Advances in Contrast-Enhanced Cardiovascular CT for the Evaluation of Myocardial Perfusion

Multidetector CT (MDCT) angiography is a robust method for the accurate diagnosis of coronary artery disease (CAD) in selected patient populations. Recent advances in CT technology have broadened the application of MDCT as a stand-alone imaging modality to identify both CAD and myocardial ischemia in a single examination. Although myocardial perfusion scintigraphy has an extensive evidence base for the diagnosis of myocardial ischemia, MDCT perfusion imaging has several potential advantages including better spatial resolution, which may allow more accurate detection of small areas of ischemia, as well as ability to detect actual rather than relative blood flow, potentially improving diagnostic accuracy for detecting hemodynamically significant multivessel CAD. The purpose of this review is to provide an overview of the evolution of technical and practical aspects related to MDCT perfusion imaging, and to highlight important studies that have assessed the diagnostic accuracy of MDCT stress perfusion imaging, concluding with the emerging role of 320-detector row MDCT.