1
|
Kawaguchi Y, Kato S, Horita N, Utsunomiya D. Value of Dynamic Computed Tomography Myocardial Perfusion in CAD: A Systematic Review and Meta-analysis. Eur Heart J Cardiovasc Imaging 2024:jeae118. [PMID: 38693883 DOI: 10.1093/ehjci/jeae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS Dynamic stress computed tomography (CT) perfusion is a non-invasive method for quantifying myocardial ischemia by assessing myocardial blood flow (MBF). In this meta-analysis, we evaluated the diagnostic accuracy of dynamic CT perfusion for the detection of significant coronary artery disease (CAD) across various CT scanners, obese patients, and its prognostic value. METHODS AND RESULTS We systematically searched PubMed, Embase, Web of Science, and Cochrane library for published studies evaluating the accuracy of CT myocardial perfusion in diagnosing functional significant ischemia by invasive fractional flow reserve. The diagnostic performance of dynamic CT perfusion in detecting ischemia was evaluated using a summary receiver operating characteristic (sROC) curve. A total of 23 studies underwent meta- analysis. In myocardial region without ischemia, MBF was measured at 1.44 ml/min/g (95% confidence interval [CI]: 1.13-1.75), while in region with ischemia, it was 0.94 ml/min/g (95% CI: 0.80-1.08) (p<0.001). On the patient-based analysis, the area under the sROC curve of CT-MBF was 0.93, with a sensitivity of 0.84 and specificity of 0.88. Differences in CT type (dual source vs. single source), and body mass index (BMI) did not significantly affect the diagnostic performance. The pooled hazard ratio of dynamic CT perfusion for predicting adverse events was 4.98 (95%CI: 2.08-11.93, p=<0.001, I2=61%, p for heterogeneity = 0.07). CONCLUSIONS Dynamic CT perfusion has high diagnostic performance in the quantitative assessment of ischemia and detection of functional myocardial ischemia as defined by invasive FFR, and may be useful in risk stratification of CAD patients.
Collapse
Affiliation(s)
- Yuma Kawaguchi
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | - Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | | | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| |
Collapse
|
2
|
Sliwicka O, Sechopoulos I, Baggiano A, Pontone G, Nijveldt R, Habets J. Dynamic myocardial CT perfusion imaging-state of the art. Eur Radiol 2023; 33:5509-5525. [PMID: 36997751 PMCID: PMC10326111 DOI: 10.1007/s00330-023-09550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/01/2023]
Abstract
In patients with suspected coronary artery disease (CAD), dynamic myocardial computed tomography perfusion (CTP) imaging combined with coronary CT angiography (CTA) has become a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information on myocardial blood flow, and the presence and grading of stenosis. Recently, CTP imaging has been proven to have good diagnostic accuracy for detecting myocardial ischemia, comparable to stress magnetic resonance imaging and positron emission tomography perfusion, while being superior to single photon emission computed tomography. Dynamic CTP accompanied by coronary CTA can serve as a gatekeeper for invasive workup, as it reduces unnecessary diagnostic invasive coronary angiography. Dynamic CTP also has good prognostic value for the prediction of major adverse cardiovascular events. In this article, we will provide an overview of dynamic CTP, including the basics of coronary blood flow physiology, applications and technical aspects including protocols, image acquisition and reconstruction, future perspectives, and scientific challenges. KEY POINTS: • Stress dynamic myocardial CT perfusion combined with coronary CTA is a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information. • Dynamic CTP imaging has good diagnostic accuracy for detecting myocardial ischemia comparable to stress MRI and PET perfusion. • Dynamic CTP accompanied by coronary CTA may serve as a gatekeeper for invasive workup and can guide treatment in obstructive coronary artery disease.
Collapse
Affiliation(s)
- Olga Sliwicka
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea Baggiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesse Habets
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| |
Collapse
|
3
|
Patel P, Emrich T, Schoepf UJ, Mehta V, Bayer RR, von Assen M, Giovagnoli V, Jeudy J, Varga-Szemes A, White C. Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia. J Thorac Imaging 2023; 38:212-225. [PMID: 34029280 DOI: 10.1097/rti.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.
