NDLI: Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease.

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Incremental value of myocardial perfusion over regional left ventricular function and coronary stenosis by cardiac CT for the detection of acute coronary syndromes in high-risk patients: a subgroup analysis of the ROMICAT trial.

Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease.

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Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents.

A comparison of reconstruction and viewing parameters on image quality and accuracy of stress myocardial CT perfusion.

Quantitative myocardial CT perfusion: a pictorial review and the current state of technology development.

Paying it forward.

Year: 2011 Volume: 5 Issue: 5

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Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Bettencourt, Nuno Rocha, João Ferreira, Nuno Pires-Morais, Gustavo Carvalho, Mónica Leite, Daniel Melica, Bruno Santos, Lino Rodrigues, Alberto Braga, Pedro Teixeira, Madalena Simões, Lino Leite-Moreira, Adelino Cardoso, Silva Nagel, Eike Gama, Vasco
Spatial Coverage	Portugal
Description	Country affiliation: Portugal Author Affiliation: Bettencourt N ( Department of Cardiology, Centro Hospitalar de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. bettencourt.n@gmail.com)
Abstract	BACKGROUND: Preliminary studies have shown the potential of myocardial computed tomography perfusion (CTP) analysis for ischemia detection in both animals and humans. OBJECTIVE: To provide validation data on stress-rest CTP protocols as additive tools to improve the accuracy of multidetector computed tomography (MDCT) for coronary artery disease (CAD) in symptomatic patients. METHODS: Ninety symptomatic patients with suspected CAD (62 ± 8 years, 66% males) underwent both MDCT and invasive coronary angiography (XA). The MDCT protocol included a prospective calcium score acquisition, a helical acquisition with retrospective gating during infusion of adenosine (140 µg/kg/min) and a prospective scan for computed tomography angiography (CTA) at rest (total effective radiation dose: 5.1 ± 0.8 mSv). Significant and higher-grade CADs were defined by the presence of ≥50% or ≥70% stenosis in at least one coronary artery, as evaluated by quantitative coronary angiography (QCA) using XA images. RESULTS: On a patient-based model, CTA sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) to detect ≥50% or ≥70% stenosis were 98%, 71%, 80%, and 97% (global accuracy 86%) and 100%, 60%, 64%, and 100% (accuracy 77%), respectively. An integrative approach of CTA and CTP results had the best performance for detection of CAD with sensitivity of 83%, specificity of 98%, PPV of 98%, and NPV of 84% (accuracy 84%) for detection of 50% stenosis and 97%, 90%, 88%, and 98% (accuracy 93%), respectively, for the 70% threshold. The integration of results had the best overall performance in all scenarios but was particularly advantageous in the prediction of higher-grade CAD, with an area under the curve of 0.93, compared with 0.80 for isolated CTA and 0.82 for CTP and in patients with severe calcifications (sensitivity 92%, specificity 87%, overall accuracy of 90%). CONCLUSIONS: The integration of functional and morphological data using CTA and CTP improved MDCT accuracy for detection of clinically relevant CAD at both thresholds of 50% and 70% in this intermediate to high pretest probability population.
File Format	HTM / HTML
ISSN	19345925
Issue Number	6
Volume Number	5
e-ISSN	1876861X
Journal	Journal of Cardiovascular Computed Tomography
Language	English
Publisher	Elsevier
Publisher Date	2011-11-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology Discipline Radiology Adenosine Coronary Circulation Coronary Stenosis Myocardial Perfusion Imaging Methods Tomography, Spiral Computed Vasodilator Agents Adult Aged Coronary Angiography Physiopathology Female Hemodynamics Humans Male Middle Aged Portugal Predictive Value Of Tests Prognosis Prospective Studies Reproducibility Of Results Sensitivity And Specificity Severity Of Illness Index Vascular Calcification Journal Article Validation Studies
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine

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Clinical feasibility of accelerated, high spatial resolution myocardial perfusion imaging.

Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography.

Normal perfusion of the left ventricular myocardium using 320 MDCT.

CT stress myocardial perfusion imaging using multidetector CT--A review.

A comparison of reconstruction and viewing parameters on image quality and accuracy of stress myocardial CT perfusion.

Comparison of the extent and severity of myocardial perfusion defects measured by CT coronary angiography and SPECT myocardial perfusion imaging.

Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents.

Assessment of coronary artery stenosis severity and location: quantitative analysis of transmural perfusion gradients by high-resolution MRI versus FFR.

Additional value of transluminal attenuation gradient in CT angiography to predict hemodynamic significance of coronary artery stenosis.

Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease.

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Clinical feasibility of accelerated, high spatial resolution myocardial perfusion imaging.

Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography.

Normal perfusion of the left ventricular myocardium using 320 MDCT.

CT stress myocardial perfusion imaging using multidetector CT--A review.

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Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents.

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Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease.