Harvard Medical School, Boston, Massachusetts, USA.
JACC Cardiovasc Imaging. 2011 Aug;4(8):905-16. doi: 10.1016/j.jcmg.2011.04.017.
Coronary computed tomography angiography (CTA) has been shown by several multicenter trials to have excellent diagnostic accuracy in the detection and exclusion of significant coronary stenosis. However, a major limitation of coronary CTA is that the physiological significance of stenotic lesions identified is often unknown. Stress myocardial computed tomography perfusion (CTP) is a novel examination that provides both anatomic and physiological information (i.e., myocardial perfusion). Multiple single-center studies have established the feasibility of stress myocardial CTP. Furthermore, it has been illustrated that a combined CTA/CTP protocol improves the diagnostic accuracy to detect hemodynamic significant stenosis as compared with CTA alone; this combined protocol can also be accomplished at a radiation dose comparable to nuclear myocardial perfusion imaging exams. Although initial results hold some promise, stress myocardial CTP is a modality in its infancy. Further research is required to define, validate, and optimize this new technique. However, it is a modality with significant potential, particularly in the evaluation of chest pain patients, given the advantages of short exam time and comprehensive data acquisition. This review highlights how to perform and interpret stress myocardial CTP, summarizes the current literature, and discusses some future directions.
冠状动脉计算机断层血管造影（CTA）已被多项多中心试验证明，在检测和排除有意义的冠状动脉狭窄方面具有出色的诊断准确性。然而，冠状动脉 CTA 的一个主要限制是，狭窄病变的生理意义通常是未知的。应激心肌计算机断层灌注（CTP）是一种新的检查方法，提供解剖和生理信息（即心肌灌注）。多项单中心研究已经证实应激心肌 CTP 的可行性。此外，已经表明，与单独的 CTA 相比，联合 CTA/CTP 方案可提高检测血流动力学意义上的狭窄的诊断准确性；这种联合方案还可以在与核心肌灌注成像检查相当的辐射剂量下完成。尽管初步结果有一定的希望，但应激心肌 CTP 是一种处于起步阶段的技术。需要进一步的研究来定义、验证和优化这项新技术。然而，鉴于其检查时间短和全面的数据采集等优势，它是一种具有重要潜力的技术，特别是在评估胸痛患者方面。本综述重点介绍了如何进行和解释应激心肌 CTP，总结了当前的文献，并讨论了一些未来的方向。
