title: Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.
abstract: OBJECTIVE
  This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA).
  
  
  BACKGROUND
  Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans.
  
  
  METHODS
  Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers.
  
  
  RESULTS
  The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 +/- 10.7 years; 82% male; body mass index 30.4 +/- 5 kg/m(2)) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis > or =50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with > or =50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis > or =70%.
  
  
  CONCLUSIONS
  Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. rblankstein@partners.org
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Leon D
authors.initials: LD
authors.lastname: Shturman
authors.forename: Ian S
authors.initials: IS
authors.lastname: Rogers
authors.forename: Jose A
authors.initials: JA
authors.lastname: Rocha-Filho
authors.forename: David R
authors.initials: DR
authors.lastname: Okada
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.forename: Anand V
authors.initials: AV
authors.lastname: Soni
authors.forename: Hiram
authors.initials: H
authors.lastname: Bezerra
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.forename: Milena
authors.initials: M
authors.lastname: Petranovic
authors.forename: Ricardo
authors.initials: R
authors.lastname: Loureiro
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Henry
authors.initials: H
authors.lastname: Gewirtz
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Wilfred S
authors.initials: WS
authors.lastname: Mamuya
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine