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Purpose: We propose a new, Myocardial Perfusion Imaging (MPI) with coronary CTA, and investigate the diagnostic ability of subendocardial hypoperfusion for Coronary Artery Disease (CAD) based on degree of coronary stenosis. Methods: In twenty CAD patients, Coronary CTA and Invasive Coronary Angiography (CAG) were performed. CT-Myocardial Perfusion Image (MPI) was reconstructed at 4 cardiac phases (0%, 40%, 60%, and 80% of the R-R interval), applying CT number measured in Hounsfield Unit (HU) as an estimate of perfusion. A myocardial segment with subendocardial low attenuation at endsystole was defined as subendocardial-systolic-hypoperfusion (SSH). Results: Using >50% stenosis on CAG as standard, SSH diagnosed stenotic coronary territories with 63% sensitivity, 82% specificity, and 70% accuracy. Using >75% stenosis on CAG as standard, SSH diagnosed stenotic coronary territories with 73% sensitivity, 80% specificity, and 77% accuracy. The use of the SSH sign led to accurate diagnosis (result of CAG) in 9 of 60 territories (15%), which could not be assessed due to severe coronary calcification. Conclusion: SSH is frequently seen in the stenotic coronary territories. SSH might provide powerful information when the assessment of coronary artery is made difficult by severe calcification.

Subendocardial Systolic Hypoperfusion in Stenotic Coronary Territories: Demonstration by 256-Slice Coronary CT Angiography