Application of the One-Stop Cardiac CT Scan on 256-Row Wide Detector Revolution CT in Myocardial Ischemia of Aortic Valve Degeneration Diagnosis

Advances in Imaging has been used increasingly to assess coronary lumen and myocardial perfusion with more accuracy. The aim of this study was to evaluate the diagnostic performance of one-stop cardiac CT myocardial perfusion imaging (CT-MPI) combined with coronary artery CT angiography (CCTA) for the detection of functionally relevant myocardial ischemia of aortic valve degeneration (AVD). The study was approved by the patient and passed by the ethics committee. This study was a case-control study using random sampling. A total of 109 (109/480) patients suspected of CAD were prospectively enrolled from January 2017 to December 2018 with chest pain as their chief complaint in Renmin Hospital of Wuhan University, Wuhan, Hubei, China. All patients underwent CT-MPI and CCTA on a wide detector Revolution CT. Myocardial blood flow (MBF) was quantified and compared between normal perfusion and abnormal myocardial segments based on AHA-17-segment model. CCTA images were evaluated qualitatively based on SCCT-18-segment model. Radionuclide myocardial perfusion imaging (MPI) is the gold standard; the diagnostic accuracy of CT-MPI, CCTA, and CT-MPI combination with CCTA in the diagnosis of myocardial ischemia of AVD with hemodynamic stenosis was evaluated. All patients underwent CCTA combined with CT-MPI examination, 69 patients (63.30%) with 182 myocardial segments(15. 52%) were detected with decreased blood perfusion, the MBF value was lower than that of normal segments [(83.06 ± 20.11) mL.100 mL-1.min-1 vs. (120.02 ± 28.71) mL.100 mL-1.min-1; t = 14.361, P < 0.001]. There were 1914 segments (97.56%) that could be used for the diagnosis in CCTA, 302 (15.78%) segments have clinical significance in this study. Compared with the MPI, the diagnostic sensitivity, specificity, positive and negative predictive value of CT-MPI for myocardial ischemia of AVD were 73.33%, 73.68%, 89.80%, 70.00%, respectively, 90.00%, 68.42%, 88.24%, 72.22% for CCTA, and 88.46%, 70.59%, 90.20%, 66.67% combined with CT-MPI and CCTA. Logistic regression analysis was performed that the AVD was associated with the detection rate of calcified plaques (r = 5.207, P < 0.05), and calcification of the aortic valve were associated with the detection of plaques in the three and six segments of coronary arteries (P < 0.05). Both good CCTA and CT-MPI images can be obtained at the one-stop scanning by Revolution CT. This can be used for the diagnosis of AVD combined with myocardial ischemia. Revolution CT can accurately measure myocardial hemodynamic changes, and provide imaging evidence for the diagnosis and treatment of aortic valve degeneration.