Myocardial ischemia evaluation with dual-source computed tomography: comparison with magnetic resonance imaging.
OBJECTIVE
Computed tomography does not accurately determine which coronary lesions lead to myocardial ischemia and consequently further tests are required to evaluate ischemia induction. The aim of this study was to compare diagnostic accuracy between dual-energy computed tomography and magnetic resonance imaging in the assessment of myocardial perfusion and viability in patients suspected of coronary artery disease.


METHODS
A prospective study was performed in 56 consecutive patients (39 men [69.6%]; mean age [standard deviation], 63 [10]; range, 23-81). Computed tomography was performed with the following protocol: 1, adenosine stress perfusion; 2, coronary angiography; and 3, delayed enhancement. Magnetic resonance imaging for the evaluation of stress perfusion and delayed enhancement was performed within 30 days. Two observers in consensus analyzed the perfusion and delayed enhancement images.


RESULTS
We studied 952 myocardial segments and 168 vascular territories. In a per-segment analysis, the sensitivity, specificity, and positive and negative predictive values of computed tomography compared with magnetic resonance were 76%, 99%, 89%, and 98% for perfusion defects, and 64%, 99%, 82%, and 99% for delayed enhancement, respectively. In a per-vascular territory analysis, the same measures were 78%, 97%, 86%, and 95% for perfusion defects, and 72%, 99%, 93%, and 97% for delayed enhancement, respectively. The mean radiation dose was 8.2 (2) mSv.


CONCLUSIONS
Dual-source computed tomography may allow accurate and concomitant evaluation of perfusion defects and myocardial viability and analysis of coronary anatomy.
Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain. Electronic address: cdelgado@povisa.es.
Carlos
C
Delgado
Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain.
María
M
Vázquez
Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain.
Roque
R
Oca
Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain.
Manuel
M
Vilar
Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain.
Carmen
C
Trinidad
Servicio de Cardiología, Hospital POVISA, Vigo, Pontevedra, Spain.
Marcelo
M
Sanmartin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
CT; Cardiopatía isquémica; DECT; DSCT; Imagen de perfusión miocárdica; Ischemic heart disease; MPI; MR; Multidetector computed tomography; Myocardial perfusion imaging; Tomografía computarizada con multidetector; computed tomography; dual-energy computed tomography; dual-source computed tomography; magnetic resonance; myocardial perfusion imaging