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CT-Based Myocardial Perfusion Imaging-Practical Considerations: Acquisition, Image Analysis, Interpretation, and Challenges

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Abstract

Methods for non-invasive, cardiac risk assessment have historically relied on exercise stress testing with or without echocardiography or radionuclide imaging and pharmacological stress testing when appropriate. More recently, CT-based modalities like CT angiography (CTA) have been shown to reliably differentiate low from high-risk coronary disease. The advent of newer CT technology now allows for CT-based myocardial perfusion imaging (CTP) that provides functional information, that when analyzed with anatomic data from CTA, can provide a comprehensive risk assessment strategy. In this review, we discuss the research and implementation; as well as the quantitative, semiquantitative, and qualitative methods of image analysis of CT-based perfusion. We also discuss the present state of technology and challenges associated with the methodology. In each section, when appropriate, we provide some information regarding the translation of these methods being utilized in the international, multicenter CORE320 study that is evaluating the combined CT-based imaging (CTA and CTP) strategy of risk assessment in comparison to the combined reference standard of radionuclide myocardial perfusion imaging and invasive angiography.

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Conflicts of Interest

Drs. George, Lima, and Lardo receive research funding from Toshiba Medical Systems. Drs. George and Lima receive research funding and serve on the advisory board of Astellas Pharma US, Inc. Dr. George is a consultant for ICON medical imaging. The terms of these arrangements are managed by Johns Hopkins University in accordance with its conflict of interest policies.

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  1. Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N. Wolfe Street, Carnegie Building 565C, Baltimore, MD, 21287, USA

    Vishal C. Mehra, Marietta Ambrose, Carolina Valdiviezo-Schlomp, Karl H. Schuleri, Albert C. Lardo, Joao A. C. Lima & Richard T. George

  2. Russell Morgan Department of Radiology, Division of Nuclear Medicine, Johns Hopkins University, Baltimore, USA

    Joao A. C. Lima

  3. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Albert C. Lardo

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  1. Vishal C. Mehra
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  2. Marietta Ambrose
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Mehra, V.C., Ambrose, M., Valdiviezo-Schlomp, C. et al. CT-Based Myocardial Perfusion Imaging-Practical Considerations: Acquisition, Image Analysis, Interpretation, and Challenges. J. of Cardiovasc. Trans. Res. 4, 437–448 (2011). https://doi.org/10.1007/s12265-011-9286-y

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