Stress and Rest Dynamic Myocardial Perfusion Imaging by Evaluation of Complete Time-Attenuation Curves With Dual-Source CT

OBJECTIVES This study sought to describe a protocol for myocardial perfusion imaging using dipyridamole stress, with 128-slice dual-source computed tomography (CT), and to assess the ability of CT myocardial perfusion imaging (MPI) to detect abnormal flow reserve and infarction in comparison with nuclear MPI (NMPI). BACKGROUND CT MPI has not been previously described with the 128-slice dual-source CT scanner, or with the complete evaluation of dynamic time-attenuation curves of the myocardium. METHODS Thirty-five patients underwent a stress CT MPI protocol. Complete time-attenuation curves of the myocardium were acquired using a novel scan mode, which acquires prospectively electrocardiogram (ECG)-triggered axial images at 2 rapidly alternating positions. Myocardial blood flow (MBF) values of fixed and reversible defects obtained were compared between rest and stress. Findings on CT MPI were correlated to NMPI. Perfusion defects detected on CT were correlated to coronary stenoses detected on CT angiography (CTA) and invasive coronary angiography (ICA). RESULTS There was a 1.5-fold difference between stress (1.21 +/- 0.31 cc/cc/min) and rest (0.82 +/- 0.22 cc/cc/min) MBF in normal tissue. In reversible defects, MBF was 0.65 +/- 0.21 cc/cc/min and 0.63 +/- 0.18 cc/cc/min at stress and rest, respectively. In fixed defects, the MBF was 0.57 +/- 0.22 cc/cc/min at stress and 0.54 +/- 0.23 cc/cc/min at rest. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT MPI for identifying segments with perfusion defects was 0.83, 0.78, 0.79, and 0.82, respectively. ICA results were available for 30 patients. Sensitivity, specificity, PPV, and NPV of CT MPI compared with ICA were 0.95, 0.65, 0.78, and 0.79, respectively. The radiation dose for CT MPI was 9.15 +/- 1.32 mSv for the stress scan and 9.09 +/- 1.40 mSv for the rest scan. CONCLUSIONS Vasodilator-stress CT MPI may be feasible in human subjects at a radiation dose similar to NMPI. It identifies areas of abnormal flow reserve and infarction with a high degree of correlation to NMPI as well as to stenoses detected in CTA and ICA. (J Am Coll Cardiol Img 2010; 3: 811-20) (C) 2010 by the American College of Cardiology Foundation