The Value Of CT Perfusion Imaging In The Diagnosis Of Coronary Heart Disease

The first part:Stress dynamic CT myocardial perfusion imaging in myocardial ischemicObjective The purpose of this article is to evaluate the diagnostic value of stress dynamic CT myocardial perfusion imaging(MPI) for detecting myocardial ischemic in comparison with SPECT myocardial perfusion.Methods Thirty patient prospectively underwent stress dynamic myocardial perfusion imaging with128-DSCT dual-source CT, myocardial blood flow (MBF) was quantified according to dynamic CT-MPI. Findings were compared with SPECT-MPI,such as the sensitivity,specificity,positive predictive value(PPV) and negative predictive value (NPV).Results There was a significant difference in MBF values between normal (117.61±29.82ml/100ml/min) and hypoperfused (80.60±22.15ml/100ml/min)segments (t=15.764,P=0.000). In stress CT-MPI,19patient with26vessel controlled areas and52myocardial segments were detected myocardial perfusion defects. While in stress SPECT MPI, the numbers were13,16and34, respectively. With SPECT as a comparison,the sensitivity,specificity, PPV and NPV were92.31%(12/13),58.82%(10/17),63.16%(12/19) and90.91%(10/11) on a per-patient basis. On per-vessel and per-segment basis,the sensitivity,specificity, PPV and NPV were respectively93.75%(15/16),85.14%(63/74),57.69%(15/26),98.44%(63/64) and94.12%(32/34),95.80%(456/476),61.54%(32/52),99.56%(456/458). The accuratity were respectively0.756,0.894and0.950on a per-patient, per-vessel and per-segment basis, respectively. And the Kappa value to evaluate the consistency between CT-MPI and SPECT-MPI were0.485,0.634and0.772with a statistical significance.Conclusion Stress dynamic CT-MPI is in good consistency with SPECT-MPI in detecting myocardial perfusion defects. It can be used to evaluate myocardial ischemic. The second part:Stress dynamic CT myocardial perfusion imaging combined with CT angiography in CADObjective The purpose of this article is to evaluate the diagnostic value of stress dynamic myocardial perfusion imaging(MPI) and its combination with CTA using128-DSCT dual-source CT for detecting myocardial ischemic in comparison with SPECT myocardial perfusion and invasive catheter angiography(ICA).Methods Sixteen patient prospectively underwent stress dynamic myocardial perfusion imaging and CTA with128-DSCT dual-source CT, myocardial blood flow (MBF) was quantified according to dynamic CT-MPI.Findings were compared with SPECT-MPI and ICA,such as the sensitivity,specificity,positive predictive value(PPV) and negative predictive value (NPV).Results Sixteeng patients all underwent the four examinations.15of them had myocardial perfusion defects in stress CT-MPI. There was a significant difference in MBF values between normal (122.07±30.75ml/100ml/min) and hypoperfused (84.22±21.90ml/100ml/min)segments (t=13.267,P=0.000). With SPECT and ICA as a comparison,the sensitivity,specificity, PPV and NPV were100%(13/13),74.29%(26/35),59.09%(13/22) and100%(26/26) on a per-vessel basis. The sensitivity, specificity, PPV and NPV were respectively92.31%(12/13),48.57%(17/35),40%(12/30),94.44%(17/18) for CTA and92.31%(12/13),82.86%(29/35),66.67%(12/18),96.67%(29/30) for CT-MPI combined with CTA. The correlation between CT-MPI and SPECT-MPI combined with ICA was0.663(P=0.000), and0.690(P=0.000) for CT-MPI in combination with CTA.Conclusion Stress dynamic CT-MPI is in good correlation with SPECT-MPI and ICA in detecting myocardial perfusion defects. CT-MPI combined with CTA improves the diagnostic accuracy for functional stenosis of CAD compared with CTA alone. CT has the potential prospects in CAD.