Adenosine-stress dynamic myocardial volume perfusion imaging with second generation dual-source computed tomography: Concepts and first experiences

Recent research suggests that multidetector-row CT may have potential as a standalone modality for integrative imaging of coronary heart disease, including the assessment of the myocardial blood supply. However, the technical prerequisites for volumetric, time-resolved imaging of the passage of a contrast medium bolus through the myocardium have only been met with latest generation wide-detector CT scanners. Second-generation dual-source CT enables performing electrocardiographic (ECG)–synchronized dynamic myocardial perfusion imaging by a dedicated “shuttle” mode. With this acquisition mode, image data can be acquired during contrast medium infusion at 2 alternating table positions with the table shuttling back and forth between the 2 positions covering a 73-mm anatomic volume. We applied this acquisition technique for detecting differences in perfusion patterns between healthy and diseased myocardium and for quantifying myocardial blood flow under adenosine stress in 3 patients with coronary heart disease. According to our initial experience, the addition of adenosine stress volumetric dynamic CT perfusion to a cardiac CT protocol comprising coronary artery calcium quantification, prospectively ECG-triggered coronary CT angiography, and delayed acquisition appears promising for the comprehensive assessment of coronary artery luminal integrity, cardiac function, perfusion, and viability with a single modality.