Collapse
Affiliation(s)
- Pratik Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Varun Mehta
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Richard R Bayer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Marly von Assen
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA
| | - Vincent Giovagnoli
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Charles White
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
4
|
Hammel J, Birnbacher L, Makowski MR, Pfeiffer F, Pfeiffer D. Absolute iodine concentration for dynamic perfusion imaging of the myocardium: improved detection of poststenotic ischaemic in a 3D-printed dynamic heart phantom. Eur Radiol Exp 2022; 6:51. [PMID: 36310190 PMCID: PMC9618471 DOI: 10.1186/s41747-022-00304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the detection capabilities of myocardial perfusion defects of dual-energy computed tomography (CT) technology using time-resolved iodine-based maps for functional assessment of coronary stenosis in a dynamic heart phantom. Methods An anatomical heart model was designed using a three-dimensional (3D) printing technique. The lumen of the right coronary artery was reduced to 25% of the original areal cross-section. Scans were acquired with a 64-slice dual-layer CT equipment using a perfusion protocol with 36 time points. For distinguishing haemodynamically affected from unaffected myocardial regions, conventional and spectral mean transit time (MTT) parameter maps were compared. A dose reduction technique was simulated by using a subset of time points of the time attenuation curves (TACs). Results The tracer kinetic modeling showed decreased errors on fit parameters from conventional to spectral TACs (42% reduction for A and 40% for λ). Three characteristic regions (highly, moderately, and not affected by the simulated stenosis) can be distinguished in all spectral perfusion maps. The best distinction was observed on MTT maps. An area under the curve (AUC) value of 1.00 for the voxel-wise differentiation of haemodynamically affected tissue was achieved versus a 0.89 AUC for conventional MTT maps. By temporal under-sampling, a dose reduction of approximately 78% from 19 to 4.3 mSv was achieved with a 0.96 AUC. Conclusion Dual-energy CT can provide time-resolved iodine density data, which enables the calculation of absolute quantitative perfusion maps with decreased fitting errors, improving the accuracy for poststenotic myocardial ischaemic detection in a 3D-printed heart phantom.
Collapse
|
5
|
Lee JW, Choe YH, Kim SM, Choi JH, Pak S, Choo KS, Kim JS, Lee CE, Kim YH. Comparison of diagnostic performance between dynamic versus static adenosine-stress myocardial CT perfusion to detect hemodynamically significant coronary artery stenosis: A prospective multicenter study. Medicine (Baltimore) 2022; 101:e30477. [PMID: 36086714 PMCID: PMC10980466 DOI: 10.1097/md.0000000000030477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 08/02/2022] [Indexed: 12/30/2022] Open
Abstract
Myocardial computed tomography perfusion (CTP) imaging is a noninvasive method for detecting myocardial ischemia. This study aimed to compare the diagnostic performance of dynamic and static adenosine-stress CTPs for detecting hemodynamically significant coronary stenosis. We prospectively enrolled 42 patients (mean age, 59.7 ± 8.8 years; 31 males) with ≥40% coronary artery stenosis. All patients underwent dynamic CTP for adenosine stress. The static CTP was simulated by choosing the seventh dynamic dataset after the initiation of the contrast injection. Diagnostic performance was compared with invasive fractional flow reserve (FFR) <0.8 as the reference. Of the 125 coronary vessels in 42 patients, 20 (16.0%) in 16 (38.1%) patients were categorized as hemodynamically significant. Dynamic and static CTP yielded similar diagnostic accuracy (90.4% vs 88.8% using visual analysis, P = .558; 77.6% vs 80.8% using quantitative analysis, P = .534; 78.4% vs 82.4% using combined visual and quantitative analyses, P = .426). The diagnostic accuracy of combined coronary computed tomography angiography (CCTA) and dynamic CTP (89.6% using visual analysis, P = .011; 88.8% using quantitative analysis, P = .018; 89.6% using combined visual and quantitative analyses, P = .011) and that of combined CCTA and static CTP (88.8% using visual analysis, P = .018; 90.4% using quantitative analysis, P = .006; 91.2% using combined visual and quantitative analyses, P = .003) were significantly higher than that of CCTA alone (77.6%). Dynamic CTP and static CTP showed similar diagnostic performance in the detection of hemodynamically significant stenosis.
Collapse
Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Emergency Medicine and Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongyong Pak
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Jeong Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Chong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
6
|
Kouchi T, Tanabe Y, Takemoto T, Yoshida K, Yamamoto Y, Miyazaki S, Fukuyama N, Nishiyama H, Inaba S, Kawaguchi N, Kido T, Yamaguchi O, Kido T. A Novel Quantitative Parameter for Static Myocardial Computed Tomography: Myocardial Perfusion Ratio to the Aorta. J Clin Med 2022; 11:jcm11071816. [PMID: 35407424 PMCID: PMC8999663 DOI: 10.3390/jcm11071816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023] Open
Abstract
We evaluated the feasibility of myocardial perfusion ratio to the aorta (MPR) in static computed tomography perfusion (CTP) for detecting myocardial perfusion abnormalities assessed by single-photon emission computed tomography (SPECT). Twenty-five patients with suspected coronary artery disease who underwent dynamic CTP and SPECT were retrospectively evaluated. CTP images scanned at a sub-optimal phase for detecting myocardial perfusion abnormalities were selected from dynamic CTP images and used as static CTP images in the present study. The diagnostic accuracy of MPR derived from static CTP was compared to those of visual assessment and conventional quantitative parameters such as myocardial CT attenuation (HU) and transmural perfusion ratio (TPR). The area under the curve of MPR (0.84; 95% confidence interval [CI], 0.76−0.90) was significantly higher than those of myocardial CT attenuation (0.73; 95% CI, 0.65−0.79) and TPR (0.76; 95% CI, 0.67−0.83) (p < 0.05). Sensitivity and specificity were 67% (95% CI, 54−77%) and 90% (95% CI, 86−92%) for visual assessment, 51% (95% CI, 39−63%) and 86% (95% CI, 82−89%) for myocardial CT attenuation, 63% (95% CI, 51−74%) and 84% (95% CI, 80−88%) for TPR, and 78% (95% CI, 66−86%) and 84% (95% CI, 80−88%) for MPR, respectively. MPR showed higher diagnostic accuracy for detecting myocardial perfusion abnormality compared with myocardial CT attenuation and TPR.
Collapse
Affiliation(s)
- Takanori Kouchi
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Yuki Tanabe
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
- Correspondence:
| | - Takumasa Takemoto
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Kazuki Yoshida
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Yuta Yamamoto
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Shigehiro Miyazaki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (S.M.); (S.I.); (O.Y.)
| | - Naoki Fukuyama
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Hikaru Nishiyama
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (S.M.); (S.I.); (O.Y.)
| | - Naoto Kawaguchi
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Tomoyuki Kido
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (S.M.); (S.I.); (O.Y.)
| | - Teruhito Kido
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| |
Collapse
|
7
|
Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part II. Eur Heart J Cardiovasc Imaging 2022; 23:e136-e161. [PMID: 35175348 PMCID: PMC8944330 DOI: 10.1093/ehjci/jeab292] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/12/2022] Open
Abstract
Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. In this article, emerging CT technologies and biomarkers, such as CT-derived fractional flow reserve, perfusion imaging, and pericoronary adipose tissue attenuation, are described. In addition, the role of cardiac CT in the evaluation of atherosclerotic plaque, cardiomyopathies, structural heart disease, and congenital heart disease is revised.
