CT-Based Myocardial Perfusion Imaging-Practical Considerations: Acquisition, Image Analysis, Interpretation, and Challenges |
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| Authors: | Vishal C Mehra Marietta Ambrose Carolina Valdiviezo-Schlomp Karl H Schuleri Albert C Lardo Joao A C Lima Richard T George |
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| Institution: | (1) Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N. Wolfe Street, Carnegie Building 565C, Baltimore, MD 21287, USA;(2) Russell Morgan Department of Radiology, Division of Nuclear Medicine, Johns Hopkins University, Baltimore, USA;(3) Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; |
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| Abstract: | Methods for non-invasive, cardiac risk assessment have historically relied on exercise stress testing with or without echocardiography
or radionuclide imaging and pharmacological stress testing when appropriate. More recently, CT-based modalities like CT angiography
(CTA) have been shown to reliably differentiate low from high-risk coronary disease. The advent of newer CT technology now
allows for CT-based myocardial perfusion imaging (CTP) that provides functional information, that when analyzed with anatomic
data from CTA, can provide a comprehensive risk assessment strategy. In this review, we discuss the research and implementation;
as well as the quantitative, semiquantitative, and qualitative methods of image analysis of CT-based perfusion. We also discuss
the present state of technology and challenges associated with the methodology. In each section, when appropriate, we provide
some information regarding the translation of these methods being utilized in the international, multicenter CORE320 study
that is evaluating the combined CT-based imaging (CTA and CTP) strategy of risk assessment in comparison to the combined reference
standard of radionuclide myocardial perfusion imaging and invasive angiography. |
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