Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience

• Published in: European radiology 2010-05, Vol.20 (5), p.1168-1173
• Main Authors: Bamberg, Fabian, Klotz, Ernst, Flohr, Thomas, Becker, Alexander, Becker, Christoph R., Schmidt, Bernhard, Wintersperger, Bernd J., Reiser, Maximilian F., Nikolaou, Konstantin
• Format: Article
• Language: English
• Subjects: Aged; Cardiac; Cardiac-Gated Imaging Techniques - methods; Contrast Media; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Circulation - physiology; Diagnostic Radiology; Electrocardiography; Female; Humans; Imaging; Imaging, Three-Dimensional; Internal Medicine; Interventional Radiology; Iohexol - analogs & derivatives; Medicine; Medicine & Public Health; Neuroradiology; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted - methods; Radiology; Stents; Systole; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-010-1715-9

Objective To detail the principles of using model-based determination of regional myocardial blood flow (MBF) by computed tomography (CT) and demonstrate its in vivo applicability. Methods Dual-source CT was performed with a dynamic protocol comprising acquisition with alternating table positions in ECG-triggered end-systolic timing every second for 30 s. The results of two reconstructions were merged into one final image stack (coverage 73 mm), with low spatial frequency components from a 360° reconstruction and high spatial frequency components from a dual-source cardiac partial image reconstruction. A parametric deconvolution technique was used to fit the time–attenuation curves (TAC), the maximum slope of which was used to derive MBF. Results One study participant underwent dynamic myocardial stress perfusion imaging (9.6 mSv) followed by invasive coronary angiography and measurement of fractional flow reserve as the gold standard. MBF was 159 ml/100 ml/min in the non-ischaemic anterolateral and 86 ml/100 ml/min in the inferoseptal ischaemic wall. Conclusion This first evaluation indicates that mathematical modelling of voxel TACs can potentially be used to quantify differences in MBF in a clinical setting. If confirmed in feasibility studies, cardiac CT may allow for parallel assessment of morphology and haemodynamic relevance of coronary artery disease.