Collapse
Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
| |
Collapse
|
8
|
Kim MY, Yang DH, Choo KS, Lee W. Beyond Coronary CT Angiography: CT Fractional Flow Reserve and Perfusion. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:3-27. [PMID: 36237355 PMCID: PMC9238199 DOI: 10.3348/jksr.2021.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
심장 전산화단층촬영은 비약적인 기술발전과 다양한 연구 결과를 바탕으로 심혈관위험 계층화와 치료 결정을 위한 관상동맥 질환의 진단과 예후 평가성능이 입증되었다. 전산화단층촬영 관상동맥조영술은 폐쇄성 관상동맥 질환에 대한 음성 예측도가 높아서 침습적 혈관조영술의 빈도를 줄일 수 있는 관상동맥 질환 관련 검사의 관문으로 부상했지만, 진단특이도가 상대적으로 낮다. 하지만 심장 전산화단층촬영을 이용한 분획혈류예비력과 심근관류를 분석하여 관상동맥 질환의 혈역학적 유의성을 확인하는 기능적 평가를 통해 그 한계를 극복할 수 있다. 최근에는 이를 보다 객관적이고 재현 가능하도록 인공지능을 접목하는 연구들이 활발히 진행되고 있다. 본 종설에서는 심장 전산화단층촬영의 기능적 영상화 기법들에 대해 알아보고자 한다.
Collapse
Affiliation(s)
- Moon Young Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Yun CH, Hung CL, Wen MS, Wan YL, So A. CT Assessment of Myocardial Perfusion and Fractional Flow Reserve in Coronary Artery Disease: A Review of Current Clinical Evidence and Recent Developments. Korean J Radiol 2021; 22:1749-1763. [PMID: 34431244 PMCID: PMC8546143 DOI: 10.3348/kjr.2020.1277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) is routinely used for anatomical assessment of coronary artery disease (CAD). However, invasive measurement of fractional flow reserve (FFR) is the current gold standard for the diagnosis of hemodynamically significant CAD. CT-derived FFRCT and CT perfusion are two emerging techniques that can provide a functional assessment of CAD for risk stratification and clinical decision making. Several clinical studies have shown that the diagnostic performance of concomitant CCTA and functional CT assessment for detecting hemodynamically significant CAD is at least non-inferior to that of other routinely used imaging modalities. This article aims to review the current clinical evidence and recent developments in functional CT techniques.
Collapse
Affiliation(s)
- Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei, Taiwan
| | - Ming-Shien Wen
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Aaron So
- Department of Medical Biophysics, University of Western Ontario, Imaging Program, Lawson Health Research Institute, London, Canada
| |
Collapse
|
10
|
Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
11
|
From Inception to 2020: a Review of Dynamic Myocardial CT Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-020-09551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Levi J, Wu H, Eck BL, Fahmi R, Vembar M, Dhanantwar A, Fares A, Bezerra HG, Wilson DL. Comparison of automated beam hardening correction (ABHC) algorithms for myocardial perfusion imaging using computed tomography. Med Phys 2021; 48:287-299. [PMID: 33206403 PMCID: PMC8022227 DOI: 10.1002/mp.14599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/23/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Myocardial perfusion imaging using computed tomography (MPI-CT) and coronary CT angiography (CTA) have the potential to make CT an ideal noninvasive imaging gatekeeper exam for invasive coronary angiography. However, beam hardening can prevent accurate blood flow estimation in dynamic MPI-CT and can create artifacts that resemble flow deficits in single-shot MPI-CT. In this work, we compare four automatic beam hardening correction algorithms (ABHCs) applied to CT images, for their ability to produce accurate single images of contrast and accurate MPI flow maps using images from conventional CT systems, without energy sensitivity. METHODS Previously, we reported a method, herein called ABHC-1, where we iteratively optimized a cost function sensitive to beam hardening artifacts in MPI-CT images and used a low order polynomial correction on projections of segmentation-processed CT images. Here, we report results from two new algorithms with higher order polynomial corrections, ABHC-2 and ABHC-3 (with three and seven free parameters, respectively), having potentially better correction but likely reduced estimability. Additionally, we compared results to an algorithm reported by others in the literature (ABHC-NH). Comparisons were made on a digital static phantom with simulated water, bone, and iodine regions; on a digital dynamic anthropomorphic phantom, with simulated blood flow; and on preclinical porcine experiments. We obtained CT images on a prototype spectral detector CT (Philips Healthcare) scanner that provided both conventional and virtual keV images, allowing us to quantitatively compare corrected CT images to virtual keV images. To test these methods' parameter optimization sensitivity to noise, we evaluated results on images obtained using different mAs. RESULTS In images of the static phantom, ABHC-2 reduced beam hardening artifacts better than our previous ABHC-1 algorithm, giving artifacts smaller than 1.8 HU, even in the presence of high noise which should affect parameter optimization. Taken