CT myocardial perfusion imaging: ready for prime time?

The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. It allows for the quantitation of myocardial blood flow and calculation of coronary flow reserve and shows good correlation with 15O-H2O positron emission tomography and invasive fractional flow reserve. In addition, patients prefer CCTA/CT-MPI over SPECT, MRI and invasive coronary angiography. CT-MPI is ready for clinical use for detecting myocardial ischaemia caused by obstructive disease. Nevertheless, the clinical utility of CT-MPI to identify ischaemia in patients with non-obstructive/microvascular disease still has to be established. KEY POINTS: • CT-MPI can improve the positive predictive value of CCTA for lesion-specific ischaemia. • CT-MPI adds incremental prognostic value over CCTA for major adverse cardiac events. • CT-MPI correlates with 15 O-H 2 O PET. • CT-MPI/CCTA shows high overall patient satisfaction.