Abstract 16091: Adenosine Stress High-Pitch 128-Slice Dual Source Flash Computed Tomography for Imaging of Reversible Myocardial Ischemia and Coronary Arteries
Purpose: Primary aim was to explore 128-slice dual source computed tomography (CT) using high-pitch (Flash) for complementary imaging of stress myocardial CT perfusion and coronary CT angiography (CTA). Secondary aim was to validate stress-CT against stress-cardiac magnetic resonance imaging (CMR)
Methods: 73 patients with known coronary artery disease confirmed by invasive angiography were recruited in this prospective IRB approved study. 30 patients met inclusion criteria and undewent 128-slice dual source CT (128x0.6mm, 0.28s gantry rot; Definition Flash™Siemens) and adenosine stress 1.5 T CMR. CT protocol consisted of 2 steps:Adenosine stress-CT using high-(3.4)-pitch ECG-synchronized mode and rest-CT using either high pitch (if HR<65bpm) or prospective ECG-triggering (>65bpm) was performed. Image quality of coronary arteries was scored using 16-segment AHAclassification.Myocardial perfusion defects were evaluated using AHA-classification by CT and CMR
Results: Stress-CT and -MR exams were completed in 30pts (64±10y, 6% females). In 93.3% of CT exams, image quality of all coronary segments was diagnostic. There were overall 26 (5.4%) non-diagnostic coronary segments on stress-CT and 3 (0.6%) on rest-CT. Radiation exposure for the entire CT protocol was 3.2mSv±2.1 (range,1.6–11.8), CTDIvol 10.94mGy±9. Out of 480 myocardial segments, there were n=103 with complete reversible, 41 with partial reversible ischemia and 52 fixed defects/scars by CT. The performance of stress-CT for detection of any defects during adenosine was on a per segment basis: sens. 78% (163/209), spec. 87% (238/271); and on a per vessel basis: sens. 96% (53/55) and spec. 88% (31/35), NPV 94% (31/33); when using CMR stress perfusion/DE as reference standard. Confidence scores of adenosine stress- CT were with mean 1.3 ±0.3 significantly better than by CMR 2.1 ±0.9 (p<0.001).On a per vessel basis, the performance of CT for imaging of reversible ischemia was: sens 95% (45/47), spec 96% (41/43), NPV 96% (41/43), as compared to perfusion CMR.
Conclusion: High-pitch 128-dual source CT allows for complementary assessment of reversible myocardial ischemia and coronary arteries at low radiation exposure, and is accurate as compared to CMR.
- © 2010 by American Heart Association, Inc.