Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Myocardial Perfusion and Fractional Flow Reserve

  • Chapter
  • First Online:
Cardiac CT

Abstract

Myocardial CT perfusion imaging is a rapidly evolving technology that allows assessment of the functional significance of potentially obstructive coronary stenosis. The opportunity for quantification of myocardial perfusion is the greatest potential advantage of CT compared with other perfusion techniques. On the other hand, fractional flow reserve during coronary angiography provides a functional assessment of coronary lesions identified with this modality. Recently, a non-invasive method for estimating fractional flow reserve, based on coronary CT angiography has been introduced. Nevertheless, at present neither CT perfusion nor CT FFR are ready for widespread use in clinical routine.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Recommended Reading

  • Abbara S, Arbab-Zadeh A, Callister TQ et al (2009) SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 3:190–204

    PubMed  Google Scholar 

  • Bamberg F, Becker A, Schwarz F et al (2011) Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 260:689–698

    PubMed  Google Scholar 

  • Bamberg F, Hinkel R, Schwarz F et al (2012) Accuracy of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model. Invest Radiol 47:71–77

    PubMed  Google Scholar 

  • Bech GJ, De Bruyne B, Pijls NH et al (2001) Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation 103:2928–2934

    CAS  PubMed  Google Scholar 

  • Bischoff B, Bamberg F, Marcus R et al (2013) Optimal timing for first-pass stress CT myocardial perfusion imaging. Int J Cardiovasc Imaging 29:435–442

    PubMed  Google Scholar 

  • Blankstein R, Shturman LD, Rogers IS et al (2009) Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 54:1072–1084

    PubMed  Google Scholar 

  • Cury RC, Nieman K, Shapiro MD, Nasir K, Cury RC, Brady TJ (2007) Comprehensive cardiac CT study: evaluation of coronary arteries, left ventricular function, and myocardial perfusion – is it possible? J Nucl Cardiol 14:229–243

    PubMed  Google Scholar 

  • De Bruyne B, Pijls NH, Kalesan B et al (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 367:991–1001

    PubMed  Google Scholar 

  • Dewey M, Gaemperli O, Schlattmann P (2013) Noninvasive approach to assess coronary artery stenoses and ischemia. JAMA 309(3):233–234

    CAS  PubMed  Google Scholar 

  • Feuchtner G, Goetti R, Plass A et al (2011) Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia/clinical perspective. Circ Cardiovasc Imaging 4:540–549

    PubMed  Google Scholar 

  • George RT, Silva C, Cordeiro MA et al (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48:153–160

    PubMed  Google Scholar 

  • George RT, Arbab-Zadeh A, Miller JM et al (2009) Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging 2:174–182

    PubMed Central  PubMed  Google Scholar 

  • Ghoshhajra BB, Maurovich-Horvat P, Techasith T et al (2012) Infarct detection with a comprehensive cardiac CT protocol. J Cardiovasc Comput Tomogr 6:14–23

    PubMed  Google Scholar 

  • Greenwood JP, Maredia N, Younger JF et al (2012) Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 379:453–460

    PubMed Central  PubMed  Google Scholar 

  • Ho KT, Chua KC, Klotz E, Panknin C (2010) Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT. JACC Cardiovasc Imaging 3:811–820

    PubMed  Google Scholar 

  • Ichihara T, Sakuma H, Ishida M et al (2009) Quantitative analysis of first-pass contrast-enhanced myocardial perfusion MRI using a Patlak plot method and blood saturation correction. Magn Reson Med 62:373–383

    PubMed  Google Scholar 

  • Ishida M, Sakuma H, Murashima S et al (2009) Absolute blood contrast concentration and blood signal saturation on myocardial perfusion MRI: estimation from CT data. J Magn Reson Imaging 29:205–210

    PubMed  Google Scholar 

  • Ishida M, Ichihara T, Nagata M et al (2011) Quantification of myocardial blood flow using model based analysis of first-pass perfusion MRI: extraction fraction of Gd-DTPA varies with myocardial blood flow in human myocardium. Magn Reson Med 66:1391–1399

    PubMed  Google Scholar 

  • Kim SM, Kim YN, Choe YH (2013) Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT: optimization of the CT protocol to reduce the radiation dose. Int J Cardiovasc Imaging 29:875–884

    PubMed  Google Scholar 

  • Kitagawa K, George RT, Arbab-Zadeh A, Lima JA, Lardo AC (2010) Characterization and correction of beam-hardening artifacts during dynamic volume CT assessment of myocardial perfusion. Radiology 256:111–118

    PubMed  Google Scholar 

  • Kleiman NS (2011) Bringing it all together: integration of physiology with anatomy during cardiac catheterization. J Am Coll Cardiol 58:1219–1221

    PubMed  Google Scholar 

  • Ko S, Choi J, Song M et al (2011) Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol 21:26–35

    PubMed  Google Scholar 

  • Ko BS, Cameron JD, Leung M et al (2012) Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease: a comparison with fractional flow reserve. JACC Cardiovasc Imaging 5:1097–1111

