Evaluation of myocardial scarring and perfusion

2019 ◽  
pp. 271-284
Keyword(s):  
Clinical Practice ◽  
Myocardial Perfusion ◽  
Myocardial Ischaemia ◽  
Coronary Stenosis ◽  
Ct Perfusion ◽  
Image Interpretation ◽  
Routine Clinical Practice ◽  
Functional Evaluation ◽  
Myocardial Scarring ◽  
Myocardial Ct Perfusion

Myocardial CT perfusion (CTP) imaging is increasingly being used in routine clinical practice as a technique for detecting myocardial ischaemia. CTP offers the advantage of combining anatomical and functional evaluation of coronary stenosis in the same examination and enhances the accuracy of CTA in both patients with suspected and known CAD. This chapter covers contrast pharmacokinetics, scan acquisition, image interpretation, delayed CCT, and evaluation of myocardial perfusion.

Abstract 18795: Resting Patient- and Vessel-Specific Myocardial Perfusion Attenuation Patterns Improves Diagnostic Performance of Coronary Computed Tomographic Angiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Guanglei Xiong ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
Deeksha Kola ◽  
Kimberly Elmore ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Diagnostic Accuracy ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Ct Perfusion ◽  
Quantitative Coronary Angiography ◽  
High Grade ◽  
Operating Characteristics ◽  
Luminal Diameter ◽  
Coronary Stenoses

Introduction: Coronary CT angiography (CCTA) demonstrates improved performance for diagnosis of high-grade coronary stenoses, but may be affected by artifacts and overestimation of stenosis severity. Whether the addition of resting myocardial perfusion attenuation patterns subtended by stenosis seen on CCTA improves diagnostic performance has not been examined to date. Methods: We evaluated 127 patients (mean age 53.0, 54.3% male) who underwent CCTA and ICA. Percentage of coronary stenosis was assessed by quantitative coronary angiography (QCA), which served as the reference comparator to CCTA. CCTA stenosis was categorized as 0%, 1-24%, 25-49%, 50-69%, 70-99%, and 100% luminal diameter reduction. Automated software (SmartHeart, Redwood City, CA) was used to measure resting CT perfusion attenuation patterns in myocardial segments by AHA 17-segment model. Segmental CT attenuation values were assigned to territories subtended by left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Per-patient and per-vessel analyses were based on highest severity (maximal stenosis, minimal attenuation). On both per-patient and per-vessel basis, logistic regression was devised for CCTA stenosis alone and for CCTA plus resting myocardial attenuation. Diagnostic accuracy and area under the receiver operating characteristics curve (AUC) were determined. Results: Diagnostic accuracy of CCTA alone was 84.0%, 85.5%, 90.4%, and 88.6%, at per-patient, per-LAD, per-LCX and per-RCA level, respectively. In comparison, the accuracy of CCTA plus myocardial attenuation were 89.6%, 91.9%, 95.2%, and 92.7%. The AUCs using CCTA alone to discriminate QCA-confirmed coronary stenoses >70% were 0.823 (95% CI: 0.737-0.909), 0.782 (95% CI: 0.667-0.898), 0.690 (95% CI: 0.503-0.878), and 0.793 (95% CI: 0.640-0.945) for per-patient, per-LAD, per-LCX, and per-RCA analysis, respectively. The AUCs using CCTA plus myocardial attenuation improved to 0.864 (95% CI: 0.765-0.962), 0.881 (95% CI: 0.793-0.968), 0.772 (95% CI: 0.535-1.000), and 0.820 (95% CI: 0.685-0.954). Conclusions: The addition of resting CT myocardial perfusion attenuation patterns improves identification and discrimination of high-grade coronary stenosis by CCTA.

scholarly journals Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

2020 ◽  
Vol 17 (7) ◽  
pp. 427-450 ◽  
Author(s):  
Marc Dewey ◽  
◽  
Maria Siebes ◽  
Marc Kachelrieß ◽  
Klaus F. Kofoed ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Myocardial Ischaemia ◽  
Cardiac Imaging ◽  
Perfusion Imaging ◽  
Coronary Flow ◽  
Complex Disease ◽  
Ct Perfusion ◽  
Imaging Modality ◽  
Invasive Treatment ◽  
Technological Potential

Abstract Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.

Diagnosis and Management of Cardiomyopathies – A Focus on Genetics, Cardiac Magnetic Resonance and Clinical Features

2011 ◽  
Vol 7 (3) ◽  
pp. 225
Author(s):  
Gianfranco Sinagra ◽  
Michele Moretti ◽  
Giancarlo Vitrella ◽  
Marco Merlo ◽  
Rossana Bussani ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Imaging Techniques ◽  
Molecular Genetic ◽  
Molecular Genetic Analysis ◽  
Routine Clinical Practice ◽  
Clinical Approach ◽  
Diagnosis And Management ◽  
Made In

In recent years, outstanding progress has been made in the diagnosis and treatment of cardiomyopathies. Genetics is emerging as a primary point in the diagnosis and management of these diseases. However, molecular genetic analyses are not yet included in routine clinical practice, mainly because of their elevated costs and execution time. A patient-based and patient-oriented clinical approach, coupled with new imaging techniques such as cardiac magnetic resonance, can be of great help in selecting patients for molecular genetic analysis and is crucial for a better characterisation of these diseases. This article will specifically address clinical, magnetic resonance and genetic aspects of the diagnosis and management of cardiomyopathies.

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