Sung Min Ko, Presenter: Nothing to Disclose

Youngjun Kim MD, Abstract Co-Author: Nothing to Disclose

Na-Ra Kim, Abstract Co-Author: Nothing to Disclose

Hee-Sun Park, Abstract Co-Author: Nothing to Disclose

Jee Young Son, Abstract Co-Author: Nothing to Disclose

Hyunwoo Chung, Abstract Co-Author: Nothing to Disclose

To evaluate the feasibility of dual-energy CT(DECT) for diagnosing myocardial ischemia with adenosine stress compared with SPECT-myocardial perfusion imaging (MPI), cardiac MRI (cMRI), conventional coronary angiography (CCA) and CT angiography (CTA)

A total of 45 patients (27men, 18 women; mean age 64 years) with suspected or known coronary artery disease underwent retrospectively ECG-gated dual-source CT for diagnosing coronary artery stenosis and adenosine stress DECT for diagnosing myocardial ischemia. DECT was performed by independently operating the two tubes of a dual-source CT system at high (140kV) and low (80kV) energy x-ray spectra settings. DECT image analysis was performed by mapping the myocardial iodine content distribution based on high and low energy X-ray spectra and superimposing color coded iodine maps onto multiplanar reconstructions of the myocardium in long- and short-axis views. Myocardial blood pool deficit (reversible/fixed myocardial ischemia) was evaluated by two radiologists in consensus using AHA 17 segment model and 3 major coronary artery territories. Results were compared with SPECT-MPI (n=27), cMRI (n=27), CTA (n=45), and CCA (n=41).

A total of 765 myocardial segments and 135 coronary artery territories of 45 patients were evaluated. The mean heart rate of the patients was 69.8±10.6 b.p.m. The mean patient radiation dose was 11.4±3.3 mSv on dual-source CTA and 5.8±0.6 mSv on adenosine stress DECT. Totally 359 segments and 82 territories in 40 patients showed blood-pool deficits on DECT. The sensitivity, specificity, accuracy, positive and negative predictive value of DECT for detecting ischemic myocardial territories (segments) were 100% (87%), 66% (66%), 77% (69%), 58% (29%), and 100% (98%) compared with SPECT-MPI, 98%(89%), 73% (78%), 87% (82%), 83% (74%), and 96% (91%) compared with cMRI, 91%, 69%, 81%, 79%, and 86% compared with CTA territories, and 93%, 72%, 82%, 77%, and 91% compared with CCA territories, respectively.

Adenosine stress DECT is a promising modality for evaluation of myocardial perfusion compared with other clinical reference standards. Further researches are required to explore this imaging technique.

Adenosine stress dual-energy cardiac CT can be used in routine clinical practice for diagnosing myocardial ischemia.

Ko, S, Kim, Y, Kim, N, Park, H, Son, J, Chung, H, Myocardial Perfusion Imaging Using Adenosine Stress Dual-Energy CT of the Heart: Correlation with SPECT-MPI, Cardiac MRI, CT Angiography, and Invasive Coronary Angiography.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015383.html