| Detection of myocardial perfusion abnormalities using ultra-low radiation dose regadenoson stress multidetector computed tomography. | |
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MedLine Citation:
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PMID: 21723516 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: The ability of multidetector computed tomography (MDCT) to detect stress-induced myocardial perfusion abnormalities is of great clinical interest as a potential tool for the combined evaluation of coronary stenosis and its significance. However, stress testing requires repeated scanning that is associated with additional radiation exposure and iodine contrast. OBJECTIVE: Our goal was to determine the effects of reduced tube voltage and contrast dose on the ability to detect perfusion abnormalities. METHODS: We studied 40 patients referred for coronary CT angiography (CTA) who agreed to undergo additional imaging after administration of an A(2A)-agonist (regadenoson 0.4 mg). Images were acquired at rest and during hyperemia with prospective gating with 120 kV tube voltage with 80-90 mL of contrast in 20 patients (group 1) and 100 kV with 55-70 mL of contrast in the remaining 20 patients (group 2). Custom 3D analysis software was used to define 3D myocardial segments and measure x-ray attenuation in each segment. In each group of patients, myocardial attenuation was averaged for segments supplied by coronary arteries with stenosis causing >50% luminal narrowing on coronary CTA and separately for segments supplied by arteries without significant stenosis. RESULTS: Coronary CTA detected stenosis >50% in 23 of 120 coronary arteries in 16 of 40 patients. In all patients combined, myocardial attenuation increased from 86 ± 9 at rest to 110 ± 17 HU with stress, reflecting an increase in tissue blood flow, despite the decrease in left ventricular cavity attenuation (347 ± 72 to 281 ± 55 HU), reflecting an increase in cardiac output. Importantly, in both groups, myocardial attenuation was equally reduced in segments supplied by diseased arteries (group 1: 119 ± 19 vs 103 ± 14 HU, P < 0.05; group 2: 108 ± 20 vs 97 ± 16 HU, P < 0.05), despite the 74% reduction in radiation (from 7.4 ± 2.8 to 1.9 ± 0.45 mSv) and the 28% reduction in contrast dose (from 84 ± 7 to 60 ±7 mL) (both P < 0.05). CONCLUSIONS: Regadenoson stress MDCT imaging can detect hypoperfused myocardium even when imaging settings are optimized to provide a significant reduction in radiation and contrast doses. |
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Authors:
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Amit R Patel; Joseph A Lodato; Sonal Chandra; Nadjia Kachenoura; Homaa Ahmad; Benjamin H Freed; Barbara Newby; Roberto M Lang; Victor Mor-Avi |
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Publication Detail:
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Type: Journal Article Date: 2011-06-12 |
Journal Detail:
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Title: Journal of cardiovascular computed tomography Volume: 5 ISSN: 1876-861X ISO Abbreviation: J Cardiovasc Comput Tomogr Publication Date: 2011 Jul-Aug |
Date Detail:
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Created Date: 2011-07-04 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101308347 Medline TA: J Cardiovasc Comput Tomogr Country: United States |
Other Details:
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Languages: eng Pagination: 247-54 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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University of Chicago, MC5084, 5841 S Maryland Ave, Chicago, IL 60637, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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