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van Assen M, Pelgrim GJ, Slager E, van Tuijl S, Schoepf UJ, Vliegenthart R, Oudkerk M. Low CT temporal sampling rates result in a substantial underestimation of myocardial blood flow measurements. Int J Cardiovasc Imaging 2019; 35:539-547. [PMID: 30284642 PMCID: PMC6454077 DOI: 10.1007/s10554-018-1451-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/05/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the effect of temporal sampling rate in dynamic CT myocardial perfusion imaging (CTMPI) on myocardial blood flow (MBF). Dynamic perfusion CT underestimates myocardial blood flow compared to PET and SPECT values. For accurate quantitative analysis of myocardial perfusion with dynamic perfusion CT a stable calibrated HU measurement of MBF is essential. Three porcine hearts were perfused using an ex-vivo Langendorff model. Hemodynamic parameters were monitored. Dynamic CTMPI was performed using third generation dual source CT at 70 kVp and 230-350 mAs/rot in electrocardiography(ECG)-triggered shuttle-mode (sampling rate, 1 acquisition every 2-3 s; z-range, 10.2 cm), ECG-triggered non-shuttle mode (fixed table position) with stationary tube rotation (1 acquisition every 0.5-1 s, 5.8 cm), and non-ECG-triggered continuous mode (1 acquisition every 0.06 s, 5.8 cm). Stenosis was created in the circumflex artery, inducing different fractional flow reserve values. Volume perfusion CT Myocardium software was used to analyze ECG-triggered scans. For the non-ECG triggered scans MASS research version was used combined with an in-house Matlab script. MBF (mL/g/min) was calculated for non-ischemic segments. True MBF was calculated using input flow and heart weight. Significant differences in MBF between shuttle, non-shuttle and continuous mode were found, with median MBF of 0.87 [interquartile range 0.72-1.00], 1.20 (1.07-1.30) and 1.65 (1.40-1.88), respectively. The median MBF in shuttle mode was 56% lower than the true MBF. In non-shuttle and continuous mode, the underestimation was 41% and 18%. Limited temporal sampling rate in standard dynamic CTMPI techniques contributes to substantial underestimation of true MBF.
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Affiliation(s)
- Marly van Assen
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, EB44, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Gert Jan Pelgrim
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, EB44, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Emmy Slager
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, EB44, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | | | | | - Rozemarijn Vliegenthart
- Department of Radiology, Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, EB44, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Lukas S, Feger S, Rief M, Zimmermann E, Dewey M. Noise reduction and motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP): preliminary clinical evaluation of the ASTRA4D algorithm. Eur Radiol 2019; 29:4572-4582. [DOI: 10.1007/s00330-018-5899-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/15/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
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Pontone G, Andreini D, Guaricci AI, Baggiano A, Fazzari F, Guglielmo M, Muscogiuri G, Berzovini CM, Pasquini A, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M. Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease. JACC Cardiovasc Imaging 2019; 12:338-349. [DOI: 10.1016/j.jcmg.2017.10.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
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54
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Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis. Eur Radiol 2019; 29:3044-3061. [DOI: 10.1007/s00330-018-5919-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
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55
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Diagnostic accuracy of simultaneous evaluation of coronary arteries and myocardial perfusion with single stress cardiac computed tomography acquisition compared to invasive coronary angiography plus invasive fractional flow reserve. Int J Cardiol 2018; 273:263-268. [DOI: 10.1016/j.ijcard.2018.09.065] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/16/2018] [Accepted: 09/19/2018] [Indexed: 11/18/2022]
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56
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Dai X, Yu M, Pan J, Lu Z, Shen C, Wang Y, Lu B, Zhang J. Image quality and diagnostic accuracy of coronary CT angiography derived from low-dose dynamic CT myocardial perfusion: a feasibility study with comparison to invasive coronary angiography. Eur Radiol 2018; 29:4349-4356. [DOI: 10.1007/s00330-018-5777-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/27/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022]
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57
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Comprehensive Cardiac CT With Myocardial Perfusion Imaging Versus Functional Testing in Suspected Coronary Artery Disease. JACC Cardiovasc Imaging 2018; 11:1625-1636. [DOI: 10.1016/j.jcmg.2017.10.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 09/26/2017] [Accepted: 10/06/2017] [Indexed: 02/02/2023]
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58
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CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7295460. [PMID: 30406139 PMCID: PMC6204157 DOI: 10.1155/2018/7295460] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/09/2018] [Indexed: 12/21/2022]
Abstract
The past two decades have witnessed rapid and remarkable technical improvement of multidetector computed tomography (CT) in both image quality and diagnostic accuracy. These improvements include higher temporal resolution, high-definition and wider detectors, the introduction of dual-source and dual-energy scanners, and advanced postprocessing. Current new generation multidetector row (≥64 slices) CT systems allow an accurate and reliable assessment of both coronary epicardial stenosis and myocardial CT perfusion (CTP) imaging at rest and during pharmacologic stress in the same examination. This novel application makes CT the unique noninvasive "one-stop-shop" method for a comprehensive assessment of both anatomical coronary atherosclerosis and its physiological consequences. Myocardial CTP imaging can be performed with different approaches such as static arterial first-pass imaging, and dynamic CTP imaging, with their own advantages and disadvantages. Static CTP can be performed using single-energy or dual-energy CT, employing qualitative or semiquantitative analysis. In addition, dynamic CTP can obtain quantitative data of myocardial blood flow and coronary flow reserve. The purpose of this review was to summarize all available evidence about the emerging role of myocardial CTP to identify ischemia-associated lesions, focusing on technical considerations, clinical applications, strengths, limitations, and the more promising future fields of interest in the broad spectra of ischemic heart disease.
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Abstract
Computed tomography (CT) has become an important modality in the evaluation of coronary artery disease (CAD). The tremendous technological advances in CT in the last two decades has made it possible to obtain high quality images of coronary arteries with high spatial and temporal resolutions. Multiple trials have confirmed the accuracy of CT compared to invasive catheter angiography. CT is also able to evaluate beyond the lumen in characterizing and quantifying atherosclerotic plaques, including evaluation of high risk features. Although CTA has low specificity in identification of lesion-specific ischemia, functional techniques are now possible such as CT myocardial perfusion and CT-fractional flow reserve (FFR) which evaluate the hemodynamic significance of stenosis and help with revascularization strategies. Multi-energy CT provides additional information beyond what is possible with a conventional CT and is useful in variety of clinical applications, including myocardial perfusion imaging, lesion characterization and low contrast studies. Large trials have confirmed the ability of CT to predict major adverse cardiovascular events and recent trials have even demonstrated improved clinical outcomes by using CT for the evaluation of CAD. CT is also useful in structural heart disease and 3 D printing is now increasingly used for surgical/interventional planning. Machine learning is evolving rapidly and is likely to impact diagnosis and management.
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Affiliation(s)
- P Rajiah
- From the Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - S Abbara
- From the Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
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60
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Bian Z, Zeng D, Zhang Z, Gong C, Tian X, Yan G, Huang J, Guo H, Chen B, Zhang J, Feng Q, Chen W, Ma J. Low-dose dynamic myocardial perfusion CT imaging using a motion adaptive sparsity prior. Med Phys 2018; 44:e188-e201. [PMID: 28901610 DOI: 10.1002/mp.12285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 02/20/2017] [Accepted: 04/09/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Dynamic myocardial perfusion computed tomography (DM-PCT) imaging offers benefits over quantitative assessment of myocardial blood flow (MBF) for diagnosis and risk stratification of coronary artery disease. However, one major drawback of DM-PCT imaging is that a high radiation level is imparted by repeated scanning. To address this issue, in this work, we developed a statistical iterative reconstruction algorithm based on the penalized weighted least-squares (PWLS) scheme by incorporating a motion adaptive sparsity prior (MASP) model to achieve high-quality DM-PCT imaging with low tube current dynamic data acquisition. For simplicity, we refer to the proposed algorithm as "PWLS-MASP''. METHODS The MASP models both the spatial and temporal structured sparsity of DM-PCT sequence images with the assumption that the differences between adjacent frames after motion correction are sparse in the gradient image domain. To validate and evaluate the effectiveness of the present PWLS-MASP algorithm thoroughly, a modified XCAT phantom and preclinical porcine DM-PCT dataset were used in the study. RESULTS The present PWLS-MASP algorithm can obtain high-quality DM-PCT images in both phantom and porcine cases, and outperforms the existing filtered back-projection algorithm and PWLS-based algorithms with total variation regularization (PWLS-TV) and robust principal component analysis regularization (PWLS-RPCA) in terms of noise reduction, streak artifacts mitigation, and time density curve estimation. Moreover, the PWLS-MASP algorithm can yield more accurate diagnostic hemodynamic parametric maps than the PWLS-TV and PWLS-RPCA algorithms. CONCLUSIONS The study indicates that there is a substantial advantage in using the present PWLS-MASP algorithm for low-dose DM-PCT, and potentially in other dynamic tomography areas.
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Affiliation(s)
- Zhaoying Bian
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Dong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhang Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Changfei Gong
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Xiumei Tian
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Gang Yan
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jing Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Hong Guo
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Bo Chen
- College of Mathematics and Statistics, Shenzhen University, Shenzhen, 518060, China
| | - Jing Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Wufan Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China
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61
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Sui S, Hou Y, Ma Y, Wang Y, Yu M, Yang Y, Huang N. T max is a sensitive indicator of myocardial ischaemia under adenosine stress as determined by static PET imaging: a study in a porcine model. Clin Radiol 2018; 73:657-664. [DOI: 10.1016/j.crad.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/16/2018] [Indexed: 12/01/2022]
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62
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Ramsey BC, Fentanes E, Choi AD, Branch KR, Thomas DM. Myocardial Assessment with Cardiac CT: Ischemic Heart Disease and Beyond. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018; 11:16. [PMID: 29963220 PMCID: PMC5984644 DOI: 10.1007/s12410-018-9456-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent advancements, current trends, and the expanding role for cardiac CT (CCT) in the evaluation of ischemic heart disease, nonischemic cardiomyopathies, and some specific congenital myocardial disease states. RECENT FINDINGS CCT is a highly versatile imaging modality for the assessment of numerous cardiovascular disease states. Coronary CT angiography (CCTA) is now a well-established first-line imaging modality for the exclusion of significant coronary artery disease (CAD); however, CCTA has modest positive predictive value and specificity for diagnosing obstructive CAD in addition to limited capability to evaluate myocardial tissue characteristics. SUMMARY CTP, when combined with CCTA, presents the potential for full functional and anatomic assessment with a single modality. CCT is a useful adjunct in select patients to both TTE and CMR in the evaluation of ventricular volumes and systolic function. Newer applications, such as dynamic CTP and DECT, are promising diagnostic tools offering the possibility of more quantitative assessment of ischemia. The superior spatial resolution and volumetric acquisition of CCT has an important role in the diagnosis of other nonischemic causes of cardiomyopathies.
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Affiliation(s)
- Bryan C. Ramsey
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
| | - Emilio Fentanes
- Cardiology Division, Department of Medicine, Tripler Army Medical Center, Honolulu, HI USA
| | - Andrew D. Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC USA
| | | | - Dustin M. Thomas
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
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63
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Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: A systematic review and meta-analysis. Int J Cardiol 2018; 258:325-331. [DOI: 10.1016/j.ijcard.2018.01.095] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 01/02/2023]
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64
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Enjilela E, Lee TY, Hsieh J, Wisenberg G, Teefy P, Yadegari A, Bagur R, Islam A, Branch K, So A. Ultra-low dose quantitative CT myocardial perfusion imaging with sparse-view dynamic acquisition and image reconstruction: A feasibility study. Int J Cardiol 2018; 254:272-281. [DOI: 10.1016/j.ijcard.2017.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/24/2017] [Accepted: 11/10/2017] [Indexed: 12/30/2022]
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65
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Branch KR. Incremental Benefit of CT Perfusion to CT Coronary Angiography: Another Step to the One-Stop-Shop? JACC Cardiovasc Imaging 2018; 12:350-352. [PMID: 29454771 DOI: 10.1016/j.jcmg.2017.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kelley R Branch
- Department of Cardiology, University of Washington, Seattle, Washington.
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66
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[Redundancy information-induced image reconstruction for low-dose myocardial perfusion computed tomography]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:27-33. [PMID: 33177030 PMCID: PMC6765608 DOI: 10.3969/j.issn.1673-4254.2018.01.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In the clinic, myocardial perfusion computed tomography (MPCT) imaging is commonly used to detect and assess myocardial ischemia quantitatively. However, repeated scanning on the myocardial region in the cine mode will increase the radiation dose for patients. With lowering radiation dose, the quality of images are degraded by noise induced artifact, which hampers the diagnostic accuracy. Therefore, in this paper, we propose a redundancy information induced iterative reconstruction framework for high quality MPCT images at the case of low dose. METHODS MPCT images have redundant structural information within frames and highly similarity between adjacent frames. Inspired by the two properties, in this work we propose a penalized weighted least-squares (PWLS) model incorporating NLM and TV based hybrid constraints, which is referred to as PWLS-aviNLM-TV for simplicity. The proposed algorithm can effectively eliminate noise and artifacts by taking into account the similarity between adjacent frames and redundancy information within frames, which also can improve spatial resolution within frames and maintain temporal resolution. RESULTS The experimental results on the 4D extended cardiac-torso (XCAT) phantom and preclinical porcine dataset demonstrates that the PWLS-aviNLM-TV algorithm obtains better performance in terms of noise reduction and artifacts suppression than the PWLS-TV and PWLSaviNLM algorithm. Moreover, the proposed algorithm can preserve the edges and detail information thereby efficiently differentiate ischemia from myocardium. CONCLUSIONS The present redundancy information induced reconstruction algorithm can reconstruct high-quality images from low-dose MPCT for better clinical imaging diagnosis.
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67
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Kitagawa K, Goto Y, Nakamura S, Takafuji M, Hamdy A, Ishida M, Sakuma H. Dynamic CT Perfusion Imaging: State of the Art. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kakuya Kitagawa
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yoshitaka Goto
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Satoshi Nakamura
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Masafumi Takafuji
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Ahmed Hamdy
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
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68
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Zreik M, Lessmann N, van Hamersvelt RW, Wolterink JM, Voskuil M, Viergever MA, Leiner T, Išgum I. Deep learning analysis of the myocardium in coronary CT angiography for identification of patients with functionally significant coronary artery stenosis. Med Image Anal 2017; 44:72-85. [PMID: 29197253 DOI: 10.1016/j.media.2017.11.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
In patients with coronary artery stenoses of intermediate severity, the functional significance needs to be determined. Fractional flow reserve (FFR) measurement, performed during invasive coronary angiography (ICA), is most often used in clinical practice. To reduce the number of ICA procedures, we present a method for automatic identification of patients with functionally significant coronary artery stenoses, employing deep learning analysis of the left ventricle (LV) myocardium in rest coronary CT angiography (CCTA). The study includes consecutively acquired CCTA scans of 166 patients who underwent invasive FFR measurements. To identify patients with a functionally significant coronary artery stenosis, analysis is performed in several stages. First, the LV myocardium is segmented using a multiscale convolutional neural network (CNN). To characterize the segmented LV myocardium, it is subsequently encoded using unsupervised convolutional autoencoder (CAE). As ischemic changes are expected to appear locally, the LV myocardium is divided into a number of spatially connected clusters, and statistics of the encodings are computed as features. Thereafter, patients are classified according to the presence of functionally significant stenosis using an SVM classifier based on the extracted features. Quantitative evaluation of LV myocardium segmentation in 20 images resulted in an average Dice coefficient of 0.91 and an average mean absolute distance between the segmented and reference LV boundaries of 0.7 mm. Twenty CCTA images were used to train the LV myocardium encoder. Classification of patients was evaluated in the remaining 126 CCTA scans in 50 10-fold cross-validation experiments and resulted in an area under the receiver operating characteristic curve of 0.74 ± 0.02. At sensitivity levels 0.60, 0.70 and 0.80, the corresponding specificity was 0.77, 0.71 and 0.59, respectively. The results demonstrate that automatic analysis of the LV myocardium in a single CCTA scan acquired at rest, without assessment of the anatomy of the coronary arteries, can be used to identify patients with functionally significant coronary artery stenosis. This might reduce the number of patients undergoing unnecessary invasive FFR measurements.
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Affiliation(s)
- Majd Zreik
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Nikolas Lessmann
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
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69
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Clinical significance of transluminal attenuation gradient in 320-row area detector coronary CT angiography. Heart Vessels 2017; 33:462-469. [PMID: 29134268 DOI: 10.1007/s00380-017-1081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
The clinical significance of the transluminal attenuation gradient (TAG) has not been established. We evaluated the incremental diagnostic value of TAG by 320-row area detector computed tomography (320-ADCT). Subjects were 65 patients who underwent one-rotation scanning by 320-ADCT and invasive coronary angiography (ICA) within 3 months. TAG values were obtained for the major epicardial vessels 2 mm or more each in RCA, LAD and LCX using automatic analysis software. Moreover, TAG values that excluded calcified lesions in calculation of the regression line were also evaluated (excluded-TAG). In LAD, 21 intermediate lesions underwent functional flow reserve (FFR), and the incremental diagnostic value for functional stenosis was evaluated. The TAG values in the normal vessels were - 8.3 ± 5.0 (HU/cm) for the RCA (n = 32), - 23.3 ± 4.3 for the LAD (n = 9) and - 20.6 ± 10.0 for the LCX (n = 32). The RCA value was significantly higher (p < 0.001). The TAG values with stenosis degrees of ≤ 25%, 26-75%, ≥ 76% on ICA were - 8.3 ± 5.0 (n = 32) vs - 10.3 ± 7.2 (n = 25) vs - 10.0 ± 5.4 (n = 4) in the RCA, - 23.3 ± 4.3 (n = 9) vs - 21.0 ± 11.5 (n = 35) vs - 23.5 ± 15.3 (n = 10) in the LAD and - 21.1 ± 15.1 (n = 32) vs - 21.1 ± 15.1 (n = 16) vs - 17.7 ± 15.7 (n = 6) in the LCX, with no significant difference among the three groups. The excluded-TAG values also showed no significant difference. The area under the curve in the diagnosis of FFR < 0.8 in 21 LAD cases was 0.542 for CT only, 0.694 for CT + TAG, and 0.694 for CT + excluded-TAG. In single time-phase scanning by 320-ADCT, TAG does not offer an incremental diagnostic value.
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70
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Hubbard L, Lipinski J, Ziemer B, Malkasian S, Sadeghi B, Javan H, Groves EM, Dertli B, Molloi S. Comprehensive Assessment of Coronary Artery Disease by Using First-Pass Analysis Dynamic CT Perfusion: Validation in a Swine Model. Radiology 2017; 286:93-102. [PMID: 29059038 DOI: 10.1148/radiol.2017162821] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To retrospectively validate a first-pass analysis (FPA) technique that combines computed tomographic (CT) angiography and dynamic CT perfusion measurement into one low-dose examination. Materials and Methods The study was approved by the animal care committee. The FPA technique was retrospectively validated in six swine (mean weight, 37.3 kg ± 7.5 [standard deviation]) between April 2015 and October 2016. Four to five intermediate-severity stenoses were generated in the left anterior descending artery (LAD), and 20 contrast material-enhanced volume scans were acquired per stenosis. All volume scans were used for maximum slope model (MSM) perfusion measurement, but only two volume scans were used for FPA perfusion measurement. Perfusion measurements in the LAD, left circumflex artery (LCx), right coronary artery, and all three coronary arteries combined were compared with microsphere perfusion measurements by using regression, root-mean-square error, root-mean-square deviation, Lin concordance correlation, and diagnostic outcomes analysis. The CT dose index and size-specific dose estimate per two-volume FPA perfusion measurement were also determined. Results FPA and MSM perfusion measurements (PFPA and PMSM) in all three coronary arteries combined were related to reference standard microsphere perfusion measurements (PMICRO), as follows: PFPA_COMBINED = 1.02 PMICRO_COMBINED + 0.11 (r = 0.96) and PMSM_COMBINED = 0.28 PMICRO_COMBINED + 0.23 (r = 0.89). The CT dose index and size-specific dose estimate per two-volume FPA perfusion measurement were 10.8 and 17.8 mGy, respectively. Conclusion The FPA technique was retrospectively validated in a swine model and has the potential to be used for accurate, low-dose vessel-specific morphologic and physiologic assessment of coronary artery disease. © RSNA, 2017.
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Affiliation(s)
- Logan Hubbard
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Jerry Lipinski
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Benjamin Ziemer
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Shant Malkasian
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Bahman Sadeghi
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Hanna Javan
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Elliott M Groves
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Brian Dertli
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Sabee Molloi
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
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Scholtz JE, Ghoshhajra B. Advances in cardiac CT contrast injection and acquisition protocols. Cardiovasc Diagn Ther 2017; 7:439-451. [PMID: 29255688 PMCID: PMC5716940 DOI: 10.21037/cdt.2017.06.07] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/25/2017] [Indexed: 01/27/2023]
Abstract
Cardiac computed tomography (CT) imaging has become an important part of modern cardiovascular care. Coronary CT angiography (CTA) is the first choice imaging modality for non-invasive visualization of coronary artery stenosis. In addition, cardiac CT does not only provide anatomical evaluation, but also functional and valvular assessment, and myocardial perfusion evaluation. In this article we outline the factors which influence contrast enhancement, give an overview of current contrast injection and acquisition protocols, with focus on current emerging topics such as pre-transcatheter aortic valve replacement (TAVR) planning, cardiac CT for congenital heart disease (CHD) patients, and myocardial CT perfusion (CTP). Further, we point out areas where we see potential for future improvements in cardiac CT imaging based on a closer interaction between CT scanner settings and contrast injection protocols to tailor injections to patient- and exam-specific factors.
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Affiliation(s)
- Jan-Erik Scholtz
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brian Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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72
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Sethi P, Panchal HB, Veeranki SP, Ur Rahman Z, Mamudu H, Paul TK. Diagnostic Value of Noninvasive Computed Tomography Perfusion Imaging and Coronary Computed Tomography Angiography for Assessing Hemodynamically Significant Native Coronary Artery Lesions. Am J Med Sci 2017; 354:291-298. [DOI: 10.1016/j.amjms.2017.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/08/2017] [Indexed: 01/24/2023]
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74
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Myocardial CT Perfusion: A Review of Current Modalities, Technology, and Clinical Performance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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75
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Pelgrim GJ, Das M, van Tuijl S, van Assen M, Prinzen FW, Stijnen M, Oudkerk M, Wildberger JE, Vliegenthart R. Validation of myocardial perfusion quantification by dynamic CT in an ex-vivo porcine heart model. Int J Cardiovasc Imaging 2017; 33:1821-1830. [PMID: 28536897 PMCID: PMC5682851 DOI: 10.1007/s10554-017-1171-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/17/2017] [Indexed: 12/23/2022]
Abstract
To test the accuracy of quantification of myocardial perfusion imaging (MPI) using computed tomography (CT) in ex-vivo porcine models. Five isolated porcine hearts were perfused according to Langendorff. Hearts were perfused using retrograde flow through the aorta and blood flow, blood pressure and heart rate were monitored throughout the experiment. An inflatable cuff was placed around the circumflex (Cx) artery to create stenosis grades which were monitored using a pressure wire, analysing perfusion at several fractional flow reserve values of 1.0, 0.7, 0.5, 0.3, and total occlusion. Second-generation dual-source CT was used to acquire dynamic MPI in shuttle mode with 350 mAs/rot at 100 kVp. CT MPI was performed using VPCT myocardium software, calculating myocardial blood flow (MBF, ml/100 ml/min) for segments perfused by Cx artery and non-Cx myocardial segments. Microspheres were successfully infused at three stenosis grades in three of the five hearts. Heart rate ranged from 75 to 134 beats per minute. Arterial blood flow ranged from 0.5 to 1.4 l min and blood pressure ranged from 54 to 107 mmHg. MBF was determined in 400 myocardial segments of which 115 were classified as ‘Cx-territory’. MBF was significantly different between non-Cx and Cx segments at stenosis grades with an FFR ≤0.70 (Mann–Whitney U test, p < 0.05). MBF showed a moderate correlation with microsphere MBF for the three individual hearts (Pearson correlation 0.62–0.76, p < 0.01). CT MPI can be used to determine regional differences in myocardial perfusion parameters, based on severity of coronary stenosis. Significant differences in MBF could be measured between non-ischemic and ischemic segments.
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Affiliation(s)
- Gert Jan Pelgrim
- Center for Medical Imaging - North East Netherlands, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box EB44, 9713 GZ, Groningen, The Netherlands
| | - Marco Das
- Department of Radiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marly van Assen
- Center for Medical Imaging - North East Netherlands, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box EB44, 9713 GZ, Groningen, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | | | - Matthijs Oudkerk
- Center for Medical Imaging - North East Netherlands, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box EB44, 9713 GZ, Groningen, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rozemarijn Vliegenthart
- Center for Medical Imaging - North East Netherlands, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box EB44, 9713 GZ, Groningen, The Netherlands.
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76
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Modgil D, Bindschadler MD, Alessio AM, La Rivière PJ. Variable temporal sampling and tube current modulation for myocardial blood flow estimation from dose-reduced dynamic computed tomography. J Med Imaging (Bellingham) 2017; 4:026002. [PMID: 28523283 DOI: 10.1117/1.jmi.4.2.026002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
Abstract
Quantification of myocardial blood flow (MBF) can aid in the diagnosis and treatment of coronary artery disease. However, there are no widely accepted clinical methods for estimating MBF. Dynamic cardiac perfusion computed tomography (CT) holds the promise of providing a quick and easy method to measure MBF quantitatively. However, the need for repeated scans can potentially result in a high patient radiation dose, limiting the clinical acceptance of this approach. In our previous work, we explored techniques to reduce the patient dose by either uniformly reducing the tube current or by uniformly reducing the number of temporal frames in the dynamic CT sequence. These dose reduction techniques result in noisy time-attenuation curves (TACs), which can give rise to significant errors in MBF estimation. We seek to investigate whether nonuniformly varying the tube current and/or sampling intervals can yield more accurate MBF estimates for a given dose. Specifically, we try to minimize the dose and obtain the most accurate MBF estimate by addressing the following questions: when in the TAC should the CT data be collected and at what tube current(s)? We hypothesize that increasing the sampling rate and/or tube current during the time frames when the myocardial CT number is most sensitive to the flow rate, while reducing them elsewhere, can achieve better estimation accuracy for the same dose. We perform simulations of contrast agent kinetics and CT acquisitions to evaluate the relative MBF estimation performance of several clinically viable variable acquisition methods. We find that variable temporal and tube current sequences can be performed that impart an effective dose of 5.5 mSv and allow for reductions in MBF estimation root-mean-square error on the order of 20% compared to uniform acquisition sequences with comparable or higher radiation doses.
