Use of Flash and DE to replace SPECT in detection of ischemia tests?

The following question has been sent by Antonio Maestro:

Use of Flash and DE to replace SPECT in detection of ischemia tests?

Hi, i am doing a research to assess the clinical and patient workflow results of using a DSCT Definition Flash for the Chest Pain Unit patients.
It seems clear to me that we can use it to rule out low risk patients, but what i am trying to suggest is the possibility of including it as the ”first choice” test to detect ischemia for patients with a non conclusive ECG.
Using the dual energy, can we get perfusion images similar to the ones that we get with SPECT? Can we replace SPECT by Def. Flash or there are not enough researches about it yet?

Thank you so much for your help
Antonio Maestro

Stephan Achenbach, MD, University Hospital Erlangen:

It is difficult to answer this question because there is very little research on CT myocardial perfusion imaging. Also, in acute chest pain patients, a difference needs to be made in resting perfusion (which may be sufficient for some) and stress perfusion. All in all, CT has no reliable data to fall back on, while for SPECT there is an abundance of data. So it is a worthy area of research, but no recommendations for clinical use of CT perfusion or for its exact comparison to SPECT can be given.

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