Skip to main content
SpringerLink
Log in

Value of multidetector computed tomography evaluation of myocardial perfusion in the assessment of ischemic heart disease: comparison with nuclear perfusion imaging

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

MDCT-derived myocardial perfusion has not yet been validated against accepted standards. We developed a technique for quantification of myocardial perfusion from MDCT images and studied its diagnostic value against SPECT myocardial perfusion imaging (MPI). Ninety-eight patients were studied. Abnormal perfusion was detected by comparing normalized segmental x-ray attenuation against values obtained in 20 control subjects. Disagreement with resting MPI was investigated in relationship to MDCT image quality, severity of MPI abnormalities, and stress MPI findings. Resting MPI detected mild or worse abnormalities in 20/78 patients. MDCT detected abnormalities in 15/20 patients (sensitivity of 0.75). Most abnormalities missed by MDCT analysis were graded as mild on MPI. Additional abnormalities found in 16/78 patients were not confirmed on resting MPI (specificity of 0.72). However, 8 of these 16 apparently false positive MDCT perfusion tests had abnormal stress MPI; of these 8 patients, 7 had optimal MDCT image quality, while in 6/8 remaining patients, image quality was suboptimal. When compared with resting MPI, MDCT detected perfusion abnormalities with high accuracy. Moreover, half of MDCT perfusion abnormalities not confirmed by resting MPI were associated with abnormal stress MPI. Importantly, this information can be obtained without additional radiation dose or contrast agent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. de Roos A, Kroft LJ, Bax JJ, Geleijns J (2007) Applications of multislice computed tomography in coronary artery disease. J Magn Reson Imaging 26:14–22

    Article  PubMed  Google Scholar 

  2. Deetjen AG, Conradi G, Mollmann S et al (2007) Diagnostic value of the 16-detector row multislice spiral computed tomography for the detection of coronary artery stenosis in comparison to invasive coronary angiography. Clin Cardiol 30:118–123

    Article  PubMed  Google Scholar 

  3. Schroeder S, Achenbach S, Bengel F et al (2008) Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 29:531–556

    Article  PubMed  Google Scholar 

  4. Leber AW, Knez A, von ZF et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154

    Article  PubMed  Google Scholar 

  5. Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323

    Article  PubMed  Google Scholar 

  6. Raff GL, Gallagher MJ, O, Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557

    Article  PubMed  Google Scholar 

  7. Ropers D, Rixe J, Anders K et al (2006) Usefulness of multidetector row spiral computed tomography with 64- × 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 97:343–348

    Article  PubMed  Google Scholar 

  8. Budoff MJ, Rasouli ML, Shavelle DM et al (2007) Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI)—a comparison in detecting significant coronary artery disease. Acad Radiol 14:252–257

    Article  PubMed  Google Scholar 

  9. Rubinshtein R, Halon DA, Gaspar T et al (2007) Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation 115:1762–1768

    Article  PubMed  Google Scholar 

  10. Hacker M, Jakobs T, Matthiesen F et al (2005) Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences. J Nucl Med 46:1294–1300

    PubMed  Google Scholar 

  11. Schuijf JD, Wijns W, Jukema JW et al (2006) Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 48:2508–2514

    Article  PubMed  Google Scholar 

  12. Schuijf JD, Wijns W, Jukema JW et al (2006) A comparative regional analysis of coronary atherosclerosis and calcium score on multislice CT versus myocardial perfusion on SPECT. J Nucl Med 47:1749–1755

    PubMed  Google Scholar 

  13. Hacker M, Jakobs T, Matthiesen F et al (2007) Combined functional and morphological imaging consisting of gated myocardial perfusion SPECT and 16-detector multislice spiral CT angiography in the noninvasive evaluation of coronary artery disease: first experiences. Clin Imaging 31:313–320

    Article  PubMed  Google Scholar 

  14. Kuettner A, Kopp AF, Schroeder S et al (2004) Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 43:831–839

    Article  PubMed  Google Scholar 

  15. George RT, Silva C, Cordeiro MA et al (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48:153–160

    Article  PubMed  Google Scholar 

  16. Cury RC, Nieman K, Shapiro MD et al (2007) Comprehensive cardiac CT study: evaluation of coronary arteries, left ventricular function, and myocardial perfusion—is it possible. J Nucl Cardiol 14:229–243

