Computed tomographic evaluation of myocardial ischemia

• Published in: Japanese journal of radiology Vol. 38; no. 5; pp. 411 - 433
• Main Authors: Tanabe, Yuki, Kurata, Akira, Matsuda, Takuya, Yoshida, Kazuki, Baruah, Dhiraj, Kido, Teruhito, Mochizuki, Teruhito, Rajiah, Prabhakar
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.05.2020; Springer Nature B.V
• Subjects: Angiography; Cardiovascular disease; Computational fluid dynamics; Computed tomography; Computed Tomography Angiography - methods; Computer applications; Contrast media; Coronary Angiography - methods; Coronary artery; Coronary artery disease; Coronary vessels; Decision making; Echocardiography; EKG; Electrocardiography; Emission analysis; Evaluation; Female; Flow resistance; Fluid dynamics; Fluid flow; Heart diseases; Hemodynamics; Humans; Hydrodynamics; Imaging; Invited Review; Ischemia; Magnetic resonance imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Myocardial ischemia; Myocardial Ischemia - diagnostic imaging; Myocardium; Nuclear Medicine; Oxygen consumption; Perfusion; Photon emission; Predictive Value of Tests; Radiology; Radiotherapy; Sensitivity and Specificity; Stenosis; Tomography; Myocardial ischemia; Computed tomography; Myocardial perfusion; Coronary artery disease; Fractional flow reserve
• ISSN: 1867-1071; 1867-108X
• DOI: 10.1007/s11604-020-00922-8

Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CT-fractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.