title: Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve.
abstract: BACKGROUND
  Coronary CT angiography (CCTA) allows accurate evaluation of coronary artery stenosis but has limitations in information on hemodynamic significance of stenotic lesions.
  
  
  OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine.
authors.forename: Ki Seok
authors.initials: KS
authors.lastname: Choo
authors.affiliation: Department of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine.
authors.forename: Lee
authors.initials: L
authors.lastname: Hwangbo
authors.affiliation: Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine.
authors.forename: June Hong
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine nadroj@chol.com.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine.
authors.forename: Jun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine.
authors.forename: Kook Jin
authors.initials: KJ
authors.lastname: Chun
authors.affiliation: Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Kim Hae Jungang Hospital, Korea.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Lim
mesh_terms: D000241:Adenosine; D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D007472:Iohexol; C038192:iopromide; D000241:Adenosine
keywords: Coronary artery disease; computed tomography; coronary angiography; fractional flow reserve; myocardial perfusion