Regadenoson-Stress Dynamic Myocardial Perfusion Improves Diagnostic Performance of CT Angiography in Assessment of Intermediate Coronary Artery Stenosis in Asymptomatic Patients

Figure 1

(a–h) 61-year-old male with severe occlusions of iliac arteries was referred to aortobifemoral bypass and without history of CHD symptoms underwent complete CT protocol: coronary CT angiography (CTA), stress CT perfusion (CTP), and rest CTP. Heart rate (HR) during CTA was 71/min (3.1 mSv) and 96/min during stress CTP (5.3 mSv) after 400 micrograms of regadenoson application (60 sec interval). Rest CTP (7.9 mSv) was performed 15 min after stress CTP and HR was 75/min. ICA was performed with 1-day interval. Volume rendering technique images (a, b) show calcified plaques in proximal parts of coronary arteries. Multiplanar reformation images (c, d) show irregular stenosis of the right coronary artery (RCA) and left anterior descending (LAD) artery described as significant using CTA. Colour-coded maps (e, f) of stress myocardial perfusion (blood volume) show perfusion defect in RCA territory and normal perfusion in LAD territory (complete perfusion recovery in rest myocardial perfusion). Invasive coronarography confirmed significant stenosis of RCA (g) and just mild irregularity on LAD (h) artery, CTA decision correctly reclassified by CTP.

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