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Affiliation(s)
- Dimple Modgil
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Michael D Bindschadler
- University of Washington, Department of Radiology, Seattle, Washington, United States.,University of Washington, Department of Bioengineering, Seattle, Washington, United States
| | - Adam M Alessio
- University of Washington, Department of Radiology, Seattle, Washington, United States.,University of Washington, Department of Bioengineering, Seattle, Washington, United States
| | - Patrick J La Rivière
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
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Detection of Hemodynamically Significant Coronary Artery Stenosis With CT Enhancement Ratio: A Validation Study in a Porcine Model. AJR Am J Roentgenol 2017; 209:103-109. [PMID: 28504545 DOI: 10.2214/ajr.16.16698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although numerous techniques that are based on CT number analysis have been proposed, the assessment of hemodynamically significant coronary artery stenosis remains a great challenge. The purpose of this study is to validate use of the CT enhancement ratio in the detection of hemodynamically significant coronary artery stenosis in a porcine model. MATERIALS AND METHODS Experiments involving eight closed-chest swine were performed. A balloon catheter was placed into the left anterior descending coronary artery to simulate different degrees of luminal stenosis. The myocardial blood flow (MBF) ratio was measured using the colored microsphere technique. The fractional flow reserve was measured using an invasive pressure wire. CT scans were performed during the first-pass phase, while the pigs were undergoing adenosine stress tests. The CT enhancement ratio and the CT attenuation ratio were calculated using data from the CT images obtained. RESULTS Results suggested that the CT enhancement ratio had a strong correlation (y = 0.07245 + 0.09963x; r2 = 0.898; p < 0.001) with the MBF ratio measured using the microsphere technique, whereas only moderate correlation (y = -1.5508 + 2.2684x; r2 = 0.498; p < 0.001) was noted between the CT attenuation ratio and the MBF ratio measured using the microsphere technique. In ROC curve analysis, the AUC values of the CT enhancement ratio and the CT attenuation ratio were 0.927 and 0.829, respectively, with regard to the detection of significant ischemia during adenosine stress tests, as defined by the fractional flow reserve. CONCLUSION The CT enhancement ratio provides a reliable prediction of the MBF ratio measured using the microsphere technique, indicating that this metric has good diagnostic performance in the detection of hemodynamically significant coronary artery stenosis. The CT enhancement ratio may have potential for use as an imaging biomarker for the relative quantitative assessment of myocardial perfusion.
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Tanabe Y, Kido T, Kurata A, Yokoi T, Fukuyama N, Uetani T, Nishiyama H, Kawaguchi N, Tahir E, Miyagawa M, Mochizuki T. Peak enhancement ratio of myocardium to aorta for identification of myocardial ischemia using dynamic myocardial computed tomography perfusion imaging. J Cardiol 2017; 70:565-570. [PMID: 28501269 DOI: 10.1016/j.jjcc.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/24/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study aimed to evaluate the feasibility of peak enhancement (PE) ratio of myocardium to aorta (PER) derived from stress dynamic computed tomography myocardial perfusion imaging (CTP) for the detection of myocardial ischemia assessed by magnetic resonance (MR) imaging. METHODS Forty-four patients who underwent stress dynamic CTP and MR imaging were retrospectively evaluated. From the time-attenuation curve, myocardial PE, PER, and myocardial blood flow (MBF) were calculated on a segment-based analysis. The correlation between myocardial and aortic PE was assessed by Spearman's correlation, and the differences in myocardial PE and PER between normal and ischemic myocardium were assessed by the Mann-Whitney U-test. The diagnostic accuracies of myocardial PE, PER, and MBF for detecting myocardial ischemia were compared by receiver operating characteristic analysis. RESULTS Of 704 segments, 258 segments (37%) were diagnosed as myocardial ischemia with MR imaging. Myocardial and aortic PE were significantly correlated in both normal and ischemic segments (r=0.76 and 0.58; p<0.05, in each). The myocardial PE and PER of ischemic segments were significantly lower than those of normal segments (p<0.05, in each). Sensitivity and specificity were 61% [95% confidence interval (CI), 55-70%] and 83% (95% CI, 73-87%) for myocardial PE, 78% (67-88%) and 82% (95% CI, 70-91%) for PER, and 81% (95% CI, 73-87%) and 85% (95% CI, 79-92%) for MBF. There was a significantly larger area under the curve for PER (0.87; 95% CI, 0.84-0.90) and MBF (0.88; 95%CI, 0.85-0.91), compared to myocardial PE (0.75; 95% CI, 0.70-0.79) (p<0.05, in each). There was no significant difference in area under the curve between PER and MBF. CONCLUSIONS The semi-quantitative parameter of PER showed a high diagnostic accuracy for the detection of myocardial ischemia, comparable to that of MBF.
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Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Takahiro Yokoi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Naoki Fukuyama
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Teruyoshi Uetani
- Department of Cardiovascular Internal Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Hikaru Nishiyama
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
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Rossi A, Wragg A, Klotz E, Pirro F, Moon JC, Nieman K, Pugliese F. Dynamic Computed Tomography Myocardial Perfusion Imaging: Comparison of Clinical Analysis Methods for the Detection of Vessel-Specific Ischemia. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005505. [PMID: 28389506 DOI: 10.1161/circimaging.116.005505] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical analysis of myocardial dynamic computed tomography myocardial perfusion imaging lacks standardization. The objective of this prospective study was to compare different analysis approaches to diagnose ischemia in patients with stable angina referred for invasive coronary angiography. METHODS AND RESULTS Patients referred for evaluation of stable angina symptoms underwent adenosine-stress dynamic computed tomography myocardial perfusion imaging with a second-generation dual-source scanner. Quantitative perfusion parameters, such as blood flow, were calculated by parametric deconvolution for each myocardial voxel. Initially, perfusion parameters were extracted according to standard 17-segment model of the left ventricle (fully automatic analysis). These were then manually sampled by an operator (semiautomatic analysis). Areas under the receiver-operating characteristic curves of the 2 different approaches were compared. Invasive fractional flow reserve ≤0.80 or diameter stenosis ≥80% on quantitative coronary angiography was used as reference standard to define ischemia. We enrolled 115 patients (88 men; age 57±9 years). There were 72 of 286 (25%) vessels causing ischemia in 52 of 115 (45%) patients. The semiautomatic analysis method was better than the fully automatic method at predicting ischemia (areas under the receiver-operating characteristic curves, 0.87 versus 0.69; P<0.001) with readings obtained in the endocardial myocardium performing better than those in the epicardial myocardium (areas under the receiver-operating characteristic curves, 0.87 versus 0.72; P<0.001). The difference in performance between blood flow, expressed as relative to remote myocardium, and absolute blood flow was not statistically significant (areas under the receiver-operating characteristic curves, 0.90 versus 0.87; P=ns). CONCLUSIONS 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.
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Affiliation(s)
- Alexia Rossi
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Andrew Wragg
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Ernst Klotz
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Federica Pirro
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - James C Moon
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Koen Nieman
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.)
| | - Francesca Pugliese
- From the Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom and Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (A.R., A.W., F. Pirro, F. Pugliese); Siemens Healthineers, Forchheim, Germany (E.K.); Institute of Cardiovascular Science, University College London, United Kingdom (J.C.M.); and Departments of Cardiology and Radiology, Erasmus MC University Medical Centre Rotterdam, The Netherlands (K.N.).
