Stress Myocardial Perfusion Imaging with Multidetector CT
Stress Myocardial Perfusion Imaging with Multidetector CT
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DOI：
10.1148/radiol.13112739
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发表时间：
2014-01-01
期刊：
影响因子：
19.7
通讯作者：
Krestin, Gabriel P.
中科院分区：
文献类型：
--
作者：
Rossi, Alexia;Merkus, Daphne;Krestin, Gabriel P.
计算机断层扫描（CT）冠状动脉造影术是一种成熟的、用于检测冠状动脉狭窄的非侵入性成像方式，但其在证明冠状动脉狭窄是否具有血流动力学意义方面的准确性有限。通常需要额外的功能测试，因为需要解剖和功能信息来指导患者护理。CT技术的最新发展允许在血管扩张应激期间对心肌灌注进行CT评价，从而提供关于心肌缺血的信息。在几项单中心研究中，研究者已经确定了在一小群患者中进行负荷心肌灌注CT成像的可行性，并表明负荷心肌灌注CT联合CT冠状动脉造影术与单独CT冠状动脉造影术相比提高了诊断准确性。然而，CT灌注采集协议必须在采集和重建参数、造影剂协议注射和辐射剂量方面进行优化。需要进一步的研究来确定这种新技术的临床实用性。本综述的目的是：（a）提供冠状动脉循环和心肌灌注生理学的概述;（B）描述与CT灌注成像相关的技术前提、挑战和数学建模;（c）注意CT扫描仪和CT灌注协议的最新进展;（d）讨论CT灌注图像的解释。最后，对现有文献进行了回顾和总结，并对未来的研究方向进行了讨论。(C)RSNA，2014年
Computed tomographic (CT) coronary angiography is a well-established, noninvasive imaging modality for detection of coronary stenosis, but it has limited accuracy in demonstrating whether a coronary stenosis is hemodynamically significant. An additional functional test is often required because both anatomic and functional information is needed for guiding patient care. Recent developments in CT technology allow CT evaluation of myocardial perfusion during vasodilator stress, thereby providing information about myocardial ischemia. Investigators in several single-center studies have established the feasibility of performing stress myocardial perfusion CT imaging in small groups of patients and have shown that stress myocardial perfusion CT in combination with CT coronary angiography improved the diagnostic accuracy in comparison with CT coronary angiography alone. However, CT perfusion acquisition protocols must be optimized in terms of acquisition and reconstruction parameters, contrast material protocol injections, and radiation dose. Further research is needed to establish the clinical usefulness of this novel technique. The purpose of this review is to (a) provide an overview of the physiology of coronary circulation and myocardial perfusion; (b) describe the technical prerequisites, challenges, and mathematic modeling related to CT perfusion imaging; (c) note recent advances in CT scanners and CT perfusion protocols; and (d) discuss the interpretation of CT perfusion images. Finally, a review and summary of the current literature are provided, and future directions for research are discussed. (C) RSNA, 2014