together, the quality of static phantom results ordered ABHC-2> ABHC-3> ABHC-1>> ABHC-NH. In an anthropomorphic MPI-CT simulator with homogeneous myocardial blood flow of 100 ml⋅min-1 ⋅100 g-1 , blood flow estimation results were 122 ± 24 (FBP), 135 ± 24 (ABHC-NH), 104 ± 14 (ABHC-1), 100 ± 12 (ABHC-2), and 108 ± 18 (ABHC-3) ml⋅min-1 ⋅100 g-1 , showing ABHC-2 as a clear winner. Visual and quantitative evaluations showed much improved homogeneity of myocardial flow with ABHC-2, nearly eliminating substantial artifacts in uncorrected flow maps which could be misconstrued as flow deficits. ABHC-2 performed universally better than ABHC-1, ABHC-3, and ABHC-NH in simulations with different acquisitions (varying noise and kVp values). In the presence of a simulated flow deficit, all ABHC methods retained the flow deficit, and ABHC-2 gave the most accurate flow ratio and homogeneity. ABHC-3 corrected phantom flow values were slightly better than ABHC-2, in noiseless images, suggesting that reduced quality in noisy images was due to reduced estimability. In an experiment with a pig expected to have uniform flow, ABHC-2 applied to conventional images improved flow maps to compare favorably to those from 70keV images. CONCLUSION The automated algorithm can be used with different parametric BH correction models. ABHC-2 improved MPI-CT blood flow estimation as compared to other approaches and was robust to noisy images. In simulation and preclinical experiments, ABHC-2 gave results approaching gold standard 70 keV measurements.
Collapse
Affiliation(s)
- Jacob Levi
- Department of Physics, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hao Wu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Brendan L Eck
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Rachid Fahmi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mani Vembar
- Philips Healthcare, Cleveland, OH, 44143, USA
| | | | - Anas Fares
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Hiram G Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
| |
Collapse
|
13
|
Panetta D, Gabelloni M, Faggioni L, Pelosi G, Aringhieri G, Caramella D, Salvadori PA. Cardiac Computed Tomography Perfusion: Contrast Agents, Challenges and Emerging Methodologies from Preclinical Research to the Clinics. Acad Radiol 2021; 28:e1-e13. [PMID: 32220550 DOI: 10.1016/j.acra.2019.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
Abstract
Computed Tomography (CT) has long been regarded as a purely anatomical imaging modality. Recent advances on CT technology and Contrast Agents (CA) in both clinical and preclinical cardiac imaging offer opportunities for the use of CT in functional imaging. Combined with modern ECG-gating techniques, functional CT has now become a reality allowing a comprehensive evaluation of myocardial global and regional function, perfusion and coronary angiography. This article aims at reviewing the current status of cardiac CT perfusion and micro-CT perfusion with established and experimental scanners and contrast agents, from clinical practice to the experimental domain of investigations based on animal models of heart diseases.
Collapse
|
14
|
Seitun S, Clemente A, De Lorenzi C, Benenati S, Chiappino D, Mantini C, Sakellarios AI, Cademartiri F, Bezante GP, Porto I. Cardiac CT perfusion and FFR CTA: pathophysiological features in ischemic heart disease. Cardiovasc Diagn Ther 2020; 10:1954-1978. [PMID: 33381437 PMCID: PMC7758766 DOI: 10.21037/cdt-20-414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 01/24/2023]
Abstract
Cardiac computed tomography (CCT) has rapidly evolved, becoming a powerful integrated tool for the evaluation of coronary artery disease (CAD), and being superior to other noninvasive methods due to its high accuracy and ability to simultaneously assess both lumen stenosis and atherosclerotic plaque burden. Furthermore, CCT is regarded as an effective gatekeeper for coronary angiography, and carries independent important prognostic information. In the last decade, the introduction of new functional CCT applications, namely CCT perfusion (CCTP) imaging and CT-derived fractional flow reserve (FFRCTA), has opened the door for accurate assessment of the haemodynamic significance of stenoses. These new CCT technologies, thus, share the unique advantage of assessing both myocardial ischemia and patient-specific coronary artery anatomy, providing an integrated anatomical/functional analysis. In the present review, starting from the pathophysiology of myocardial ischemia, we evaluate the existing evidence for functional CCT imaging and its value in relation to alternative, well-established, non-invasive imaging modalities and invasive indices of ischemia (currently the gold-standard). The knowledge of clinical applications, benefits, and limitations of these new CCT technologies will allow efficient and optimal use in clinical practice in the near future.
