title: Myocardial ischemia detection with single-phase CT perfusion in symptomatic patients using high-pitch helical image acquisition technique.
abstract: Coronary CT angiography (CCTA) suffers from a reduced diagnostic accuracy in patients with heavily calcified coronary arteries or prior myocardial revascularisation due to artefacts caused by calcifications and stent material. CT myocardial perfusion imaging (CTMPI) yields high potential for the detection of myocardial ischemia and might help to overcome the above mentioned limitations. We analysed CT single-phase perfusion using high-pitch helical image acquisition technique in patients with prior myocardial revascularisation. Thirty-six patients with an indication for invasive coronary angiography (28 with coronary stents, 2 with coronary artery bypass grafts and 6 with both) were included in this prospective study at two study sites. All patients were examined on a 2nd generation dual-source CT system. Stress CT images were obtained using a prospectively ECG-triggered single-phase high-pitch helical image acquisition technique. During stress the tracer for myocardial perfusion (MP) SPECT imaging was administered. Rest CT images were acquired using prospectively ECG-triggered sequential CT. MP-SPECT imaging and invasive coronary angiography served as standard of reference. In this heavily diseased patient cohort CCTA alone showed a low overall diagnostic accuracy for detection of hemodynamically relevant coronary artery stenosis of only 31% on a per-patient base and 60% on a per-vessel base. Combining CCTA and CTMPI allowed for a significantly higher overall diagnostic accuracy of 78% on a per-patient base and 92% on a per-vessel base (p < 0.001). Mean radiation dose for stress CT scans was 0.9 mSv, mean radiation dose for rest CT scans was 5.0 mSv. In symptomatic patients with known coronary artery disease and prior myocardial revascularization combining CCTA and CTMPI showed significantly higher diagnostic accuracy in detection of hemodynamically significant coronary artery stenosis when compared to CCTA alone.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany. bernhard.bischoff@med.uni-muenchen.de.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany. bernhard.bischoff@med.uni-muenchen.de.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Bischoff
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Deseive
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Rampp
authors.affiliation: Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Andrei
authors.initials: A
authors.lastname: Todica
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der TU München, Munich, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Wermke
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der TU München, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.affiliation: DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.|Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Massberg
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Becker
authors.affiliation: Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D015607:Stents; D015899:Tomography, Emission-Computed, Single-Photon; D036542:Tomography, Spiral Computed
keywords: CT-perfusion; Dual-source CT; High-pitch mode; Myocardial ischemia