A stepwise approach to the visual interpretation of CT-based myocardial perfusion

Vishal C. Mehra, Carolina Valdiviezo, Armin Arbab-Zadeh, Brian S. Ko, Sujith K. Seneviratne, Rodrigo Cerci, Joao A C Lima, Richard T. George

Research output: Contribution to journalReview ArticleResearchpeer-review

55 Citations (Scopus)


Cardiovascular anatomic and functional testing have been longstanding and key components of cardiac risk assessment. As part of that strategy, CT-based imaging has made steady progress, with coronary computed tomography angiography (CTA) now established as the most sensitive noninvasive strategy for assessment of significant coronary artery disease. Myocardial CT perfusion imaging (CTP), as the functional equivalent of coronary CTA, is being tested in currently ongoing multicenter trials and is proposed to enhance the accuracy of coronary CTA alone. However, unlike coronary CTA that has published guidelines for interpretation and is rapidly gaining applicability in the noninvasive risk assessment paradigms, myocardial CTP is rapidly evolving, and guidance on a standard approach to its interpretation is lacking. In this article we describe a practical stepwise approach for interpretation of myocardial CTP that should add to the clinical applicability of this modality. These steps include (1) coronary CTA interpretation for potentially obstructive atherosclerosis, (2) reconstruction and preprocessing of myocardial CTP images, (3) image quality assessment and the identification of potentially confounding artifacts, (4) rest and stress image interpretation for enhancement patterns and areas of hypoattenuation, and (5) correlation of coronary anatomy and myocardial perfusion deficits. This systematic review uses already published methods from multiple clinical studies and is intended for general usage, independent of the platform used for image acquisition.

Original languageEnglish
Pages (from-to)357-369
Number of pages13
JournalJournal of Cardiovascular Computed Tomography
Issue number6
Publication statusPublished - Nov 2011
Externally publishedYes


  • Computed tomography
  • Coronary artery disease
  • Myocardial perfusion
  • Risk assessment
  • Stress testing

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