Evaluation of Myocardial Perfusion by Computed Tomography - Principles, Technical Background and Recommendations
Arq Bras Cardiol. 2019 Nov 4;113(4):758-767.
doi: 10.5935/abc.20190217.
eCollection 2019.
[Article in
English,
Portuguese]
Affiliations
- 1 Universidade Federal do Paraná - Complexo Hospital de Clínicas (CHC) -Universidade Federal do Paraná, Curitiba, PR - Brazil.
- 2 Hospital do Coração (HCor) - Division of cardiovascular CT/MR, São Paulo, SP - Brazil.
- 3 Diagnósticos da América SA, São Paulo, SP - Brazil.
- 4 Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil.
- 5 Instituto do Coração (InCor) - Universidade de São Paulo - Division of Cardiovascular CT/MR, São Paulo, SP - Brazil.
- 6 Casa de Saúde São José - Division of Radiology, Rio de Janeiro, RJ - Brazil.
- 7 Complexo Hospitalar de Niterói - Division of Radiology, Niterói, RJ - Brazil.
- 8 Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.
- 9 Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.
- 10 Hospital da Bahia, Salvador, BA - Brazil.
- 11 Hospital Moinhos de Vento - Division of Cardiovascular CT/MR, Porto Alegre, RS - Brazil.
Abstract
Coronary computed tomography angiography (CCTA) has gained a prominent role in the evaluation of coronary artery disease. However, its anatomical nature does not allow the evaluation of the functional repercussion of coronary obstructions. It has been made possible to evaluate Myocardial computed tomography perfusion (Myocardial CTP) recently, based on myocardial contrast changes related to coronary stenoses. Several studies have validated this technique against the anatomical reference method (cardiac catheterization) and other functional methods, including myocardial perfusion scintigraphy and fractional flow reserve. The Myocardial CTP is performed in conjunction with the CCTA, a combined analysis of anatomy and function. The stress phase (with assessment of myocardial perfusion) can be performed before or after the resting phase (assessment of resting perfusion and coronary arteries), and different acquisition parameters are proposed according to the protocol and type of equipment used. Stressors used are based on coronary vasodilation (e.g. dipyridamole, adenosine). Image interpretation, similar to other perfusion assessment methods, is based on the identification and quantification of myocardial perfusion defects. The integration of both perfusion and anatomical findings is fundamental for the examination interpretation algorithm, allowing to define if the stenoses identified are hemodynamically significant and may be related to myocardial ischemia.
MeSH terms
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Computed Tomography Angiography / methods*
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Computed Tomography Angiography / standards
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Contrast Media
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Coronary Angiography / methods*
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Coronary Angiography / standards
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Coronary Artery Disease / diagnostic imaging
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Humans
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Myocardial Ischemia / diagnostic imaging
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Myocardial Perfusion Imaging / methods*
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Myocardial Perfusion Imaging / standards