Underestimation of myocardial blood flow by dynamic perfusion CT: Explanations by two-compartment model analysis and limited temporal sampling of dynamic CT

Ishida, Masaki; Kitagawa, Kakuya; Ichihara, T.; Natsume, Takahiro; Nakayama, Ryohei; Nagasawa, Naoki; Kubooka, Makiko; Ito, Tatsuro; Uno, Mio; Goto, Yoshitaka; Nagata, Motonori; Sakuma, Hajime

doi:10.1016/j.jcct.2016.01.008

Cited by 44 publications

(38 citation statements)

References 27 publications

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“…Future developments. Two-compartment analysis might reduce underestimation of MBF by CT 163,164 , and the semiquantitative transmural perfusion ratio might improve diagnosis of myocardial ischaemia compared with using the MBF 165 . Low kilovolt scanning (70-80 kV) enables a substantial reduction in radiation dose, while increasing contrast-to-noise ratio 166 .…”

Section: Key Points For Echocardiographymentioning

confidence: 99%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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International guidelines advocate noninvasive testing for patients with suspected ischaemia before proceeding with revascularization decision-making 1-4. Noninvasive clinical cardiac imaging continues to undergo rapid evolution, focusing on quantitative perfusion technologies for the assessment of myocardial ischaemia and coronary flow. At present, imaging of myocardial ischaemia stands at a crossroads. During a European meeting on quantitative cardiac imaging, a bench-to-bedside-to-bench perspective was used to summarize the current status and future potential of myocardial ischaemia imaging from the viewpoint of basic scientists and clinical researchers. This approach created discussions, which led to this Consensus Statement on the main advantages and disadvantages of each imaging modality, a clinical consensus on the appropriateness for specific indications and a summary of the latest developments, which together provide a framework for future quantitative imaging of myocardial ischaemia. Pathophysiology considerations The coronary circulation comprises the epicardial conductance vessels (diameter 1-6 mm) feeding an extensive network of small vessels (diameter <300-400 μm) that penetrates the cardiac muscle tissue and is the site of regulation of myocardial blood flow (MBF; Fig. 1a,b). High-resolution 3D fluorescence cryomicrotome imaging 5 has also revealed the existence of abundant small

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Section: Key Points For Echocardiographymentioning

confidence: 99%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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“…Quantitative parameters are useful for assessment of balanced ischemia in triple-vessel disease, which is difficult to assess on SPECT. There are several mathematical methods for quantifying myocardial perfusion in dynamic CTP, including maximum upslope, a compartment model, an extended Toft model, a Patlak plot, a Fermi parametric model, and model-independent deconvolution [35,63,64]. However, the optimal quantification method remains controversial and the cut-off value on dynamic CTP imaging is still not standardized.…”

Section: Interpretation Of Ctp Imagesmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CTfractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.

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“…In the maximum slope method, myocardial blood flow (MBF) is estimated as the ratio of the maximum instantaneous slope of the myocardial iodine enhancement curve to the maximum value of the input function, multiplied by the reciprocal of the tissue density based on the assumption that the rate of arrival of contrast agent is proportional to the tissue perfusion level [34]. However, mathematically, MBF determined by the equation is equal to the blood-to-myocardium transfer constant, Ktrans in the Patlak model, which requires flow-dependent extraction fraction of contrast medium to be converted to MBF [35,36]. In addition, limited sampling rate may lead to substantial underestimation of MBF [35].…”

Section: Quantitative Myocardial Perfusion Estimationmentioning

confidence: 99%

“…However, mathematically, MBF determined by the equation is equal to the blood-to-myocardium transfer constant, Ktrans in the Patlak model, which requires flow-dependent extraction fraction of contrast medium to be converted to MBF [35,36]. In addition, limited sampling rate may lead to substantial underestimation of MBF [35]. Expected systemic underestimation of MBF by the maximum slope method has been seen experimentally in comparison with microsphere-derived MBF [37,38].…”

Section: Quantitative Myocardial Perfusion Estimationmentioning

confidence: 99%

Dynamic CT Perfusion Imaging: State of the Art

Kitagawa

Goto

Nakamura

et al. 2018

Cardiovasc Imaging Asia

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Recent advances in computed tomography (CT) technology have enabled stress dynamic CT perfusion (CTP) imaging of the entire myocardium to be performed with high temporal resolution and reasonable radiation dose. The most important advantage of dynamic CTP is the feasibility of complete quantification of myocardial perfusion in mL/min/g. Although high diagnostic values have been reported for the detection of myocardial ischemia, standardization of acquisition method, mathematical modeling and interpretation, as well as further evaluation of its accuracy, clinical role, and cost effectiveness are required before its routine clinical implementation. The current review focuses on the state-of-the-art of dynamic CTP and outlines its current status and future directions as a new technology for the physiologic assessment of coronary artery disease.

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Underestimation of myocardial blood flow by dynamic perfusion CT: Explanations by two-compartment model analysis and limited temporal sampling of dynamic CT

Cited by 44 publications

References 27 publications

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Computed tomographic evaluation of myocardial ischemia

Dynamic CT Perfusion Imaging: State of the Art

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