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doi:10.1093/ehjci/jet034 Online publish-ahead-of-print 18 March 2013
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Myocardial perfusion imaging using dual-energy computed tomography: a clinical case Gianluca Pontone1*, Luca Grancini1, Daniele Andreini1,2, Mauro Pepi1, and Antonio L. Bartorelli1,2 1
Centro Cardiologico Monzino, IRCCS, Milan, Italy and 2Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
* Corresponding author. Via C. Parea 4, 20138 Milan, Italy. Tel: +39 02 58002574; fax: +39 02 58002231, Email:
[email protected]
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email:
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Evaluation of myocardial perfusion imaging (MPI) by single-energy computed tomography is limited by beam hardening (BH). Recently, dual-energy CT (DECT) has been introduced for a more reproducible MPI evaluation through the reduction of BH-artefacts by using monochromatic image reconstruction obtained with rapid switching between low and high tube voltage. We present the case of a 61-year-old man referred for chest pain and equivocal stress ECG. To rule out the presence of significant coronary artery disease and ischaemia, a rest-stress DECT(GE Healthcare CT750HD) using 80 –140 KVp switching was performed. The exam showed chronic total occlusion (CTO) of the left anterior descending (LAD) coronary artery due to a non-calcified plaque (Panels A and B, arrows) without significant perfusion defect (Panels A and C ). Under stress condition (i.v. adenosine injection), DECT showed a large perfusion defect (18% of myocardial mass) of the anterior wall of the left ventricle (Panels D –F, arrows). The patient underwent CTO revascularization by PCI with three DES implantations. Three days later, stress DECT showed patency of LAD stent (Panels G and H, arrows) and significant reduction of the perfusion defect (1.8% of myocardial mass) (Panels G, circle, and I). The total amount of contrast agent and effective radiation dose for a single rest-stress DECT was 120 cc and 4.4 mSv, respectively. This case demonstrates that DECT may be a useful technique for simultaneous evaluation of coronary anatomy and myocardial perfusion. Further studies are needed to assess whether DECT shows better accuracy as compared to other imaging modalities.
