Document Detail


Quantitative three-dimensional evaluation of myocardial perfusion during regadenoson stress using multidetector computed tomography.
MedLine Citation:
PMID:  22805675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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 hemodynamic significance. We tested the hypothesis that quantitative 3-dimensional (3D) analysis of myocardial perfusion from MDCT images obtained during regadenoson stress would more accurately detect the presence of significant coronary artery disease (CAD) than identical analysis when performed on resting MDCT images.
METHODS: We prospectively studied 50 consecutive patients referred for CT coronary angiography (CTCA) who agreed to undergo additional imaging with regadenoson (0.4 mg; Astellas). Images were acquired using prospective gating (256-channel; Philips). Custom analysis software was used to define 3D myocardial segments, and calculate for each segment an index of severity and extent of perfusion abnormality, Qh, which was compared with perfusion defects predicted by the presence and severity of coronary stenosis on CTCA.
RESULTS: Three patients were excluded because of image artifacts. In the remaining 47 patients, CTCA depicted stenosis more than 50% in 23 patients in 37 of 141 coronary arteries. In segments supplied by the obstructed arteries, myocardial attenuation was slightly reduced compared with normally perfused segments at rest (mean [SD], 91 [21] vs 93 [26] Hounsfield units, not significant) and, to a larger extent, at peak stress (102 [21] vs 112 [20] Hounsfield units, P < 0.05). In contrast, index Qh was significantly increased at rest (0.40 [0.48] vs 0.26 [0.41], P < 0.05) and reached a nearly 3-fold difference at peak stress (0.66 [0.74] vs 0.28 [0.51], P < 0.05). The addition of regadenoson improved the diagnosis of CAD, as reflected by an increase in sensitivity (from 0.57 to 0.91) and improvement in accuracy (from 0.65 to 0.77).
CONCLUSIONS: Quantitative 3D analysis of MDCT images allows objective detection of CAD, the accuracy of which is improved by regadenoson stress.
Authors:
Victor Mor-Avi; Joseph A Lodato; Nadjia Kachenoura; Sonal Chandra; Benjamin H Freed; Barbara Newby; Roberto M Lang; Amit R Patel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of computer assisted tomography     Volume:  36     ISSN:  1532-3145     ISO Abbreviation:  J Comput Assist Tomogr     Publication Date:    2012 Jul-Aug
Date Detail:
Created Date:  2012-07-18     Completed Date:  2012-09-25     Revised Date:  2013-07-18    
Medline Journal Info:
Nlm Unique ID:  7703942     Medline TA:  J Comput Assist Tomogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  443-9     Citation Subset:  IM    
Affiliation:
University of Chicago Medical Center, Chicago, IL 60637, USA. vmoravi@bsd.uchicago.edu
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MeSH Terms
Descriptor/Qualifier:
Adenosine A2 Receptor Antagonists / diagnostic use
Cardiac-Gated Imaging Techniques / methods*
Coronary Angiography / methods*
Coronary Stenosis / physiopathology,  radiography*
Female
Humans
Imaging, Three-Dimensional / methods*
Male
Middle Aged
Multidetector Computed Tomography / methods*
Predictive Value of Tests
Prospective Studies
Purines / diagnostic use
Pyrazoles / diagnostic use
ROC Curve
Sensitivity and Specificity
Software
Chemical
Reg. No./Substance:
0/Adenosine A2 Receptor Antagonists; 0/Purines; 0/Pyrazoles; 0/regadenoson

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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