Collapse
Affiliation(s)
- Sara Seitun
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region ‘Gabriele Monasterio’ Foundation (FTGM), Massa, Italy
| | - Cecilia De Lorenzi
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Stefano Benenati
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region ‘Gabriele Monasterio’ Foundation (FTGM), Massa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, “G. d’Annunzio” University, Chieti, Italy
| | - Antonis I. Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Gian Paolo Bezante
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Italo Porto
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| |
Collapse
|
15
|
Tian XW, Ma AL, Zhou RB, Jiang LJ, Hao Y, Zou XG. Advances in Cardiac Computed Tomography Functional Imaging Technology. Cardiology 2020; 145:615-622. [PMID: 32829331 DOI: 10.1159/000505317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among patients in China, and cardiac computed tomography (CT) is one of the most commonly used examination methods for CVD. Coronary artery CT angiography can be used for the morphologic evaluation of the coronary artery. At present, cardiac CT functional imaging has become an important direction of development of CT. At present, common CT functional imaging technologies include transluminal attenuation gradient, stress dynamic CT myocardial perfusion imaging, and CT-fractional flow reserve. These three imaging modes are introduced and analyzed in this review.
Collapse
Affiliation(s)
- Xu-Wei Tian
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Ai-Lin Ma
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Ren-Bing Zhou
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Liu-Jiang Jiang
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Yue Hao
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China
| | - Xiao-Guang Zou
- Department of Radiology, Department of Medical Imaging, The First People's Hospital Kashgar Region, Kashgar, China,
| |
Collapse
|
16
|
Tanabe Y, Kurata A, Matsuda T, Yoshida K, Baruah D, Kido T, Mochizuki T, Rajiah P. Computed tomographic evaluation of myocardial ischemia. Jpn J Radiol 2020; 38:411-433. [PMID: 32026226 PMCID: PMC7186254 DOI: 10.1007/s11604-020-00922-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 01/02/2023]
Abstract
Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CT-fractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.
Collapse
Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takuya Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Dhiraj Baruah
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
- Department of Radiology, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, Moscow, Russia
| | | |
Collapse
|
17
|
Singh A, Mor-Avi V, Patel AR. The role of computed tomography myocardial perfusion imaging in clinical practice. J Cardiovasc Comput Tomogr 2020; 14:185-194. [DOI: 10.1016/j.jcct.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 01/17/2023]
|
18
|
Regadenoson dynamic computed tomography myocardial perfusion using low-dose protocol for evaluation of the ischemic burden. ULYSSES study. J Cardiovasc Comput Tomogr 2020; 14:428-436. [PMID: 32029383 DOI: 10.1016/j.jcct.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The purpose of this study was to assess the feasibility of low-dose dynamic regadenoson computed tomography perfusion (CTP) protocol, and to determine which parameters provide the best diagnostic yield for the presence and burden of ischemia in reference to the magnetic resonance myocardial perfusion imaging (MR MPI). METHODS Fifty six patients with ≥1 intermediate (50-90%) coronary artery stenosis on CTA underwent dynamic stress CTP and MR MPI. The distribution of contrast agent in CTP was represented for each myocardial segment as either absolute or indexed: myocardial blood flow (MBF), myocardial blood volume (MBV), perfused capillary blood volume (PCBV), peak value (PV), time to peak (TTP), respectively. RESULTS Of 56 patients (25 females, 63.5 ± 8.5y), 15 (27%) were diagnosed with reversible ischemia and 3 (5%) with fixed ischemia on the MR MPI. The median radiation dose for