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CLINICAL RESEARCH: CARDIAC IMAGING

Adenosine-Induced Stress Myocardial Perfusion Imaging Using Dual-Source Cardiac Computed Tomography

Ron Blankstein, MD^_*,,_*, Leon D. Shturman, MD^_*, Ian S. Rogers, MD, MBA^_*, Jose A. Rocha-Filho, MD^_*, David R. Okada, MD^_*, Ammar Sarwar, MD^_*, Anand V. Soni, MD^_*, Hiram Bezerra, MD^_*,, Brian B. Ghoshhajra, MD, MBA^_*, Milena Petranovic, MD^_*, Ricardo Loureiro, MD^_*, Gudrun Feuchtner, MD^_*,, Henry Gewirtz, MD^_*, Udo Hoffmann, MD, MPH^_*, Wilfred S. Mamuya, MD, PhD^_*,||, Thomas J. Brady, MD^_* and Ricardo C. Cury, MD^_*,¶

^_* Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Noninvasive Cardiovascular Imaging Program, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Harrington McLaughlin Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio
Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
^|| Lown Cardiovascular Group, Brookline, Massachusetts
^¶ Cardiovascular MR and CT Program, Baptist Cardiac and Vascular Institute, Miami, Florida

Manuscript received February 2, 2009; revised manuscript received May 18, 2009, accepted June 2, 2009.

^_* Reprint requests and correspondence: Dr. Ron Blankstein, Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114 (Email: rblankstein{at}partners.org).

Objectives: This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA).

Background: Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans.

Methods: Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers.

Results: The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 ± 10.7 years; 82% male; body mass index 30.4 ± 5 kg/m²) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis 50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with 50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis 70%.

Conclusions: Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.

Key Words: infarction • ischemia • imaging • coronary disease • computed tomography

Abbreviations and Acronyms   CAD = coronary artery disease   CT = computed tomography   CTA = computed tomography angiography   CTP = computed tomography perfusion   DE = delayed enhancement   DSCT = dual-source computed tomography   MPHR = maximal predicted heart rate   MPI = myocardial perfusion imaging   MRI = magnetic resonance imaging   SPECT = single-photon emission computed tomography

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