Assessment of the hemodynamic relevance of moderate coronary artery stenoses by myocardial stress perfusion imaging using dual-energy CT

CT血管造影（CTA）可快速检测或排除动脉粥样硬化斑块引起的冠状动脉狭窄，因此对疑似冠状动脉疾病的患者有益。CTA无法准确评价它们对心肌灌注的影响。如果检测到中度冠状动脉狭窄，则需要进行额外检查以阐明对心肌灌注的影响。由于技术的发展，目前的研究表明，心肌灌注成像（MPI）在CT中是可靠的。研究停留的目的是加深我对药物诱导应激后双能CT（DE-CT）中MPI的了解。计划进行一项国际多中心研究，以评估与MRI（参考标准）相比，使用双能CT中的应激MPI对中度冠状动脉狭窄的血流动力学相关性。DE-CT允许对额外的原始数据进行后处理，增加软组织对比度。在一项前瞻性单中心研究中，将评估使用DE-CT的动态应力MPI和静态静息MPI的诊断价值和临床结果。动态应力MPI提供了心肌血流量的额外计算。参与本研究的患者患有中度冠状动脉狭窄或由于冠状动脉中的高钙负荷而进行非诊断性CTA。将来，具有中等心血管风险或疑似急性冠状动脉疾病的患者将受益于一站式CT检查，包括冠状动脉和心肌灌注的评估。这种CT检查具有高效诊断血流动力学相关冠状动脉狭窄和改善患者预后的潜力。

Patients with suspected coronary artery disease benefit from CT-angiography (CTA) due to the fast detection or exclusion of coronary artery stenoses due to artherosclerotic plaques. CTA does not allow an exact evaluation of their impact on myocardial perfusion. If a moderate coronary artery stenosis is detected, additional examinations are necessary to clarify the impact on myocardial perfusion. The results are crucial for further treatment.Due to technical development, current studies show that myocardial perfusion imaging (MPI) is reliable in CT. The intention for the research stay is to deepen my knowledge in MPI in Dual-Energy CT (DE-CT) after drug induced stress.An international multi-center study is planned to assess the hemodynamic relevance of moderate coronary artery stenoses using stress MPI in dual-energy CT in comparison to MRI (reference standard). DE-CT allows additional raw data post-processing increasing soft-tissue contrast.In a prospective mono-center study diagnostic value and clinical outcome of dynamic stress MPI and static rest MPI using DE-CT will be assessed. Dynamic stress MPI provides additional calculation of the myocardial blood flow. Patients participating in this study suffer from moderate coronary artery stenoses or non-diagnostic CTAs due to a high calcium load in the coronary arteries.In the future, patients with intermediate cardiovascular risk or suspected acute coronary artery disease will benefit from a one-stop shop CT examination including evaluation of the coronary arteries and the myocardial perfusion. This CT examination has the potential of a high efficient diagnosis of hemodynamic relevant coronary artery stenoses and improved patient outcome.