Stress CT perfusion imaging compares well to MRI to detect ischemia

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CHICAGO—Adenosine stress multidetector CT (MDCT) myocardial perfusion imaging can be successfully performed in patients with coronary artery disease (CAD), proving to have good agreement with stress myocardial perfusion MRI, according to research presented at the 94th annual meeting of the Radiological Society of North America (RSNA).

According to the authors, stress myocardial perfusion imaging using contrast-enhanced MDCT might be of great value in detecting myocardial ischemia in patients with CAD.

Shingo Kato, MD, and colleagues from the National Institute of Radiological Sciences in Chiba, Japan, performed retrospectively gated cardiac CT in 13 patients during continuous injection of adenosine.

Images were reconstructed with beam-hardening correction and total radiation dose during CT study was less than 20 mSv.

The researchers performed adenosine stress myocardial perfusion MRI within two weeks of the CT study in nine patients. Both CT and MR images were qualitatively assessed by two observers using a 16-segment model, according to Kato.
      
The averaged heart rate in the 13 patients was 62 BPM at rest and 70 BPM during adenosine stress. Perfusion abnormality during stress was observed in 57 (40 percent) of 144 segments by MDCT and in 55 (38 percent) of 144 segments by MRI, the authors wrote.

On a vessel-based analysis, stress CT and stress MRI findings were concordant in 23 (85 percent) of 27 territories. The sensitivity, specificity and accuracy of adenosine stress myocardial perfusion CT imaging for the detection of abnormal perfusion was 88 percent, 80 percent and 85 percent, respectively, compared with stress first-pass contrast-enhanced MRI.
      
Kato said that the clinical relevance of the study results suggest that the “ability of MDCT to perform both stress perfusion imaging and coronary angiography will significantly enhance the value of cardiac MDCT in the diagnosis and treatment of patients with CAD.”