    PubMed  Google Scholar 

  • Koo BK, Erglis A, Doh JH et al (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 58:1989–1997

    PubMed  Google Scholar 

  • Lardo AC, Cordeiro MA, Silva C et al (2006) Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 113:394–404

    PubMed Central  PubMed  Google Scholar 

  • Levine GN, Bates ER, Blankenship JC et al (2011) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 58:e44–e122

    PubMed  Google Scholar 

  • Mahnken AH, Klotz E, Pietsch H et al (2010) Quantitative whole heart stress perfusion CT imaging as noninvasive assessment of hemodynamics in coronary artery stenosis: preliminary animal experience. Invest Radiol 45:298–305

    PubMed  Google Scholar 

  • Martus P, Schueler S, Dewey M (2012) Fractional flow reserve estimation by coronary computed tomography angiography. J Am Coll Cardiol 59(15):1410–1411

    Google Scholar 

  • Mehra VC, Valdiviezo C, Arbab-Zadeh A et al (2011) A stepwise approach to the visual interpretation of CT-based myocardial perfusion. J Cardiovasc Comput Tomogr 5:357–369

    PubMed  Google Scholar 

  • Min JK, Koo BK, Erglis A et al (2012a) Effect of image quality on diagnostic accuracy of noninvasive fractional flow reserve: results from the prospective multicenter international discover-flow study. J Cardiovasc Comput Tomogr 6:191–199

    PubMed  Google Scholar 

  • Min JK, Leipsic J, Pencina MJ et al (2012b) Diagnostic accuracy of fractional flow reserve from anatomic ct angiography. JAMA 308:1237–1245

    CAS  PubMed  Google Scholar 

  • Motwani M, Fairbairn TA, Larghat A et al (2012) Systolic versus diastolic acquisition in myocardial perfusion MR imaging. Radiology 262:816–823

    PubMed  Google Scholar 

  • Nieman K, Shapiro MD, Ferencik M et al (2008) Reperfused myocardial infarction: contrast-enhanced 64-Section CT in comparison to MR imaging. Radiology 247:49–56

    PubMed  Google Scholar 

  • Nørgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, Jensen JM, Mauri L, De Bruyne B, Bezerra H, Osawa K, Marwan M, Naber C, Erglis A, Park SJ, Christiansen EH, Kaltoft A, Lassen JF, Bøtker HE, Achenbach S; NXT trial study group (2014) Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: The NXT trial. J Am Coll Cardiol pii: S0735-1097(14)00165-X. doi:10.1016/j.jacc.2013.11.043. [Epub ahead of print]

  • Pijls NH, Sels JW (2012) Functional measurement of coronary stenosis. J Am Coll Cardiol 59:1045–1057

    PubMed  Google Scholar 

  • Ramirez-Giraldo JC, Yu L, Kantor B, Ritman EL, McCollough CH (2012) A strategy to decrease partial scan reconstruction artifacts in myocardial perfusion CT: phantom and in vivo evaluation. Med Phys 39:214–223

    PubMed Central  PubMed  Google Scholar 

  • Rief M, Zimmermann E, Stenzel F, Martus P, Stangl K, Greupner J, Knebel F, Kranz A, Schlattmann P, Laule M, Dewey M (2013) CT angiography and myocardial CT perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography. J Am Coll Cardiol 62:1476–1485

    Google Scholar 

  • So A, Hsieh J, Narayanan S et al (2012) Dual-energy CT and its potential use for quantitative myocardial CT perfusion. J Cardiovasc Comput Tomogr 6:308–317

    PubMed  Google Scholar 

  • Taylor CA, Fonte TA, Min JK (2013) Computational fluid dynamics applied to cardiac ct for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol 61(22):2233–2241

    PubMed  Google Scholar 

  • Techasith T, Cury RC (2011) Stress myocardial CT perfusion: an update and future perspective. JACC Cardiovasc Imaging 4:905–916

    PubMed  Google Scholar 

  • Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224

    CAS  PubMed  Google Scholar 

  • Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31:2501–2555

    PubMed  Google Scholar 

  • Zoghbi GJ, Dorfman TA, Iskandrian AE (2008) The effects of medications on myocardial perfusion. J Am Coll Cardiol 52:401–416

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mie University Hospital, Tsu, Japan

    K. Kitagawa MD, PhD

  2. Insititute of Cardiology, Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu 13, LV1001, Riga, Latvia

    A. Erglis Prof. MD, PhD

  3. Institut für Radiologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    M. Dewey Prof. Dr. med.

Authors
  1. K. Kitagawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Erglis Prof. MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Dewey Prof. Dr. med.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Kitagawa MD, PhD .

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Kitagawa, K., Erglis, A., Dewey, M. (2014). Myocardial Perfusion and Fractional Flow Reserve. In: Cardiac CT. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-41883-9_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-41883-9_22

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-41882-2

  • Online ISBN: 978-3-642-41883-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation