Quantitative Whole Heart Stress Perfusion CT Imaging as Noninvasive Assessment of Hemodynamics in Coronary Artery Stenosis

Mahnken, Andreas H.; Klotz, Ernst; Pietsch, Hubertus; Schmidt, Bernhard; Allmendinger, Thomas; Haberland, Ulrike; Kalender, Willi A.; Flohr, Thomas

doi:10.1097/rli.0b013e3181dfa3cf

Cited by 112 publications

(74 citation statements)

References 22 publications

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“…It helps physicians to recognize various quantitative parameters of the LV at a glance, such as the intensity, intensity difference, and transmural perfusion ratio and thickness 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 . This 2D polar plot was generated from 17 myocardial segments on 3D polar coordinates.…”

Section: Methodsmentioning

confidence: 99%

Patient‐specific 17‐segment myocardial modeling on a bull's‐eye map

Jung

Kim

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to develop and validate cardiac computed tomography (CT) quantitative analysis software with a patient‐specific, 17‐segment myocardial model that uses electrocardiogram (ECG)‐gated cardiac CT images to differentiate between normal controls and severe aortic stenosis (AS) patients. ECG‐gated cardiac CT images from 35 normal controls and 144 AS patients were semiautomatically segmented to create a patient‐specific, 17‐segment myocardial model. Two experts then manually determined the anterior and posterior interventricular grooves to be boundaries between the 1st and 2nd segments and between the 3rd and 4th segments, respectively, to correct the model. Each segment was automatically identified as follows. The outer angle of two boundaries was divided to differentiate the 1st, 4th, 5th, and 6th segments in the basal plane, whereas the inner angle divided the 2nd and 3rd segments. The segments of the midplane were similarly divided. Segmental area distributions were quantitatively evaluated on the bull's‐eye map on the basis of the morphological boundaries by measuring the area of each segment. Segmental areas of severe AS patients and normal controls were significantly different (t‐test, all p‐values<0.011) in the proposed model because the septal regions of the severe AS patients were smaller than those of normal controls and the difference was enough to divide the two groups. The capabilities of the 2D segmental areas (p<0.011) may be equivalent to those of 3D segmental analysis (all p‐values<0.001) for differentiating the two groups (t‐test, all p‐values<0.001). The proposed method is superior to the conventional 17‐segment in relation to reflection of patient‐specific morphological variation and allows to obtain a more precise mapping between segments and the AHA recommended nomenclature. It can be used to differentiate severer AS patients and normal controls and also helps to understand the left ventricular morphology at a glance.PACS number(s): 87.57.N‐, 87.57.R‐, 87.57.qp

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Section: Methodsmentioning

confidence: 99%

Patient‐specific 17‐segment myocardial modeling on a bull's‐eye map

Jung

Kim

et al. 2016

J Applied Clin Med Phys

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“…As has been previously described, 24 MBF was estimated using a dedicated parametric deconvolution technique based on a 2-compartment model of the intravascular and extravascular spaces to fit the time attenuation curves. The algorithm then generated a MBF map with 3-mm thickness and 1-mm increments by applying the maximum slope approach onto the model curve that was fit for every voxel.…”

Section: Ct Perfusion and Ctde Data Evaluationmentioning

confidence: 99%

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Goto

Kitagawa

Uno

et al. 2017

Circ J

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limited response to vasodilator stress, resulting in globally reduced hyperemic MBF. 15 Because the endocardial layer is most susceptible to ischemia, 16,17 the ratio of endocardial MBF and epicardial MBF might be a more useful indicator of flow-limiting CAD.The purpose of this study was to investigate whether the transmural ratio of absolute MBF can improve the accuracy of CTP when compared with absolute MBF for the detection of flow-limiting CAD, as defined by fractional flow reserve (FFR). We also explored the prevalence of myocardial scar in candidates for CTP and its effect on the diagnostic performance of CTP. Methods Study PopulationIn the comprehensive cardiac CT registry at Mie University C oronary computed tomography angiography (CCTA) allows noninvasive assessment of the morphology of coronary artery stenosis and is highly useful for ruling out the presence of obstructive coronary artery disease (CAD). 1,2 However, because obstructive stenosis identified by CCTA is a poor predictor of the presence of myocardial ischemia, a functional test is generally recommended to investigate the hemodynamic significance of the stenotic lesion. 3 Stress dynamic CT perfusion (CTP) with absolute quantification of myocardial blood flow (MBF) is a new noninvasive technique for the assessment of myocardial ischemia. 4,5 Previous CTP studies used absolute MBF thresholds in mL/100 g/min to discriminate flow-limiting CAD, 6-10 but the absolute MBF can vary because of factors other than the degree of coronary artery stenosis. Yoshitaka Goto, MD; Kakuya Kitagawa, MD; Mio Uno, MD; Shiro Nakamori, MD; Tatsuro Ito, MD; Naoki Nagasawa, PhD; Kaoru Dohi, MD; Hajime Sakuma, MD Background: Previous dynamic stress computed tomography perfusion (CTP) studies used absolute myocardial blood flow (MBF in mL/100 g/min) as a threshold to discriminate flow-limiting coronary artery disease (CAD), but absolute MBF can be vary because of multiple factors. The aim of this study was to compare the diagnostic performance of absolute MBF and the transmural perfusion ratio (TPR) for the detection of flow-limiting CAD, and to clarify the influence of CT delayed enhancement (CTDE) on the diagnostic performance of CTP.

