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J Am Coll Cardiol, 2009; 54:1072-1084, doi:10.1016/j.jacc.2009.06.014
© 2009 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

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

Ron Blankstein, MD*,{dagger},*, 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*,{ddagger}, 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
{dagger} Noninvasive Cardiovascular Imaging Program, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
{ddagger} 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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