Volumetric quantification of myocardial perfusion using analysis of multi-detector computed tomography 3D datasets: comparison with nuclear perfusion imaging

Kachenoura, Nadjia; Veronesi, Federico; Lodato, Joseph A.; Corsi, Cristiana; Mehta, Rupa; Newby, Barbara; Lang, Roberto M.; Mor‐Avi, Victor

doi:10.1007/s00330-009-1552-x

Cited by 21 publications

(20 citation statements)

References 30 publications

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“…Figure 7 shows the mean attenuations obtained for all segments. Notice the wave-like variation among segments, consistent with analogous results obtained by Kachenoura et al [2]. Considering the small number of patients involved, these are preliminary results and we aim to extend this study to a larger population.…”

Section: Segmental Attenuation Histogramsupporting

confidence: 91%

“…As proposed by Kachenoura et al [2] using a mixed index accounting for severity (how low the attenuation goes) and volume (how much voxels are below the reference) of the lesions leads to a good distinction between healthy and hypoperfused segments. Furthermore, this method also allows proper adjustments considering the naturally occurring mean attenuation differences among myocardial segments.…”

Section: Discussionmentioning

confidence: 97%

“…A different approach to perfusion analysis tested (as proposed by Kachenoura et al [2]), consists in performing the analysis using the statistics of each myocardial segment instead of the statistics for the whole myocardium. For each segment the attenuation histogram is computed.…”

Section: Segmental Attenuation Histogrammentioning

confidence: 99%

“…Furthermore, perfusion analysis is usually performed visually and depends on manual window/level adjustments which might vary among operators [2].…”

Section: Introductionmentioning

confidence: 99%

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Myocardial Perfusion Analysis from Adenosine-Induced Stress MDCT

Silva

Bettencourt

Leite

et al. 2011

Pattern Recognition and Image Analysis

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Abstract. Myocardial perfusion assessment is of paramount importance for the diagnosis of coronary artery disease. This can be performed using different image modalities such as single-photon emission computed tomography (SPECT) or magnetic resonance imaging (MRI). Recently, cardiac multiple-detector computed tomography (MDCT) has shown promising results with the benefit of gathering data regarding coronary anatomy, ventricular function and myocardial perfusion in a single study. Preliminary results for three different methods for automatic assessment of myocardial perfusion from adenosine-induced stress MDCT are presented.

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Section: Segmental Attenuation Histogramsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Segmental Attenuation Histogrammentioning

confidence: 99%

“…Furthermore, perfusion analysis is usually performed visually and depends on manual window/level adjustments which might vary among operators [2].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Myocardial Perfusion Analysis from Adenosine-Induced Stress MDCT

Silva

Bettencourt

Leite

et al. 2011

Pattern Recognition and Image Analysis

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“…Beginning in 2005, different authors [1,[7][8][9] attempted perfusion imaging with CT under resting conditions to evaluate the density of the myocardium in normal CTA or in test bolus data acquisitions [10]. All these authors found good correlation, with nuclear medicine or MRI serving as the gold standard.…”

