Computed tomography myocardial perfusion

Abstract

Coronary computed tomography angiography (CTA) has been widely adopted as a non-invasive tool for the evaluation of coronary artery disease. Given its high negative predictive value, it is an accurate modality to rule out obstructive coronary artery disease in the setting of chest pain. While the sensitivity and derived negative predictive value of coronary CTA are excellent, the specificity and positive predictive value are lower due to the difficult image interpretation in the presence of heavy coronary calcification, stents, coronary bypass grafts, motion artefacts, and arrhythmias. Vasodilator computed tomography myocardial perfusion (CTP) is an emerging technique with the ability to identify myocardial segments perfused by haemodynamically significant coronary stenoses. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CTP in comparison to a number of reference standards, including single-photon emission computed tomography, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow reserve testing. This chapter summarizes the current state of CTP.