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Hubbard L, Ziemer B, Lipinski J, Sadeghi B, Javan H, Groves EM, Malkasian S, Molloi S. Functional Assessment of Coronary Artery Disease Using Whole-Heart Dynamic Computed Tomographic Perfusion. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005325. [PMID: 27956409 DOI: 10.1161/circimaging.116.005325] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomographic (CT) angiography is an important tool for the evaluation of coronary artery disease but often correlates poorly with myocardial ischemia. Current dynamic CT perfusion techniques can assess ischemia but have limited accuracy and deliver high radiation dose. Therefore, an accurate, low-dose, dynamic CT perfusion technique is needed. METHODS AND RESULTS A total of 20 contrast-enhanced CT volume scans were acquired in 5 swine (40±10 kg) to generate CT angiography and perfusion images. Varying degrees of stenosis were induced using a balloon catheter in the proximal left anterior descending coronary artery, and a pressure wire was used for reference fractional flow reserve (FFR) measurement. Perfusion measurements were made with only 2 volume scans using a new first-pass analysis (FPA) technique and with 20 volume scans using an existing maximum slope model (MSM) technique. Perfusion (P) and FFR measurements were related by PFPA=1.01 FFR-0.03 (R2=0.85) and PMSM=1.03 FFR-0.03 (R2=0.80) for FPA and MSM techniques, respectively. Additionally, the effective radiation doses were calculated to be 2.64 and 26.4 mSv for FPA and MSM techniques, respectively. CONCLUSIONS A new FPA-based dynamic CT perfusion technique was validated in a swine animal model. The results indicate that the FPA technique can potentially be used for improved anatomical and functional assessment of coronary artery disease at a relatively low radiation dose.
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Affiliation(s)
- Logan Hubbard
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Benjamin Ziemer
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Jerry Lipinski
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Bahman Sadeghi
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Hanna Javan
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Elliott M Groves
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Shant Malkasian
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Sabee Molloi
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine.
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81
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Prognostic Value of Stress Dynamic Myocardial Perfusion CT in a Multicenter Population With Known or Suspected Coronary Artery Disease. AJR Am J Roentgenol 2017; 208:761-769. [DOI: 10.2214/ajr.16.16186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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82
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Cademartiri F, Seitun S, Clemente A, La Grutta L, Toia P, Runza G, Midiri M, Maffei E. Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography. Cardiovasc Diagn Ther 2017; 7:129-150. [PMID: 28540209 DOI: 10.21037/cdt.2017.03.22] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
During the last decade coronary computed tomography angiography (CTA) has become the preeminent non-invasive imaging modality to detect coronary artery disease (CAD) with high accuracy. However, CTA has a limited value in assessing the hemodynamic significance of a given stenosis due to a modest specificity and positive predictive value. In recent years, different CT techniques for detecting myocardial ischemia have emerged, such as CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and myocardial CT perfusion (CTP) imaging. Myocardial CTP imaging can be performed with a single static scan during first pass of the contrast agent, with monoenergetic or dual-energy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson). A number of CTP techniques are available, which can assess myocardial perfusion in both a qualitative, semi-quantitative or quantitative manner. Once used primarily as research tools, these modalities are increasingly being used in routine clinical practice. All these techniques offer the substantial advantage of combining anatomical and functional evaluation of flow-limiting coronary stenosis in the same examination that would be beneficial for clinical decision-making. This review focuses on the state-of the-art and future trends of these evolving imaging modalities in the field of cardiology for the physiologic assessments of CAD.
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Affiliation(s)
- Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute, Université de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands
| | - Sara Seitun
- Department of Radiology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy
| | | | - Patrizia Toia
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Giuseppe Runza
- Department of Radiology, P.O. Umberto I, Azienda Sanitaria Provinciale 8, Siracusa, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute, Université de Montreal, Montreal, Canada
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83
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CT myocardial perfusion imaging: current status and future perspectives. Int J Cardiovasc Imaging 2017; 33:1009-1020. [DOI: 10.1007/s10554-017-1102-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
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84
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Gong C, Han C, Gan G, Deng Z, Zhou Y, Yi J, Zheng X, Xie C, Jin X. Low-dose dynamic myocardial perfusion CT image reconstruction using pre-contrast normal-dose CT scan induced structure tensor total variation regularization. Phys Med Biol 2017; 62:2612-2635. [PMID: 28140366 DOI: 10.1088/1361-6560/aa5d40] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dynamic myocardial perfusion CT (DMP-CT) imaging provides quantitative functional information for diagnosis and risk stratification of coronary artery disease by calculating myocardial perfusion hemodynamic parameter (MPHP) maps. However, the level of radiation delivered by dynamic sequential scan protocol can be potentially high. The purpose of this work is to develop a pre-contrast normal-dose scan induced structure tensor total variation regularization based on the penalized weighted least-squares (PWLS) criteria to improve the image quality of DMP-CT with a low-mAs CT acquisition. For simplicity, the present approach was termed as 'PWLS-ndiSTV'. Specifically, the ndiSTV regularization takes into account the spatial-temporal structure information of DMP-CT data and further exploits the higher order derivatives of the objective images to enhance denoising performance. Subsequently, an effective optimization algorithm based on the split-Bregman approach was adopted to minimize the associative objective function. Evaluations with modified dynamic XCAT phantom and preclinical porcine datasets have demonstrated that the proposed PWLS-ndiSTV approach can achieve promising gains over other existing approaches in terms of noise-induced artifacts mitigation, edge details preservation, and accurate MPHP maps calculation.
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Affiliation(s)
- Changfei Gong
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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85
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Giordano M, Poot DHJ, Coenen A, van Walsum T, Tezza M, Nieman K, Niessen WJ. Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories. Med Phys 2017; 44:1347-1358. [PMID: 28130886 DOI: 10.1002/mp.12126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Myocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods. METHODS The diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed. RESULTS Leave-one-case out cross-validation showed that HPV has an accuracy of 72% (58-83%) with sensitivity of 72% (47-90%) and specificity of 72% (58-83%). The accuracy of MA-MBF was 70% (57-82%) with a sensitivity of 50% (26-74%) and a specificity of 79% (64-91%). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant. CONCLUSIONS The proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.
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Affiliation(s)
- Marco Giordano
- Department of Imaging Physics, TU Delft, 2628CJ, Delft, The Netherlands.,Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam's, 3015 CE, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Imaging Physics, TU Delft, 2628CJ, Delft, The Netherlands.,Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam's, 3015 CE, Rotterdam, The Netherlands
| | - Adriaan Coenen
- Department of Radiology and Cardiology, Erasmus MC, University Medical Center Rotterdam's, 3015CE, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam's, 3015 CE, Rotterdam, The Netherlands
| | - Michela Tezza
- Istituto di Radiologia, Universitá di Verona, Policlinico G.B. Rossi, P.le L.A., 37134, Verona, Italy
| | - Koen Nieman
- Department of Radiology and Cardiology, Erasmus MC, University Medical Center Rotterdam's, 3015CE, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Imaging Physics, TU Delft, 2628CJ, Delft, The Netherlands.,Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam's, 3015 CE, Rotterdam, The Netherlands
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86
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Goto Y, Kitagawa K, Uno M, Nakamori S, Ito T, Nagasawa N, Dohi K, Sakuma H. 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. Circ J 2017; 81:1477-1483. [DOI: 10.1253/circj.cj-16-1319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Mio Uno
- Department of Radiology, Mie University Hospital
| | | | - Tatsuro Ito
- Department of Radiology, Mie University Hospital
| | | | - Kaoru Dohi
- Department of Cardiology, Mie University Hospital
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87
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Global quantification of left ventricular myocardial perfusion at dynamic CT imaging: Prognostic value. J Cardiovasc Comput Tomogr 2016; 11:16-24. [PMID: 28111212 DOI: 10.1016/j.jcct.2016.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/18/2016] [Accepted: 12/27/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI). METHODS Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint. RESULTS MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12-3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16-4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16-4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01-5.43, p = 0.0486). Global MBV and Ktrans were not independent predictors of MACE. CONCLUSION Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA.
