Low-dose CT perfusion with combined use of CTP and CTP-derived coronary CT angiography at 70 kVp: validation with invasive fractional flow reserve

Yi, Yan; Xu, Cheng; Wu, Wei; Shen, Zhu Jun; Lee, Whal; Yun, Chun Ho; Lü, Bin; Zhang, Jia Yin; Jin, Zheng; Wang, Yi Ning

doi:10.1007/s00330-020-07096-x

Cited by 13 publications

(12 citation statements)

References 22 publications

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“…Both the optimal cutoff of MBF and the MBF of the remote myocardium reported by Bamberg et al ( 5 ), Greif et al ( 19 ), and Rossi et al ( 20 ) was significantly lower, which may be due to the fact that these studies included patients with MI and a history of revascularization. Studies excluding patients with a history of MI and a history of revascularization reported a cutoff value of MBF ranging from 89.5 to 106 ml/100 ml/min, and the MBF of the remote myocardium ranged between 116 ml/100 ml/min and 169 ml/100 ml/min ( 10 , 12 , 15 , 21 – 25 ), which are consistent with the present study. Obviously, the severity of myocardial ischemia in patients affects the optimal cutoff value of MBF.…”

Section: Discussionsupporting

confidence: 91%

“…Previous publications with positron emission computed tomography (PET) ( 7 , 8 ) and magnetic resonance imaging (MRI) ( 9 ) have suggested absolute MBF values for normal participants and thresholds for discriminating ischemic myocardial disease. However, previous studies have shown that MBF values vary with different imaging modalities, and that CT underestimates the stress MBF of normal myocardia compared with PET ( 5 , 7 , 8 , 10 – 13 ). Therefore, it is necessary to establish the normal range of MBF through dynamic CT-MPI.…”

Section: Introductionmentioning

confidence: 89%

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Knowledge of Hyperemic Myocardial Blood Flow in Healthy Subjects Helps Identify Myocardial Ischemia in Patients With Coronary Artery Disease

Lyu

Pan

et al. 2022

Front. Cardiovasc. Med.

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BackgroundsDynamic CT myocardial perfusion imaging (CT-MPI) allows absolute quantification of myocardial blood flow (MBF). Although appealing, CT-MPI has not yet been widely applied in clinical practice, partly due to our relatively limited knowledge of CT-MPI. Knowledge of distribution and variability of MBF in healthy subjects helps in recognition of physiological and pathological states of coronary artery disease (CAD).ObjectivesTo describe the distribution and normal range of hyperemic MBF in healthy subjects obtained by dynamic CT-MPI and validate whether it can accurately identify functional myocardial ischemia when the cut-off value of hyperemia MBF is set to the lower limit of the normal range.Materials and MethodsFifty-one healthy volunteers (age, 38 ± 12 years; 15 men) were prospectively recruited. Eighty patients (age, 58 ± 10 years; 55 men) with suspected or known CAD who underwent interventional coronary angiography (ICA) examinations were retrospectively recruited. Comprehensive CCTA + dynamic CT-MPI protocol was performed by the third – generation dual-source CT scanner. Invasive fractional flow reserve (FFR) measurements were performed in vessels with 30–90% diameter reduction. ICA/FFR was used as the reference standard for diagnosing functional ischemia. The normal range for the hyperemic MBF were defined as the mean ± 1.96 SD. The cut-off value of hyperemic MBF was set to the lower limit of the normal range.ResultsThe global hyperemic MBF were 164 ± 24 ml/100 ml/min and 123 ± 26 ml/100 ml/min for healthy participants and patients. The normal range of the hyperemic MBF was 116–211 ml/100 ml/min. Of vessels with an ICA/FFR result (n = 198), 67 (34%) were functionally significant. In the per-vessel analysis, an MBF cutoff value of <116 ml/100 ml/min can identify myocardial ischemia with a diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 85.9% (170/198), 91.0% (61/67), 83.2 % (109/131), 73.5% (61/83), and 94.8% (109/115). CT-MPI showed good consistency with ICA/FFR in diagnosing functional ischemia, with a Cohen's kappa statistic of 0.7016 (95%CI, 0.6009 – 0.8023).ConclusionRecognizing hyperemic MBF in healthy subjects helps better understand myocardial ischemia in CAD patients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 89%

Knowledge of Hyperemic Myocardial Blood Flow in Healthy Subjects Helps Identify Myocardial Ischemia in Patients With Coronary Artery Disease

Lyu

Pan

et al. 2022

Front. Cardiovasc. Med.

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“…To minimize the sedation effect, all swine were scanned randomly within 1 h of the sedation completion. Second, the dosage of ATP is based on clinical experience ( 7 , 15 ). For animals in a sedated state, the dosage of ATP used in the present study may not allow the animals to reach the maximum vasodilated state.…”

Section: Discussionmentioning

confidence: 99%

Dose Reduction of Dynamic Computed Tomography Myocardial Perfusion Imaging by Tube Voltage Change: Investigation in a Swine Model

Geng

Gao

Zhao

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIt is unclear whether tube voltage influences the measurement of perfusion parameters. The present study sought to evaluate the influence of tube voltage change on myocardial blood flow (MBF) measurements in dynamic computed tomography myocardial perfusion imaging (CTP).Methods and ResultsSeven swine [mean weight 55.8 kg ± 1.6 (standard deviation)] underwent rest and stress dynamic CTP with tube voltages of 100 and 70 kV. The image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), radiation dose and MBF value were compared. The 70 kV images had higher CT attenuation and higher image noise (27.9 ± 2.4 vs. 21.5 ± 1.9, P < 0.001) than the 100 kV images, resulting in a higher SNR (20.5 ± 1.6 vs. 15.6 ± 1.8, P < 0.001) and CNR (17.6 ± 1.5 vs. 12.4 ± 1.7, P < 0.001). Compared to the use of conventional 100 kV, 70 kV yielded an approximately 64.6% radiation dose reduction while generating comparable MBF values, both at rest (88.3 ± 14.9 ml/100 g/min vs. 85.6 ± 17.4 ml/100 g/min, P = 0.21) and stress (101.4 ± 21.5 ml/100 g/min vs. 99.6 ± 21.4 ml/100 g/min, P = 0.58) states.ConclusionDynamic CTP using 70 kV instead of 100 kV does not substantially influence the MBF value but significantly reduces the radiation dose. Additional research is required to investigate the clinical significance of this change.

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“…Furthermore, Yi et al [14] conducted a study to investigate the diagnostic performance of 70-kVp stress dynamic myocardial CT perfusion as a low-dose, one-stop cardiac CT examination in clinical application. Seventy-one consecutive symptomatic patients were prospectively recruited and scanned with stress dynamic myocardial CTP.…”

Section: Low Dose "One-stop" Ctpmentioning

confidence: 99%

Clinical Applications of CT Myocardial Perfusion Imaging

2020

Cardiovasc Imaging Asia

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Low-dose CT perfusion with combined use of CTP and CTP-derived coronary CT angiography at 70 kVp: validation with invasive fractional flow reserve

Cited by 13 publications

References 22 publications

Knowledge of Hyperemic Myocardial Blood Flow in Healthy Subjects Helps Identify Myocardial Ischemia in Patients With Coronary Artery Disease

Knowledge of Hyperemic Myocardial Blood Flow in Healthy Subjects Helps Identify Myocardial Ischemia in Patients With Coronary Artery Disease

Dose Reduction of Dynamic Computed Tomography Myocardial Perfusion Imaging by Tube Voltage Change: Investigation in a Swine Model

Clinical Applications of CT Myocardial Perfusion Imaging

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