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March 16, 2020

SCCT Publishes Expert Consensus Document on Myocardial CT Perfusion Imaging

March 16, 2020—The Society of Cardiovascular Computed Tomography (SCCT) announced the release of the 2020 expert consensus document on myocardial CT perfusion (CTP) imaging. The 2020 guideline, a result of a consensus statement of experts in the field, was published by Amit Patel, MD, et al in Journal of Cardiovascular Computed Tomography (2020;14:87–100).

According to SCCT, the new recommendations outline the use of both coronary anatomy and myocardial perfusion to help identify those patients who might benefit most from further invasive procedures to treat their coronary artery disease.

The society advised that the new consensus statement provides expert consensus regarding the performance and interpretation of CTP imaging, including patient selection, image acquisition, postprocessing, and interpretation of CTP results.

The consensus document includes:

  • Recommendations for when myocardial CTP may be useful and who should be performing myocardial CTP imaging
  • Recommendations for safe use of pharmacologic stress agents in the CT environment
  • Recommendations on image acquisition and interpretation of CTP
  • Recommendations for reporting CTP results

The recommendations were written by 12 experts and based on the level of consensus: strong (≥ 9 in agreement), moderate (7–8), and weak (6). Recommendations with fewer than six of the author group in support of the statement were not adopted into the 2020 expert consensus document.

The SCCT stated that there is a growing body of evidence that establishes the diagnostic accuracy and incremental value of myocardial CTP versus coronary CTA. In single-center studies, myocardial CTP imaging has demonstrated high accuracy when compared with single-photon emission CT, cardiovascular magnetic resonance, invasive coronary angiography, positron emission tomography, and invasive fractional flow reserve. Multicenter studies have also established the accuracy of combining myocardial CTP with coronary CTA. These studies suggest that CTP is particularly accurate when interpreted in the context of coronary CTA findings.

In the society's announcement, Dr. Patel commented, “[CTP] has been developed and significantly validated over the last decade; however, its adoption into clinical practice has been limited by the lack of standardization and other factors. This international expert consensus group was comprised of a diverse group of individuals with significant experience in [CTP] imaging and were tasked to identify some of the key principles that unify the various approaches to CTP.”

Writing group co-chair Ron Blankstein, MD, who is SCCT president, added, “The combination of coronary CTA and CTP can be used to detect both coronary atherosclerosis as well as its physiological consequences. While further studies will continue to refine the capabilities of CTP, the current expert consensus statement will be useful for clinicians and researchers who are interested in adopting this technique.”

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