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      Myocardial perfusion imaging using computed tomography: Current status, clinical value and prognostic implications

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          Abstract

          Combined anatomical and functional evaluation of coronary artery disease (CAD) using computed tomography (CT) has recently emerged as an accurate, robust, and non-invasive tool for the evaluation of ischemic heart disease. Cardiac CT has become a one-stop-shop imaging modality that allows the simultaneous depiction, characterization, and quantification of coronary atherosclerosis and the assessment of myocardial ischemia. Advancements in scanner technology (improvements in spatial and temporal resolution, dual-energy imaging, wide detector panels) and the implementation of iterative reconstruction algorithms enables the detection of myocardial ischemia in both qualitative and quantitative fashion using low-dose scanning protocols. The addition of CT perfusion (CTP) to standard coronary CT angiography is a reliable tool to improve diagnostic accuracy. CTP using static first-pass imaging enables qualitative assessment of the myocardial tissue, whereas dynamic perfusion imaging can also provide quantitative information on myocardial blood flow. Myocardial tissue assessment by CTP holds the potential to refine risk in stable chest pain or microvascular dysfunction. CTP can aid the detection of residual ischemia after coronary intervention. Comprehensive evaluation of CAD using CTP might therefore improve the selection of patients for aggressive secondary prevention therapy or coronary revascularization with high diagnostic certainty. In addition, prognostic information provided by perfusion CT imaging could improve patient outcomes by quantifying the ischemic burden of the left ventricle. The current review focuses on the clinical value of myocardial perfusion imaging by CT, current status of CTP imaging and the use of myocardial CTP in various patient populations for the diagnosis of ischemic heart disease.

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          Author and article information

          Contributors
          Journal
          1647
          Imaging
          Imaging
          Akadémiai Kiadó (Budapest )
          2732-0960
          19 June 2021
          10 March 2021
          : 13
          : 1
          : 49-60
          Affiliations
          [1] MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , Budapest, Hungary
          Author notes
          [* ]Corresponding author. Tel.: +36 20 666 3857. E-mail: bori.vattay@ 123456gmail.com
          Article
          10.1556/1647.2020.00009
          1ccd43d1-ad42-4843-bd5d-c58de8c71dc1
          © 2020 The Author(s)

          Open Access. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated. (SID_1)

          Page count
          Figures: 3, Tables: 2, Equations: 0, References: 83, Pages: 12
          Custom metadata
          1

          Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
          ischemic heart disease,cardiac CT,myocardial CT perfusion

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