Skip to main content
SpringerLink
Log in

Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the feasibility and diagnostic accuracy of adenosine-stress dual-energy computed tomography (DECT) for detecting haemodynamically significant stenosis causing reversible myocardial perfusion defect (PD) compared with stress perfusion magnetic resonance imaging (SP-MRI) and conventional coronary angiography (CCA).

Methods

Fifty patients with known coronary artery disease (CAD) detected by dual-source CT (DSCT) were investigated by contrast-enhanced, stress DECT with high- and low-energy x-ray spectra settings during adenosine infusion. A colour-coded iodine map was used for evaluation of myocardial PDs compared with rest DSCT perfusion images. Reversible myocardial PDs according to the stress DECT/rest DSCT were compared with SP-MRI on a segmental basis and CCA on a vascular territorial basis.

Results

A total of 697 myocardial segments and 123 vascular territories of 41 patients were analysed. Three hundred one segments and 72 vascular territories in 38 patients showed reversible PDs on stress DECT. Stress DECT had 89% sensitivity, 78% specificity and 82% accuracy for detecting segments with reversible PDs seen on SP-MRI (n = 28). Compared with CCA (n = 41), stress DECT had 89% sensitivity, 76% specificity and 83% accuracy for the detection of vascular territories with reversible myocardial PDs that had haemodynamically relevant CAD.

Conclusion

Adenosine stress DECT can identify stress-induced myocardial PD in patients with CAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nesto RW, Kowalchuk GJ (1987) The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 59:23C–30C

    Article  CAS  PubMed  Google Scholar 

  2. Leong-Poi H, Rim SJ, Le DE, Fisher NG, Wei K, Kaul S (2002) Perfusion versus function: the ischemic cascade in demand ischemia: implication of single-vessel versus multivessel stenosis. Circulation 105:987–992

    Article  PubMed  Google Scholar 

  3. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J et al (1996) Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 93:905–914

    CAS  PubMed  Google Scholar 

  4. Schwitter J, Nanz D, Kneifel S, Berschinger K, Buchi M, Knusel PR et al (2001) Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography. Circulation 103:2230–2235

    CAS  PubMed  Google Scholar 

  5. Kurata A, Mochizuki T, Koyama Y, Haraikawa T, Suzuki J, Shigematsu Y et al (2005) Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy. Circ J 69:550–557

    Article  PubMed  Google Scholar 

  6. George RT, Silva C, Cordeiro MA, DiPaula A, Thompson DR, McCarthy WF et al (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48:153–160

    Article  PubMed  Google Scholar 

  7. George RT, Jerosch-Herold M, Silva C, Kitagawa K, Bluemke DA, Lima JA et al (2007) Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol 42:815–822

    Article  PubMed  Google Scholar 

  8. Kido T, Kurata A, Higashino H, Inoue Y, Kanza RE, Okayama H et al (2008) Quantification of regional myocardial blood flow using first-pass multidetector-row computed tomography and adenosine triphosphate in coronary artery disease. Circ J 72:1086–1091

    Article  PubMed  Google Scholar 

  9. Petersilka M, Bruder H, Krauss B, Stierstorfer K, Flohr TG (2008) Technical principles of dual source CT. Eur J Radiol 68:362–368

    Article  PubMed  Google Scholar 

  10. Blankstein R, Shturman LD, Rogers IS, Rocha-Filho JR, Okada DR, Sarwar A et al (2009) Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 54:1072–1084

    Article  PubMed  Google Scholar 

  11. Johnson TR, Krauss B, Sedlmair M, Grasruck M, Bruder H, Morhard D et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517

    Article  PubMed  Google Scholar 

  12. Ruzsics B, Lee H, Zwerner PL, Gebregziabher M, Costello P, Schoepf UJ (2008) Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience. Eur Radiol 18:2414–2424

    Article  PubMed  Google Scholar 

  13. Schwarz F, Ruzsics B, Schoepf UJ, Bastarrika G, Chiaramida SA, Abro JA et al (2008) Dual-energy CT of the heart-principles and protocols. Eur J Radiol 68:423–433