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88
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Bischoff B, Deseive S, Rampp M, Todica A, Wermke M, Martinoff S, Massberg S, Reiser MF, Becker HC, Hausleiter J. Myocardial ischemia detection with single-phase CT perfusion in symptomatic patients using high-pitch helical image acquisition technique. Int J Cardiovasc Imaging 2016; 33:569-576. [PMID: 27848163 DOI: 10.1007/s10554-016-1020-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/11/2016] [Indexed: 12/14/2022]
Abstract
Coronary CT angiography (CCTA) suffers from a reduced diagnostic accuracy in patients with heavily calcified coronary arteries or prior myocardial revascularisation due to artefacts caused by calcifications and stent material. CT myocardial perfusion imaging (CTMPI) yields high potential for the detection of myocardial ischemia and might help to overcome the above mentioned limitations. We analysed CT single-phase perfusion using high-pitch helical image acquisition technique in patients with prior myocardial revascularisation. Thirty-six patients with an indication for invasive coronary angiography (28 with coronary stents, 2 with coronary artery bypass grafts and 6 with both) were included in this prospective study at two study sites. All patients were examined on a 2nd generation dual-source CT system. Stress CT images were obtained using a prospectively ECG-triggered single-phase high-pitch helical image acquisition technique. During stress the tracer for myocardial perfusion (MP) SPECT imaging was administered. Rest CT images were acquired using prospectively ECG-triggered sequential CT. MP-SPECT imaging and invasive coronary angiography served as standard of reference. In this heavily diseased patient cohort CCTA alone showed a low overall diagnostic accuracy for detection of hemodynamically relevant coronary artery stenosis of only 31% on a per-patient base and 60% on a per-vessel base. Combining CCTA and CTMPI allowed for a significantly higher overall diagnostic accuracy of 78% on a per-patient base and 92% on a per-vessel base (p < 0.001). Mean radiation dose for stress CT scans was 0.9 mSv, mean radiation dose for rest CT scans was 5.0 mSv. In symptomatic patients with known coronary artery disease and prior myocardial revascularization combining CCTA and CTMPI showed significantly higher diagnostic accuracy in detection of hemodynamically significant coronary artery stenosis when compared to CCTA alone.
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Affiliation(s)
- Bernhard Bischoff
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Martin Rampp
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andrei Todica
- Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Marc Wermke
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der TU München, Munich, Germany
| | - Stefan Martinoff
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der TU München, Munich, Germany
| | - Steffen Massberg
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Hans-Christoph Becker
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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89
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Temporal averaging for analysis of four-dimensional whole-heart computed tomography perfusion of the myocardium: proof-of-concept study. Int J Cardiovasc Imaging 2016; 33:371-382. [PMID: 27832419 DOI: 10.1007/s10554-016-1011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/25/2016] [Indexed: 01/03/2023]
Abstract
To assess the feasibility of four-dimensional (4D) whole-heart computed tomography perfusion (CTP) of the myocardium and the added value of temporal averaging of consecutive 3D datasets from different heartbeats for analysis. We included 30 patients with suspected or known coronary artery disease (CAD) who underwent 320-row coronary CT angiography (CTA) and myocardial CTP. Out of these, 15 patients underwent magnetic resonance myocardial perfusion imaging (MR MPI). All CTP examinations were initiated after 3 min of intravenous infusion of adenosine (140 µg/kg/min) and were performed dynamically covering the entire heart every heart beat over a period of 20 ± 3 heart beats. Temporal averaging for dynamic CTP visualisation was analysed for the combination of two, three, four, six, and eight consecutive 3D datasets. Input time attenuation curves (TAC) were delivered from measurement points in the centre of the left ventricle. In all 30 patients, myocardial 4D CTP was feasible and temporal averaging was successfully implemented for all planned combinations of 3D datasets. Temporal averaging of three consecutive 3D datasets showed best performance in the analysis of all CTP image quality parameters: noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality, and diagnostic accuracy with an improvement of SNR and CNR by a factor of 2.2 ± 1.3 and 1.3 ± 0.9. With increasing level of temporal averaging, the input TACs became smoother, but also shorter. Out of the 11 perfusion defects detected with MR MPI, 9 defects were also visible on the 4D CTP images. Whole-heart CTP of the myocardium is feasible and temporal averaging of dynamic datasets improves quantitative image quality parameters and visualization of perfusion defects while further studies are needed to assess its added value for quantification of perfusion parameters.
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90
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Pontone G, Muscogiuri G, Andreini D, Guaricci AI, Guglielmo M, Mushtaq S, Baggiano A, Conte E, Beltrama V, Annoni A, Formenti A, Mancini E, Rabbat MG, Pepi M. The New Frontier of Cardiac Computed Tomography Angiography: Fractional Flow Reserve and Stress Myocardial Perfusion. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:74. [DOI: 10.1007/s11936-016-0493-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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91
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Coenen A, Lubbers MM, Kurata A, Kono A, Dedic A, Chelu RG, Dijkshoorn ML, Rossi A, van Geuns RJM, Nieman K. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis. Eur Radiol 2016; 27:2309-2316. [PMID: 27704198 PMCID: PMC5408049 DOI: 10.1007/s00330-016-4567-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 12/02/2022]
Abstract
Objectives To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Methods Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Results Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Conclusions Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. Key Points • The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease • Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow • The incremental value of the transmural perfusion ratio is limited
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Affiliation(s)
- Adriaan Coenen
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands. .,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Marisa M Lubbers
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Akira Kurata
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Atsushi Kono
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Admir Dedic
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raluca G Chelu
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marcel L Dijkshoorn
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexia Rossi
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Robert-Jan M van Geuns
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Koen Nieman
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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92
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Gonçalves PDA, Rodríguez-Granillo GA, Spitzer E, Suwannasom P, Loewe C, Nieman K, Garcia-Garcia HM. Functional Evaluation of Coronary Disease by CT Angiography. JACC Cardiovasc Imaging 2016; 8:1322-35. [PMID: 26563862 DOI: 10.1016/j.jcmg.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/30/2015] [Accepted: 09/03/2015] [Indexed: 12/24/2022]
Abstract
In recent years, several technical developments in the field of cardiac computed tomography (CT) have made possible the extraction of functional information from an anatomy-based examination. Several different lines have been explored and will be reviewed in the present paper, namely: 1) myocardial perfusion imaging; 2) transluminal attenuation gradients and corrected coronary opacification indexes; 3) fractional flow reserve computed from CT; and 4) extrapolation from atherosclerotic plaque characteristics. In view of these developments, cardiac CT has the potential to become in the near future a truly 2-in-1 noninvasive evaluation for coronary artery disease.
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Affiliation(s)
| | - Gastón A Rodríguez-Granillo
- Department of Cardiovascular Imaging, Diagnostico Maipu, and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Koen Nieman
- Departments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hector M Garcia-Garcia
- Cardialysis B.V., Rotterdam, the Netherlands; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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93
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Resting multilayer 2D speckle-tracking transthoracic echocardiography for the detection of clinically stable myocardial ischemic segments confirmed by invasive fractional flow reserve. Part 1: Vessel-by-vessel analysis. Int J Cardiol 2016; 218:324-332. [DOI: 10.1016/j.ijcard.2016.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 11/23/2022]
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94
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Kang SJ, Yang DH, Koo HJ, Yun SC, Lee JG, Kang JW, Lim TH, Mintz GS, Park SW, Kim YH. Intravascular ultrasound-derived morphological predictors of myocardial ischemia assessed by stress myocardial perfusion computed tomography. Catheter Cardiovasc Interv 2016; 89:E207-E216. [DOI: 10.1002/ccd.26710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Soo-Jin Kang
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Dong Hyun Yang
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Hyun Jung Koo
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Sung-Cheol Yun
- Department of Biostatistics; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - June-Goo Lee
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Joon-Won Kang
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Tae-Hwan Lim
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Gary S. Mintz
- Cardiovascular Research Foundation; New York New York
| | - Seong-Wook Park
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Young-Hak Kim
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
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95
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Caruso D, Eid M, Schoepf UJ, Jin KN, Varga-Szemes A, Tesche C, Mangold S, Spandorfer A, Laghi A, De Cecco CN. Dynamic CT myocardial perfusion imaging. Eur J Radiol 2016; 85:1893-1899. [PMID: 27510361 DOI: 10.1016/j.ejrad.2016.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.
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Affiliation(s)
- Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Marwen Eid
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kwang Nam Jin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Adam Spandorfer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Andrea Laghi
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Latina, Italy
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
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96
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CT myocardial perfusion imaging: current status and future directions. Clin Radiol 2016; 71:739-49. [DOI: 10.1016/j.crad.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 01/15/2023]
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97
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Abstract
PURPOSE OF REVIEW Computed tomography (CT) coronary angiography is a well-validated non-invasive technique for accurate and expedient diagnosis of coronary artery disease (CAD). However, a limitation of coronary CT angiography (CCTA) is its limited capability to identify physiologically significant stenoses, which may eventuate the need for further functional testing. Stress CT myocardial perfusion imaging (CT-MPI) is an emerging technique that has the ability to identify flow-limiting stenoses. RECENT FINDINGS The combination of CCTA coronary and CT-MPI has transformed the modality from a tool to assess anatomy and morphology to a modality capable of simultaneous assessment of coronary stenoses and their physiologic significance. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CT-MPI in comparison to a number of reference standard modalities for CAD diagnosis, including single-photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve testing. SUMMARY While there is still a need for consensus regarding acquisition techniques as well as analysis and interpretation of CT-MPI, with further validation, it is likely to become a powerful adjunctive tool to CCTA in the management of patients with suspected coronary disease.
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98
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Park EA, Lee W, Park SJ, Kim YK, Hwang HY. Influence of Coronary Artery Diameter on Intracoronary Transluminal Attenuation Gradient During CT Angiography. JACC Cardiovasc Imaging 2016; 9:1074-1083. [PMID: 27372017 DOI: 10.1016/j.jcmg.2015.10.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The goal of this study was to assess the effect of coronary artery diameter on luminal attenuation and the correlation between the transluminal attenuation gradient (TAG) and transluminal diameter gradient (TDG) on computed tomography (CT) coronary angiography. BACKGROUND Recent studies have reported promising results of TAG in detecting significant stenosis. However, because of the intrinsic nature of CT reconstruction algorithms, luminal attenuation may be affected by vessel diameter. METHODS In this 3-part study, phantom simulating vessels of various diameters immersed in different contrast mixtures were scanned, and intraluminal attenuations were measured. In addition, dynamic volume CT scanning was performed in 3 mongrel dogs (untreated, a stenosis model, and an occlusion model) using 320-row area detector computed tomography and intraluminal attenuations, and TAGs were calculated at each temporal scan and compared. In a separate clinical study, TAGs and TDGs of 152 coronary arteries from 62 patients who underwent 320-row area detector computed tomography coronary angiography and invasive angiography were measured and compared. RESULTS Intraluminal attenuation of phantom vessels gradually decreased along with a decrease in diameter. Animal studies revealed that the peak attenuation of distal smaller coronary arteries did not reach that of proximal larger coronary arteries: 55.2% to 78.1% peak attenuation of proximal coronary arteries. No differences in TAG were found between stenotic and normal left circumflex arteries at temporal scans (all, p > 0.05). The clinical study demonstrated significant correlation between TAG and TDG (r = 0.580; p < 0.0001). CONCLUSIONS Intraluminal attenuation was shown to decrease with diminution of vessel diameters. In addition, TAG exhibited a significant correlation with TDG, implying that TAG may be a secondary result because of differences in diameters.
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Affiliation(s)
- Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Sang Joon Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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99
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Cardiovascular Imaging: The Past and the Future, Perspectives in Computed Tomography and Magnetic Resonance Imaging. Invest Radiol 2016; 50:557-70. [PMID: 25985464 DOI: 10.1097/rli.0000000000000164] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Today's noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CT applications. Within the past 10-15 years, MR and CT technologies have pushed each other in cardiac applications; and without the "rival" modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today.
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100
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Bindschadler M, Modgil D, Branch KR, La Riviere PJ, Alessio AM. Evaluation of static and dynamic perfusion cardiac computed tomography for quantitation and classification tasks. J Med Imaging (Bellingham) 2016; 3:024001. [PMID: 27175377 DOI: 10.1117/1.jmi.3.2.024001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
Abstract
Cardiac computed tomography (CT) acquisitions for perfusion assessment can be performed in a dynamic or static mode. Either method may be used for a variety of clinical tasks, including (1) stratifying patients into categories of ischemia and (2) using a quantitative myocardial blood flow (MBF) estimate to evaluate disease severity. In this simulation study, we compare method performance on these classification and quantification tasks for matched radiation dose levels and for different flow states, patient sizes, and injected contrast levels. Under conditions simulated, the dynamic method has low bias in MBF estimates (0 to [Formula: see text]) compared to linearly interpreted static assessment (0.45 to [Formula: see text]), making it more suitable for quantitative estimation. At matched radiation dose levels, receiver operating characteristic analysis demonstrated that the static method, with its high bias but generally lower variance, had superior performance ([Formula: see text]) in stratifying patients, especially for larger patients and lower contrast doses [area under the curve [Formula: see text] to 96 versus 0.86]. We also demonstrate that static assessment with a correctly tuned exponential relationship between the apparent CT number and MBF has superior quantification performance to static assessment with a linear relationship and to dynamic assessment. However, tuning the exponential relationship to the patient and scan characteristics will likely prove challenging. This study demonstrates that the selection and optimization of static or dynamic acquisition modes should depend on the specific clinical task.
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Affiliation(s)
- Michael Bindschadler
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
| | - Dimple Modgil
- The University of Chicago , Department of Radiology, Chicago, Illinois 60637, United States
| | - Kelley R Branch
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
| | - Patrick J La Riviere
- The University of Chicago , Department of Radiology, Chicago, Illinois 60637, United States
| | - Adam M Alessio
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
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