title: Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results.
abstract: OBJECTIVE
  Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain.
  
  
  METHODS
  Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel "shuttle" mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT.
  
  
  RESULTS
  In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments.
  
  
  CONCLUSIONS
  Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.
authors.affiliation: Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC, USA.
authors.forename: Markus
authors.initials: M
authors.lastname: Weininger
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Ashok
authors.initials: A
authors.lastname: Ramachandra
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.forename: Garrett W
authors.initials: GW
authors.lastname: Rowe
authors.forename: Philip
authors.initials: P
authors.lastname: Costello
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
mesh_terms: D000208:Acute Disease; D000241:Adenosine; D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D003199:Computer Systems; D017023:Coronary Angiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010865:Pilot Projects; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine