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Dual-Energy CT Perfusion During Pharmacologic Stress for the Assessment of Myocardial Perfusion Defects Using a Second-Generation Dual-Source CT: A Comparison With Cardiac Magnetic Resonance Imaging

Kim, Sung Mok MD*†; Chang, Sung-A MD†‡; Shin, Wonseon MD; Choe, Yeon Hyeon MD, PhD*†

Journal of Computer Assisted Tomography: January/February 2014 - Volume 38 - Issue 1 - p 44–52
doi: 10.1097/RCT.0b013e3182a77626
Cardiovascular Imaging

Objectives: This study aimed to assess the diagnostic performance of adenosine-stress dual-energy myocardial computed tomography perfusion (DECTP) imaging using 128-slice dual-source computed tomography (CT) for the detection of myocardial perfusion defects in comparison with stress-perfusion magnetic resonance imaging (MRI).

Methods: This prospective study included 50 patients (mean age, 66 [9] years; 64% men) with suspected coronary artery disease who underwent adenosine-stress DECTP using 128-slice dual-source CT as well as adenosine-stress cardiac MRI using a 1.5-T scanner. Estimates of diagnostic accuracy in detecting myocardial perfusion defects were calculatedand compared with those of cardiac MRI.

Results: The estimates of diagnostic accuracy in detecting myocardial perfusion defects using DECTP were as follows: sensitivity, 77% (95% confidence interval [CI], 67%–87%); specificity, 94% (95% CI, 92%–95%); positive predictive value, 53% (95% CI, 44%–63%); and negative predictive value, 98% (95% CI, 97%–99%). The results of DECTP imaging were positively correlated with those of cardiac MRI (r = 0.602, P < 0.001). Mean effective radiation doses for stress DECTP imaging and rest coronary CTA were 6.5 (2.2) and 4.9 (1.7) mSv, respectively.

Conclusions: Adenosine-stress DECTP imaging enables detection of myocardial ischemia. However, further technical developments are necessary to reduce artifacts and improve the sensitivity of DECTP.

From the *Department of Radiology, †Cardiovascular Imaging Center, and ‡Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and §Department of Radiology, College of Medicine, Kangwon National University, Chuncheon-Si, Gangwon-Do, Korea.

Received for publication May 1, 2013; accepted July 29, 2013.

Reprints: Yeon Hyeon Choe, MD, Department of Radiology and Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea (e-mail: yhchoe@skku.edu).

This work was supported by IN-SUNG Foundation for Medical Research (CA-98491).

The authors declare no conflict of interest.

© 2014 by Lippincott Williams & Wilkins