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Acta Radiol. 2013 May;54(4):389-95. doi: 10.1177/0284185113475440. Epub 2013 Apr 30.

Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve.

Author information

1
Department of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine.
2
Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine.
3
Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine nadroj@chol.com.
4
Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine.
5
Department of Cardiology, Kim Hae Jungang Hospital, Korea.

Abstract

BACKGROUND:

Coronary CT angiography (CCTA) allows accurate evaluation of coronary artery stenosis but has limitations in information on hemodynamic significance of stenotic lesions.

PURPOSE:

To determine the feasibility of adenosine-stress low-dose single-scan CT myocardial perfusion imaging (MPI) using a 128-slice dual-source CT scanner for the diagnosis of hemodynamically significant coronary artery stenosis as defined by fractional flow reserve (FFR).

MATERIAL AND METHODS:

This study was proved by the Institutional Review Board and informed consent was obtained from the patients before enrollment in the study. Ninety-seven patients with chest pain and low-to-intermediate pretest probability of coronary artery disease were prospectively enrolled. Adenosine-stress CCTA using ECG-correlated maximum tube current modulation (Mindose(®)) with 128-slice dual-source CT was performed in all 97 patients. In 37 patients (38.1%; 28 men, nine women; mean age, 61.7 ± 20.5 years; mean heart rate, 74.6 ± 2.8 bpm) with significant stenosis at CCTA (lumen diameter reduction >50%), FFR was performed after CCTA, as a reference standard for the evaluation of myocardial perfusion. FFR value ≤0.75 was considered as positive. CTMPI and CCTA were read by two experienced radiologists with consensus, respectively.

RESULTS:

The effective radiation dose of adenosine-stress single-scan CTMPI was 4.63 ± 2.57 mSv. Compared with FFR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying significant coronary stenoses were 93.1%, 82.7%, 75.0%, and 95.6%, respectively, on CCTA and 93.1%, 90.3%, 84.4%, and 95.9%, respectively, on CTMPI. On combined CCTA and CTMPI, sensitivity, specificity, PPV, and NPV were 93.1%, 94.2%, 90.0%, and 96.0%, respectively.

CONCLUSION:

Adenosine-stress low-dose single scan CTMPI using a 128-slice dual-source CT can provide complementary information on the hemodynamical significance of coronary artery stenosis as well as anatomical information of coronary arteries.

KEYWORDS:

Coronary artery disease; computed tomography; coronary angiography; fractional flow reserve; myocardial perfusion

PMID:
23550182
DOI:
10.1177/0284185113475440
[Indexed for MEDLINE]
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