholds to improve diagnostic specificity and clinical applicability.