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Dynamic CT-based stress myocardial perfusion imaging is plausible for  hemodynamically significant coronary artery stenosis.

 

The medical research was contributed by Fabian Bamberg, MD, MPH; Alexander Becker, MD; Florian Schwarz, MD; Roy P. Marcus, BS; Martin Greif, MD; Franz von Ziegler, MD; Ron Blankstein, MD, MPH; Udo Hoffmann, MD, MPH; Wieland H. Sommer, MD; Verena S. Hoffmann, PhD; Thorsten R. C. Johnson, MD; Hans-Christoph R. Becker, MD; Bernd J. Wintersperger, MD; Maximilian F. Reiser, MD and Konstantin Nikolaou, MD from the Departments of Clinical Radiology and Cardiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; and Institute of Biomedical Epidemiology, Ludwig-Maximilians University, Munich, Germany.

The research objective was to determine possibility of CT-based dynamic myocardial perfusion imaging for hemodynamically important coronary artery stenosis, as determined with fractional flow reserve. (Courtesy: RSNA)

Subjects with known coronary artery disease passed through electrocardiographically stirred dynamic stress myocardial perfusion imaging (MPI).

Fractional flow reserve was measured with a luminal narrowing of 50%–85% (within main coronary arteries).

Calculated myocardial blood flow was gathered from CT images through parametric deconvolution for segments; was associated to hemodynamically substantial coronary artery stenosis with fractional flow reserve (0.75 or less) in a blinded manner.

Traditional estimates of diagnostic precision were obtained, and logistic regression analysis was put in use for discriminatory power analysis.

About 33 subjects finished the study procedure; diagnostic precision of CT for anatomically vital stenosis (coronary artery) was high; low for hemodynamically considerable stenosis.

Through with gauged myocardial blood blow, 43% coronary lesions were marked as not hemodynamically important, which considerably increased positive predictive value to 78%; the existence of a coronary artery stenosis with comparable myocardial blood flow less than 75 mL/100 mL/min had a high risk for hemodynamic significance.

Conclusion: dynamic CT-based stress myocardial perfusion imaging is feasible for hemodynamically significant coronary artery stenosis.