ABC | Volume 113, Nº4, October 2019

Review Article Magalhães et al. Principles of MPCT Arq Bras Cardiol. 2019; 113(4):758-767 1. Sara L, Szarf G, Tachibana A, Shiozaki AA, Villa AV, Oliveira AC, et al. II Diretriz de Ressonancia Magnetica e Tomografia Computadorizada Cardiovascular da Sociedade Brasileira de Cardiologia e do Colegio Brasileiro de Radiologia. Arq Bras Cardiol. 2014;103(6 Suppl 3):1-86. 2. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. The N Engl J Med. 2008;359(22):2324-36. 3. Sun Z, Ng KH. Multislice CT angiography in cardiac imaging. Part II: clinical applications in coronary artery disease. SingaporeMed J. 2010;51(4):282-9. 4. Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress myocardial perfusion: imaging with multidetector CT. Radiology. 2014;270(1):25-46. 5. MeijboomWB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52(25):2135-44. 6. Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, et al. Comprehensive assessment of coronary artery stenoses: References Table 3 – Elements of the combined report CCTA + Myocardial CTP Protocol used (rest-stress, stress-rest, dynamic perfusion or dual energy perfusion) and iodinated contrast volume Scanner Stressor agent, doses and reversing agent (when applicable) Presence of symptoms and electrocardiographic changes in stress. CCTA description (quantification of stenosis) Myocardial CTP description (qualitative/quantitative analysis, artifacts) Anatomic-perfusional integration Conclusion CCTA: coronary computed tomography angiography; CTP: computed tomography perfusion. routine coronary tomography images without the need for pharmacological stress. Usually, coronary tomography images are transferred to a dedicated computer, where simulations based on computational fluid dynamics are performed, in order to create a three‑dimensional model based on the anatomical and physiological characteristics of each patient. This model identifies stenoses and quantifies changes in intracoronary pressures, reflecting the changes found in stenoses invasively assessed by FFR. 61 The most recent data point to an optimal accuracy of this method, and equivalent to the combined assessment CCTA + Myocardial CTP to define flow‑limiting stenoses using invasive FFR as a reference. 62 Although promising, this technique also faces limitations, such as the impossibility of use in revascularized patients with stents, as well as examinations with motion artifacts/calcification that prevent the proper identification of lumen boundaries to generate the three-dimensional model. Moreover, because it is a technique with specific and hard-availability software and hardware, FFR‑CT is still restricted to some centers in the world (in Brazil, only used as a research tool). Conclusion CCTA combined with stress tomography evaluation of myocardial perfusion is a safe and accurate modality for the simultaneous investigation of coronary obstructions and their repercussions on regional myocardial flow. The positive impact of this approach lies on the value added by the ischemic burden information provided by myocardial perfusion upon CT, a well-established method of anatomical and coronary stenosis assessment, with acceptable doses of radiation and the use of iodinated contrast. Author contributions Conception and design of the research and Critical revision of the manuscript for intellectual content: Magalhães TA, Cury RC, Schvartzman P; Writing of the manuscript: Magalhães TA, Cury RC, Cerci RJ, Parga Filho JR, Gottlieb I, Nacif MS, Masciarelli Pinto I, Rochitte CE, Vilas-Boas F, Schvartzman P. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 764