    Article  PubMed  Google Scholar 

  14. Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA et al (2009) Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am J Cardiol 104:318–326

    Article  PubMed  Google Scholar 

  15. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the AD Hoc Committee for Grading of Coronary Artery disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51(4 Suppl):5–40

    CAS  PubMed  Google Scholar 

  16. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  17. Pilz G, Klos M, Ali E, Hoefling B, Scheck R, Bernhardt P (2008) Angiographic correlations of patients with small vessel disease diagnosed by adenosine-stress cardiac magnetic resonance imaging. J Cardiovasc Magn Reson 10:8

    Article  PubMed  Google Scholar 

  18. Morin RL, Gerber TC, McCollough CH (2003) Radiation dose in computed tomography of the heart. Circulation 107:917–922

    Article  PubMed  Google Scholar 

  19. Gould KL, Lipscomb K (1974) Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 34:48–55

    Article  CAS  PubMed  Google Scholar 

  20. Sato A, Hiroe M, Tamura M, Ohigashi H, Nozato T, Hikita H et al (2008) Quantitative measures of coronary stenosis severity by 64-slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med 49:564–572

    Article  PubMed  Google Scholar 

  21. Gaemperli O, Schepis T, Valenta I, Koepfli P, Husmann L, Scheffel H et al (2008) Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 248:414–423

    Article  PubMed  Google Scholar 

  22. Santana CA, Garcia EV, Faber TL, Sirineni GK, Esteves FP, Sanyal R et al (2009) Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. J Nucl Cardiol 16:201–211

    Article  PubMed  Google Scholar 

  23. George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA et al (2009) Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging 2:174–182

    Article  PubMed  Google Scholar 

  24. Rocha-Filho JA, Blankstein R, Shturman LD, Bezerra HG, Okada DR, Rogers IS et al (2010) Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiology 254:410–419

    Article  PubMed  Google Scholar 

  25. Blankstein R, Okada DR, Rocha-Filho JA, Rybicki FJ, Brady TJ, Cury RC (2009) Cardiac myocardial perfusion imaging using dual source computed tomography. Int J Cardiovasc Imaging 25:209–216

    Article  Google Scholar 

  26. Rodriguez-Granillo GA, Rosales MA, Degrossi E, Rodriguez AE (2010) Signal density of left ventricular myocardial segments and impact of beam hardening artifact: implications for myocardial perfusion assessment by multidetector CT coronary angiography. Int J Cardiovasc Imaging 26:345–354

    Article  PubMed  Google Scholar 

  27. Verani MS (1991) Pharmacological stress with adenosine for myocardial perfusion imaging. Semin Nucl Med 21:266–272

    Article  CAS  PubMed  Google Scholar 

  28. Okada DR, Ghoshhajra BB, Blankstein R, Rocha-Filho JR, Shturman LD, Rogers IS et al (2010) Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT. J Nucl Cardiol 17:27–37

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Konkuk University in 2010. The authors would like to thank the CT and MR technologists, the radiology department nursing staff, the cardiology department staff physicians and the residents in the Division of Thoracic Surgery at the Konkuk University Hospital.

Author information

Authors and Affiliations

  1. Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Sung Min Ko & Jin Woo Choi

  2. Department of Thoracic surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea

    Meong Gun Song, Je Kyoun Shin & Hyun Kun Chee

  3. Department of Nuclear medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea

    Hyun Woo Chung

  4. Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, College of Medicine, Seoul, Korea

    Dong Hun Kim

Authors
  1. Sung Min Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Woo Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meong Gun Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Je Kyoun Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyun Kun Chee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun Woo Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong Hun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Min Ko.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ko, S.M., Choi, J.W., Song, M.G. et al. Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol 21, 26–35 (2011). https://doi.org/10.1007/s00330-010-1897-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-010-1897-1

Keywords

Search

Navigation