Coronary Perfusion

-a | During the scan preparation, intravenous access is obtained. ECG electrodes are placed and the patient's heart and vitals are monitored. If heart rate reduction is necessary, the patient is prepared for the scan with intravenous hydration and β-blocker administration. The injection rate for iodine contrast is 5 ml/s. The parameters for stress CTP are as follows 128 × 1.0 mm detector collimation, 120 kV, 100 mAs, 3 gantry rotations. CTA and rest CTP are obtained during the same acquisition 10 min after the adenosine was stopped. The scan parameters are as follows 256 × 0.5 mm detector collimation, 120 kV, 175 mAs, 3 gantry rotations. -b–g | Resting and stress wide-range MDCT myocardial perfusion imaging. First-pass, rest and adenosine augmented wide-range MDCT myocardial perfusion imaging in a patient referred for invasive angiography after SPECT showed a partially reversible perfusion deficit in the inferior and inferolateral territories. Wide-range MDCT images are acquired during one heart beat, providing full heart coverage and temporal uniformity of all myocardial segments.
-Panel b shows a partial reversible perfusion deficit in the inferior and inferolateral wall on radionuclide myocardial perfusion imaging in this patient with exertional angina. The upper panels show stress perfusion imaging and the lower panels show resting perfusion.
-Rest (panel c) and stress (panel d) MDCT perfusion imaging shows a reversible subendocardial perfusion deficit in the inferior and inferolateral walls (black arrows).
-Noninvasive angiography (panels d–f) confirms a major stenosis (white arrows) in the proximal right coronary artery (panels e and f) and the proximal left circumflex artery (panel g). Abbreviations: CTA, CT coronary angiography; CTP, perfusion CT; ECG, electrocardiogram; MDCT, multidetector CT; SPECT, single-photon emission CT.