Comparison Study Of Rest And Adenosine Stress In CHD By DECT Myocardial Perfusion And SPECT

Object i veWe have recently described as the assessing myocardium by adenosine stress dual source computed tomography perfusion imaging (CTPI). The aim of this study was to determine the agreement of CTP and SPECT-MPI at rest and stress including every segment and vessel of patients with CHD. To evaluate the accuracy of the both DSCT and echocardiogram on the global left ventricular function in ischemic heart disease. To investigate the relationship among the number, extent of coronary artery stenosis, and the left ventricular function by DSCT.Materials and methods47patients who underwent a nuclear stress test in3months were included in the study. Dual-energy computed tomography (DECT) was performed as follows:1) stress CT:contrast-enhanced scan during adenosine infusion;2) rest CT: contrast-enhanced scan using prospective triggering; Each of the17segments was scored based on the absence or presence of a perfusion defect. Perfusion defect severity was graded as transmural (>50%) versus nontransmural (<50%). Reversibility was defined as follows:0=none,1=minimal,2=partial,3=complete. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by2independent blinded and5yr experienced radiologists.100patients with suspected ischemic heart disease (IHD)(64male,36female, average age57.2±10.4years, ranging38to82, average heart rate70.1±11.2bpm) who underwent DECT and2D-ECHO were included. The images of the heart were reconstructed at5%of the R-R interval and were evaluated at end-diastole and end-systole. Compared left ventricular function obtained by DECT and2D-ECHO. To investigate the association of coronary lesion with the left ventricular function assessments. ResultsThe DSCT protocol was successfully completed for47subjects (average age61.4±10.7years;83%male; with an average radiation dose of13.3mSv. On a per-vessel basis, CTP alone had a sensitivity of78%and a specificity of81%for the detection of stenosis≥50%, whereas SPECT myocardial perfusion imaging had a sensitivity of66%and a specificity of83%(P=0.442for differences in sensitivity, P=0.864for differences in specificity). On the other hand,when stenosis of≥70%on CTA was usded as the reference standard, the sensitivity and specificity were84%and68%for CTP and71%、73%for SPECT (P=0.564for differences in sensitivity, P=0.688for differences in specificity).1. Original scan data were analyzed by Siemens MMWP and AQI processing workstations, There were no statistically different for the left ventricular function assessments by the two workstations.2. DSCT findings showed a significant positive correlation compared with echocardiogram (P<0.05) except the ejection fraction (EF). The end-diastolic volume (EDV), end-systolic volume (ESV), myocardial mass (MM) by DSCT were lower than by the echocardio-graphy, but the average value of was higher than that of echocardiogram stroke volume(SV).3. There were significant differences in LVMM, LVEF, LVSV, and myocardial ischemia between two-or three-branch groups or between middle or severe groups (both P<0.05). However, no such significant difference was observed between single and two branch groups and between mild and middle groups. For single branch and middle to severe stenosis of the left anterior decending(LAD) coronary artery, right coronary artery, left circumflex coronary artery, only the values of LVMM, LVEF, and LVSV in LAD group showed significant difference (P<0.05).ConclusionsAdenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis for clinical setting in patients with CHD. There was a good correlation on the left ventricular function by DSCT and ECHO. The left ventricular function, regional wall motion(RWM), and coronary in the same data by DECT, which has the potential ability for comprehensive evaluation the cardiac function compared with ECHO. DSCT with more stenotic branches and severer stenosis in coronary artery often are associated with higher incidence of myocardial ischemia, and the left ventricular was more dysfunction. Especially,the stenosis of LAD coronary artery impacts on the cardiac functions. LVMM is the sensitive indicator for myocardial ischemia in coronary artery stenosis in IHD.