    Article  PubMed  Google Scholar 

  17. Mahnken AH, Koos R, Katoh M et al (2005) Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol 45:2042–2047

    Article  PubMed  Google Scholar 

  18. Nikolaou K, Sanz J, Poon M et al (2005) Assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detector-row computed tomography of the heart: preliminary results. Eur Radiol 15:864–871

    Article  PubMed  Google Scholar 

  19. Gerber BL, Belge B, Legros GJ et al (2006) Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 113:823–833

    Article  PubMed  Google Scholar 

  20. Henneman MM, Schuijf JD, Jukema JW et al (2006) Comprehensive cardiac assessment with multislice computed tomography: evaluation of left ventricular function and perfusion in addition to coronary anatomy in patients with previous myocardial infarction. Heart 92:1779–1783

    Article  PubMed  CAS  Google Scholar 

  21. Nieman K, Cury RC, Ferencik M et al (2006) Differentiation of recent and chronic myocardial infarction by cardiac computed tomography. Am J Cardiol 98:303–308

    Article  PubMed  Google Scholar 

  22. Hoffmann U, Millea R, Enzweiler C et al (2004) Acute myocardial infarction: contrast-enhanced multi-detector row CT in a porcine model. Radiology 231:697–701

    Article  PubMed  Google Scholar 

  23. Lardo AC, Cordeiro MA, Silva C et al (2006) Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 113:394–404

    Article  PubMed  Google Scholar 

  24. Brodoefel H, Klumpp B, Reimann A et al (2007) Sixty-four-MSCT in the characterization of porcine acute and subacute myocardial infarction: determination of transmurality in comparison to magnetic resonance imaging and histopathology. Eur J Radiol 62:235–246

    Article  PubMed  CAS  Google Scholar 

  25. George RT, Jerosch-Herold M, Silva C et al (2007) Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol 42:815–822

    Article  PubMed  Google Scholar 

  26. Prat-Gonzalez S, Sanz J, Garcia MJ (2008) Cardiac CT: indications and limitations. J Nucl Med Technol 36:18–24

    Article  PubMed  Google Scholar 

  27. van Werkhoven JM, Schuijf JD, Jukema JW et al (2008) Anatomic correlates of a normal perfusion scan using 64-slice computed tomographic coronary angiography. Am J Cardiol 101:40–45

    Article  PubMed  Google Scholar 

  28. Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  29. Boll DT, Merkle EM, Paulson EK, Hoffmann MH (2008) Assessment of the myocardium on 2-phase cardiac multidetector computed tomography: does cyclic cardiac contraction influence myocardial attenuation. J Comput Assist Tomogr 32:602–608

    Article  PubMed  Google Scholar 

  30. Kurata A, Mochizuki T, Koyama Y et al (2005) Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy. Circ J 69:550–557

    Article  PubMed  Google Scholar 

  31. Choe YH, Choo KS, Jeon ES et al (2008) Comparison of MDCT and MRI in the detection and sizing of acute and chronic myocardial infarcts. Eur J Radiol 66:292–299

    Article  PubMed  Google Scholar 

  32. Limbruno U, Petronio AS, Amoroso G et al (2000) The impact of coronary artery disease on the coronary vasomotor response to nonionic contrast media. Circulation 101:491–497

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Chicago Medical Center, 5841 S. Maryland Ave., MC5084, Chicago, 60637, IL, USA

    Nadjia Kachenoura, Joseph A. Lodato, Dianna M. E. Bardo, Barbara Newby, Roberto M. Lang & Victor Mor-Avi

  2. Lady Davis Carmel Medical Center, Haifa, Israel

    Tamar Gaspar, Sarah Gips & Nathan Peled

Authors
  1. Nadjia Kachenoura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph A. Lodato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tamar Gaspar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dianna M. E. Bardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Newby
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah Gips
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nathan Peled
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roberto M. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Victor Mor-Avi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor Mor-Avi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kachenoura, N., Lodato, J.A., Gaspar, T. et al. Value of multidetector computed tomography evaluation of myocardial perfusion in the assessment of ischemic heart disease: comparison with nuclear perfusion imaging. Eur Radiol 19, 1897–1905 (2009). https://doi.org/10.1007/s00330-009-1365-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1365-y

Keywords

Search

Navigation