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“…Artefacts included motion, beam-hardening, image reconstruction and misalignment artefacts. To detect subtle perfusion defects, observers used a user-defined narrow window width and window level setting as described previously [18]. Dynamic stress CT images were evaluated visually according to the 16 myocardial segments excluding the apical segment [19].…”

Section: Cardiac Mrimentioning

confidence: 99%

“…Therefore, AIF had double the sampling rate than the tissue time-attenuation curve. An algorithm was used to establish the maximum slope using the fit model curve for every voxel and measured MBF from the following relationship: MBF5maximum slope/maximum AIF, where the maximum slope indicates the tissue time-attenuation curve, and the maximum AIF indicates the maximum AIF value [13,18]. MBF and MBV were determined in each of the 16 myocardial segments, excluding the apical segment [19].…”

Section: Cardiac Mrimentioning

confidence: 99%

Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI

Kim

Jh²,

Chang³

et al. 2013

BJR

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Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI. Br J Radiol 2013;86: 20130481. FULL PAPER Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI Objective: We assessed the diagnostic performance of adenosine-stress dynamic CT perfusion (ASDCTP) imaging and coronary CT angiography (CCTA) for the detection of ischaemic myocardial lesions using 128-slice dual-source CT compared with that of 1.5 T cardiac MRI.Methods: This prospective study included 33 patients (6168 years, 82% male) with suspected coronary artery diseases who underwent ASDCTP imaging and adenosine-stress cardiac MRI. Two investigators independently evaluated ASDCTP images in correlation with significant coronary stenosis on CCTA using two different thresholds of 50% and 70% diameter stenosis. Hypoattenuated myocardial lesions on ASDCTP associated with significant coronary stenoses on CCTA were regarded as true perfusion defects. All estimates of diagnostic performance were calculated and compared with those of cardiac MRI.Results: With use of a threshold of 50% diameter stenosis on CCTA, the diagnostic estimates per-myocardial segment were as follows: sensitivity, 81% [95% confidence interval (CI): 70-92%]; specificity, 94% (95% CI: 92-96%); and accuracy 93% (95% CI: 91-95%). With use of a threshold of 70%, the diagnostic estimates were as follows: sensitivity, 48% (95% CI: 34-62%); specificity, 99% (95% CI: 98-100%); and accuracy, 94% (95% CI: 92-96%). Conclusion: Dynamic CTP using 128-slice dual-source CT enables the assessment of the physiological significance of coronary artery lesions with high diagnostic accuracy in patients with clinically suspected coronary artery disease. Advances in knowledge: Combined CCTA and ASDCTP yielded high accuracy in the detection of perfusion defects regardless of the threshold of significant coronary stenosis.It is important to evaluate not only anatomical information about coronary arteries but also physiological information about myocardial perfusion for the precise assessment of coronary artery disease (CAD) [1]. Myocardial perfusion imaging (MPI) can provide haemodynamic information during exercise-induced or pharmacological stress. Singlephoton emission tomography (SPECT), cardiac MRI or positron emission tomography (PET) has been extensively used for MPI [2,3]. Moreover, a normal MPI determined using these techniques carries an excellent prognosis with a low rate of cardiac events [4][5][6].SPECT and PET are limited in their ability to evaluate coronary artery morphology and cardiac structures. By contrast, CT MPI with coronary CTangiography (CCTA) can evaluate not only anatomical structure, including coronary artery morphology, but also myocardial perfusion status. Although radiation dose associa...

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Quantitative Whole Heart Stress Perfusion CT Imaging as Noninvasive Assessment of Hemodynamics in Coronary Artery Stenosis

Cited by 112 publications

References 22 publications

Patient‐specific 17‐segment myocardial modeling on a bull's‐eye map

Patient‐specific 17‐segment myocardial modeling on a bull's‐eye map

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI

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