title: Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: comparison with magnetic resonance imaging.
abstract: BACKGROUND
  Coronary computed tomography angiography (CTA) enables accurate anatomic evaluation of coronary artery stenosis but lacks information about hemodynamic significance. The aim of this study was to evaluate 128-slice myocardial CT perfusion (CTP) imaging with adenosine stress using a high-pitch mode, in comparison with cardiac MRI (CMR).
  
  
  RESULTS
  Thirty-nine patients with intermediate to high coronary risk profile underwent adenosine stress 128-slice dual source CTP (128×0.6 mm, 0.28 seconds). Among those, 30 patients (64 ± 10 years, 6% women) also underwent adenosine stress CMR (1.5T). The 2-step CTP protocol consisted of (1) adenosine stress-CTP using a high-pitch factor (3.4) ECG-synchronized spiral mode and (2) rest-CTP/coronary-CTA using either high-pitch (heart rate <63 bpm) or prospective ECG-triggering (heart rate >63 bpm). Results were compared with CMR and with invasive angiography in 25 patients. The performance of stress-CTP for detection of myocardial perfusion defects compared with CMR was sensitivity, 96%; specificity, 88%; positive predictive value (PPV), 93%; negative predictive value (NPV), 94% (per vessel); and sensitivity, 78%; specificity, 87%; PPV, 83%; NPV, 84% (per segment). The accuracy of stress-CTP for imaging of reversible ischemia compared with CMR was sensitivity, 95%; specificity, 96%; PPV, 95%; and NPV, 96% (per vessel). In 25 patients who underwent invasive angiography, the accuracy of CTA for detection of stenosis >70% was (per segment): sensitivity, 96%; specificity, 88%; PPV, 67%; and NPV, 98.9%. The accuracy improved from 84% to 95% after adding stress CTP to CTA. Radiation exposure of the entire stress/rest CT protocol was only 2.5 mSv.
  
  
  CONCLUSIONS
  Adenosine-induced stress 128-slice dual-source high-pitch myocardial CTP allows for simultaneously assessment of reversible myocardial ischemia and coronary stenosis, with good diagnostic accuracy as compared with CMR and invasive angiography, at a very low radiation exposure.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland. Gudrun.Feuchtner@i-med.ac.at
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Robert
authors.initials: R
authors.lastname: Goetti
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Monika
authors.initials: M
authors.lastname: Wieser
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Christophe
authors.initials: C
authors.lastname: Wyss
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Olivio
authors.initials: O
authors.lastname: Donati
authors.forename: Johannes
authors.initials: J
authors.lastname: Schnabl
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D003326:Coronary Circulation; D018450:Disease Progression; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine