Complementary use of CT angiography and stress tests to evaluate coronary heart disease

Abstract

Reliance on any single method of investigation as a gold standard to evaluate coronary disease is no longer appropriate or sufficient. Due consideration of the disease’s complex pathomechanisms and heterogeneous symptoms entails optimized risk stratification and further clinical treatment decisions based on comprehensive knowledge of heart morphology and function. We review the latest advances in combining different CT techniques with stress/rest myocardial perfusion imaging using single photon emission CT or positron emission tomography. Particular emphasis is placed on the advantages of three-dimensional image fusion techniques, which can accurately allocate perfusion defects to the supplying coronary artery. This noninvasive cross-modal imaging method is unsurpassed for identifying the location, extent, and hemodynamic relevance of coronary artery disease, which are the key elements required for rational decisions to perform either interventional therapy or proceed with medical treatment.