Stress myocardial perfusion imaging using computed tomography in stable coronary artery disease

Over the past decade, CT coronary angiography (CCTA) has emerged as a non-invasive diagnostic imaging modality that directly visualises the coronary anatomy with a reportedly high diagnostic accuracy when compared with invasive angiography. Given the high accuracy, it remains plausible that CCTA may serve as an effective gatekeeper for invasive angiography and revascularisation in patients with symptomatic stable coronary artery disease. However it is important to note that in its current form, CCTA is limited in assessing the functional significance of coronary stenoses. CT stress myocardial perfusion imaging is a novel method to assess myocardial ischemia and when used in combination with CCTA may allow cardiac CT to have the unique ability to assess coronary anatomy and myocardial perfusion in a single examination. The aim of the thesis is first to outline the current increasing role of cardiac CT and fractional flow reserve in the contemporary assessment and management of patients with stable coronary artery disease (chapter 2), to evaluate the use of CCTA as a gatekeeper for invasive angiography and revascularisation (chapter 3), to review the basics of CT stress myocardial perfusion imaging and the literature supporting its accuracy (chapter 4), to determine the accuracy of CT stress perfusion imaging when applied in patients considered for coronary revascularisation (chapter 5), to determine the accuracy of CT stress perfusion imaging when combined with CT coronary angiography when applied in a patients with suspected CAD (chapter 6), and to finally review the role of functional coronary assessment using CT in interventional cardiology (chapter 7). 3