Dynamic, Time-Resolved CT Imaging of Myocardial Perfusion: Dual-Source CT

Abstract

A comprehensive approach to coronary artery disease (CAD) requires the assessment of the anatomy and morphology of the coronary vessels as well as collection of information regarding myocardial perfusion and vascularization. To date, despite its excellent diagnostic accuracy for detection of CAD, cardiac CT remains a purely morphological test that does not enable one to obtain reliable data on the hemodynamic significance of any given coronary artery stenosis. In regular clinical practice, hemodynamic significance is derived via nuclear medicine or cardiac magnetic resonance (CMR)-based myocardial perfusion imaging techniques or by means of the invasive estimation of the fractional flow reserve (FFR) during conventional coronary angiography. Due to technical advances, however, we may be at the beginning of a new era in cardiac CT imaging. As shown by some preliminary animal and clinical studies, second-generation DSCT-based dynamic myocardial perfusion imaging may be useful to establish the physiological significance of CAD. In this chapter, the rationale behind dynamic, time-resolved myocardial DSCT perfusion imaging is introduced, first-pass myocardial DSCT perfusion imaging protocols are proposed, and initial preclinical and clinical evidence on myocardial DSCT perfusion imaging is described. Finally, most relevant limitations of this new imaging technology are discussed.