Dynamic Computed Tomography Myocardial Perfusion Imaging

Rossi, Alexia; Wragg, Andrew; Klotz, Ernst; Pirro, Federica; Moon, James; Nieman, Koen; Pugliese, Francesca

doi:10.1161/circimaging.116.005505

Cited by 60 publications

(19 citation statements)

References 53 publications

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“…The myocardial blood flow (MBF; ml/100 ml/min) per-coronary artery territory was calculated from maximum slope of the fit model curve normalized to the peak arterial enhancement as follow: A region of interest (corresponding to 0.5 cm 3 of subendocardial myocardium) was sampled onto the MBF polar maps for each vessel territory (either in the area of suspected ischemia or centrally within territories without suspected ischemia). The reference MBF was defined as the 75th percentile of the automatically generated global endocardial MBF representing a robust measure of normal MBF in a specific patient/examination relatively unaffected by territorial ischemia or artifacts ( 18 ). Relative MBF was calculated (per vessel territory) as the absolute MBF divided by the reference MBF.…”

Section: Methodsmentioning

confidence: 99%

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison

Gibarti¹,

Murín²,

Huňavý³

et al. 2023

Exp Ther Med

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Cardiac computed tomography (CT) angiography offers several approaches to determine the hemodynamic severity of coronary artery obstruction. Dynamic myocardial perfusion is based on serial CT imaging of contrast flow into the myocardium and calculation of absolute myocardial perfusion rates. East-Slovak Institute of Cardiovascular Diseases has been the first center in Slovakia intensively using this modern technique to increase the quality level of non-invasive diagnosis of symptomatic patients with a low to moderate pre-test probability of ischemic heart disease. The present study included 46 patients with a mean age of 64 years (33 men and 13 women). Prior to the CT study, myocardial stress was pharmacologically (adenosine, n=15 and regadenoson, n=31) induced by vasodilatation of the coronary arteries. Hemodynamic parameters (myocardial blood flow) were evaluated in all patients following successful CT perfusion without complications, allergic reaction or other severe side effects. The present study revealed that regadenoson increased the heart rate following infusion with a higher magnitude compared with adenosine. Moreover, the effect of regadenoson was independent of patient's body mass index and was associated with a lower incidence of mild adverse effects. The present study provided further clinical evidence for a more wider use of regadenoson over adenosine.

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Section: Methodsmentioning

confidence: 99%

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison

Gibarti¹,

Murín²,

Huňavý³

et al. 2023

Exp Ther Med

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“…DM-CTP requires a scanner capable of obtaining 30 seconds of consecutive ECG-triggered acquisitions for every-second or every other second heartbeat covering the entire myocardium. This can be achieved with a single-tube multidetector scanner with 256 or 320 detectors resulting in 160 mm z-axis coverage or alternatively, with a third generation dual-source CT system in shuttle mode, where the table moves back and forth between the two scanning positions, resulting in up to 105 mm total z-axis coverage [34][35][36] (Fig. 4).…”

Section: Ct Scanner Requirementsmentioning

confidence: 99%

“…40,72 In order to achieve standardization across post processing software and scanners, the authors suggest a relative approach, which is partly adapted from reporting of myocardial perfusion positron emission tomography and utilized in modified versions in recent DM-CTP accuracy studies. 13,36,73,74 Relative segmental perfusion is calculated as the ratio between the absolute MBF in the segment of interest divided by the reference MBF. Reference MBF is defined as the mean value of segments supplied by healthy vessels (< 50% stenosis on CCTA).…”

Section: Dm-ctp Imagingmentioning

confidence: 99%

Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography

Møller

Schuijf²,

Oyama‐Manabe

et al. 2022

Journal of Thoracic Imaging

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Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality.

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“…Nevertheless, registration itself inherently alters the myocardial CT number, incurring errors in quantitative perfusion measurement. Moreover, dynamic CT perfusion techniques underestimate perfusion as compared to quantitative PET, especially under hyperemic conditions 13 , where such inaccuracies are further exacerbated by cardiac and respiratory motion despite registration 14 . Hence, a better solution to dynamic CT perfusion measurement remains necessary.…”

Section: Introductionmentioning

confidence: 99%

Dynamic CT myocardial perfusion without image registration

Hubbard

Malkasian

Molloi

2022

Sci Rep

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The aim of this study was to validate a motion-immune (MI) solution to dynamic CT myocardial perfusion measurement, in the presence of motion without image registration. The MI perfusion technique was retrospectively validated in six swine (37.3 ± 7.5 kg) with a motion-susceptible (MS) perfusion technique performed for comparison. In each swine, varying severities of stenoses were generated in the left anterior descending (LAD) coronary artery using a balloon under intracoronary adenosine stress, followed by contrast-enhanced imaging with 20 consecutive volume scans per stenosis. Two volume scans were then systematically selected from each acquisition for both MI and MS perfusion measurement, where the resulting LAD and left circumflex (LCx) measurements were compared to reference microsphere perfusion measurements using regression and diagnostic performance analysis. The MI (PMI) and microsphere (PMICRO) perfusion measurements were related through regression by PMI = 0.98 PMICRO + 0.03 (r = 0.97), while the MS (PMS) and microsphere (PMICRO) perfusion measurements were related by PMS = 0.62 PMICRO + 0.15 (r = 0.89). The accuracy of the MI and MS techniques in detecting functionally significant stenosis was 93% and 84%, respectively. The motion-immune (MI) perfusion technique provides accurate myocardial perfusion measurement in the presence of motion without image registration.

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Dynamic Computed Tomography Myocardial Perfusion Imaging

Abstract: Endocardial perfusion parameters obtained by semiautomatic analysis of dynamic computed tomography myocardial perfusion imaging may permit robust discrimination between coronary vessels causing ischemia versus not causing ischemia.

Cited by 60 publications

References 53 publications

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison

Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography

Dynamic CT myocardial perfusion without image registration

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