Dual-energy CT perfusion during pharmacologic stress for the assessment of myocardial perfusion defects using a second-generation dual-source CT: a comparison with cardiac magnetic resonance imaging.

Objective: This study aimed to assess the diagnostic performance of adenosine-stress dual-energy myocardial computed tomography perfusion (DECTP) imaging using 128-slice dual-source computed tomography (CT) for the detection of myocardial perfusion defects in comparison with stress-perfusion magnetic resonance imaging (MRI).

Methods: This prospective study included 50 patients (mean age, 66 [9] years; 64% men) with suspected coronary artery disease who underwent adenosine-stress DECTP using 128-slice dual-source CT as well as adenosine-stress cardiac MRI using a 1.5-T scanner. Estimates of diagnostic accuracy in detecting myocardial perfusion defects were calculatedand compared with those of cardiac MRI.

Results: The estimates of diagnostic accuracy in detecting myocardial perfusion defects using DECTP were as follows: sensitivity, 77% (95% confidence interval [CI], 67%-87%); specificity, 94% (95% CI, 92%-95%); positive predictive value, 53% (95% CI, 44%-63%); and negative predictive value, 98% (95% CI, 97%-99%). The results of DECTP imaging were positively correlated with those of cardiac MRI (r = 0.602, P < 0.001). Mean effective radiation doses for stress DECTP imaging and rest coronary CTA were 6.5 (2.2) and 4.9 (1.7) mSv, respectively.

Conclusions: Adenosine-stress DECTP imaging enables detection of myocardial ischemia. However, further technical developments are necessary to reduce artifacts and improve the sensitivity of DECTP.