mentioning

confidence: 99%

Commentary on: delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI

Wolf

2011

Eur Radiol

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In 2005, Nikolaou et al.[1] published a paper in European Radiology about the assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detectorrow computed tomography. The authors reported promising results, however, concluded carefully: "… application of delayed enhancement techniques might be useful. … However, this procedure requires a second delayed CT scan, increasing the radiation exposure of the patient."I remember the first scientific presentations about cardiac perfusion imaging and delayed enhancement using computed tomography-it was interesting, but the scientific community considered this topic more or less a scientific gimmick rather than serious work with clinical relevance. Now, in 2011, Alkadhi et al.[2] publish in European Radiology a paper entitled "Delayed enhancement imaging of myocardial viability: Low-dose high-pitch CT versus MRI." The authors included 24 patients and could show that by using the newest generation CT equipment, delayed enhancement by CT has become a reality at a ultra-low radiation dose in submillisievert range, and is now ready for clinical use: The estimated mean radiation dose was as low as 0.89±0.07 mSv (range: 0.74-1.02 mSv). This low radiation dose was obtained by using the "high-pitch" spiral CT technique with a pitch factor of 3.4 and prospective ECG-synchronization; furthermore a 100 kV tube voltage was applied for the delayed enhancement CT data acquisition, making use of the higher attenuation of iodine at lower photon energies. In the present study, the authors perform a standard contrast-enhanced CTA using a high-pitch protocol on a commercially available 128-slice, dual-source CT system after the administration of 70 ml iodinated contrast media. In order to achieve an adequate dose of iodine, 5 min after the first CT data-acquisition, a second dose of 70 ml of iodinated contrast media was administered and, after a total delay of around 15 min from the first injection, a second high-pitch delayed enhancement CT data-set was obtained. The sensitivity, specificity, and accuracy of CT for the diagnosis of non-viability were 90.0%, 92.9%, and 91.7% per patient and 60.7%, 96.8% and 94.4% per segment, respectively, with MRI serving as the gold standard.What happened in the last 6 years to make the vision of myocardial viability imaging a reality?In my opinion, new technical developments such as lowdose gating techniques, prospective ECG-triggering and high-pitch CT are all responsible for this present step forward in cardiac imaging. The Cardiac Imaging 'hype' started with the introduction of 64-slice CT with a revolution in image quality. This first wave of excitement was followed by a disillusion: the radiation dose of cardiac CT reached values of 12-14 mSv, even higher than the radiation dose values of a conventional invasive angiography. However with the introduction of newer CT equipment with 128-, 256-, and 320-slices, as well as dual source CT-machines, faster CT protocols with radically lower radiation dose have become possible. In ...

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Hemodynamic impact of coronary stenosis using computed tomography: comparison between noninvasive fractional flow reserve and 3D fusion of coronary angiography with stress myocardial perfusion

Patel

Maffessanti

Patel

et al. 2019

Int J Cardiovasc Imaging

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Vasodilator-stress CT perfusion imaging in addition to CT coronary angiography (CTCA) may provide a single-test alternative to nuclear stress testing, commonly used to assess hemodynamic significance of stenosis. Another alternative is fractional flow reserve (FFR) calculated from cardiac CT images. We studied the concordance between these two approaches and their relationship to outcomes. We prospectively studied 150 patients with chest pain, who underwent CTCA and regadenoson CT. CTCA images were interpreted for presence and severity of stenosis. Fused 3D displays of subendocardial X-ray attenuation with coronary arteries were created to detect stress perfusion defects (SPD) in each coronary territory. In patients with stenosis > 25%, CT-FFR was quantified. Significant stenosis was determined by: (1) combination of stenosis > 50% with an SPD, (2) CT-FFR ≤ 0.80. Patients were followed-up for 36 ± 25 months for death, myocardial infarction or revascularization. After excluding patients with normal arteries and technical/quality issues, in final analysis of 76 patients, CTCA depicted stenosis > 70% in 13/224 arteries, 50-70% in 24, and < 50% in 187. CT-FFR ≤ 0.80 was found in 41/224 arteries, and combination of SPD with > 50% stenosis in 31/224 arteries. Inter-technique agreement was 89%.

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Volumetric quantification of myocardial perfusion using analysis of multi-detector computed tomography 3D datasets: comparison with nuclear perfusion imaging

Abstract: Our new technique for volumetric analysis of 3D MDCT images allows accurate objective detection of perfusion defects. This perfusion information can be obtained without additional radiation or contrast load, and may aid in elucidating the significance of coronary lesions.

Cited by 21 publications

References 30 publications

Myocardial Perfusion Analysis from Adenosine-Induced Stress MDCT

Myocardial Perfusion Analysis from Adenosine-Induced Stress MDCT

Commentary on: delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI

Hemodynamic impact of coronary stenosis using computed tomography: comparison between noninvasive fractional flow reserve and 3D fusion of coronary angiography with stress myocardial perfusion

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