CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging

Figure 1

Static single-energy CTP imaging. 61-year-old male patient with multiple cardiovascular risk factors (smoke, hypercholesterolemia, and hypertension) presented with recurrent atypical chest pain. (a) Coronary CT angiography curved multiplanar reconstruction of the right coronary artery (RCA) with the corresponding orthogonal views showed a critical stenosis (>70% luminal narrowing) at the proximal segment sustained by a large noncalcified atherosclerotic plaque with positive remodeling (arrows). (b) Three-dimensional volume-rendering reconstruction demonstrating the critical stenosis of the proximal RCA (arrowhead) and showing also a tight stenosis (>90%, arrow) of the main diagonal branch (arrow). (c) 17-segment polar plot display of CT perfusion data acquired with a prospectively ECG-triggered high-pitch spiral technique at stress during the first pass, arterial phase, showed large, and severe perfusion defect color-coded in violet/blue/green at the inferior and inferolateral wall; note also a severe area of hypoperfusion in the apical lateral segment and in the apex. (d) Three-dimensional volume-rendering modeling of the left ventricular myocardial perfusion data with superimposed coronary tree (inferior view) showed the critical stenosis of the proximal segment of RCA (arrow) associated with an extensive perfusion defect at the inferior and inferolateral wall extending to apex (color-coded in violet/blue/green).