dynamic CTP scan was 352.00 [276.4-496.6] mGy*cm. The optimal cut-off point for the prediction of reversible ischemia on MR MPI for the absolute parameters were: MBF ≤156.49 (AUC=0.899), MBV ≤15.06 (AUC=0.901), PCBV ≤7.90 (AUC=0.880), PV ≤ 88.30 (AUC=0.766), TTP ≥22.58 (AUC=0.595); and for the indexed: indexed MBF ≤0.78 (AUC=0.926), indexed MBV ≤0.81 (AUC=0.924), indexed PCBV ≤0.70 (AUC=0.894); indexed PV ≤ 0.79 (AUC=0.869), indexed TTP ≤0.87 (AUC=0.685). The best parameters for ischemia detection were indexed MBF and indexed MBV, with sensitivities 91% and 89%, specificities 97% and 96%, NPV 99% and 99%, PPV 76% and 69%, and accuracies 96% and 95%, respectively. In per patient analysis, indexed MBF correlated significantly better with the ischemia burden than any of the absolute parameters (p < 0.01 for all comparisons). CONCLUSIONS Regadenoson dynamic CTP using low-dose protocol is feasible while maintaining high diagnostic accuracy. The best diagnostic value may be provided by indexed parameters, of which indexed MBF and indexed MBV may provide best incremental value in identification of the presence and burden of ischemia.
Collapse
|
19
|
Society of cardiovascular computed tomography expert consensus document on myocardial computed tomography perfusion imaging. J Cardiovasc Comput Tomogr 2020; 14:87-100. [DOI: 10.1016/j.jcct.2019.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
|
20
|
Pontone G, Rabbat MG, Rossi A. Understanding Coronary Physiology Through Dynamic CT Perfusion Imaging. JACC Cardiovasc Imaging 2019; 13:977-979. [PMID: 31542522 DOI: 10.1016/j.jcmg.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois; Edward Hines Jr. Veteran's Affairs Hospital, Hines, Illinois
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Diagnostic Imaging, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy
| |
Collapse
|
21
|
Nieman K, Balla S. Dynamic CT myocardial perfusion imaging. J Cardiovasc Comput Tomogr 2019; 14:303-306. [PMID: 31540820 DOI: 10.1016/j.jcct.2019.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/09/2019] [Accepted: 09/07/2019] [Indexed: 12/30/2022]
Abstract
Cardiac CT offers several approaches to establish the hemodynamic severity of coronary artery obstructions. Dynamic myocardial perfusion CT (MPICT) is based on serial CT imaging to measure the inflow of contrast medium into the myocardium and calculate absolute measures of myocardial perfusion. This review describes the MPICT acquisition protocol, post-image acquisition processing and calculation of quantitative parameters, the diagnostic performance of MPICT and the potential incremental value of this technique in comparison to alternative approaches. Further technical innovation using different scanner platforms and establishment of reproducible diagnostic thresholds to differentiate significant coronary artery disease will be crucial in the path to broader clinical implementation.
Collapse
Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, 94304, USA.
| | - Sujana Balla
- Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, 94304, USA
| |
Collapse
|
22
|
Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease. JACC Cardiovasc Imaging 2019; 12:1487-1497. [DOI: 10.1016/j.jcmg.2018.08.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/23/2022]
|
23
|
Impact of the sampling rate of dynamic myocardial computed tomography perfusion on the quantitative assessment of myocardial blood flow. Clin Imaging 2019; 56:93-101. [DOI: 10.1016/j.clinimag.2019.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/23/2019] [Accepted: 03/29/2019] [Indexed: 11/19/2022]
|
24
|
Nishiyama H, Tanabe Y, Kido T, Kurata A, Uetani T, Kido T, Ikeda S, Miyagawa M, Mochizuki T. Incremental diagnostic value of whole-heart dynamic computed tomography perfusion imaging for detecting obstructive coronary artery disease. J Cardiol 2019; 73:425-431. [DOI: 10.1016/j.jjcc.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/19/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
|
25
|
Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived. JACC Cardiovasc Imaging 2019; 12:2460-2471. [PMID: 31005531 DOI: 10.1016/j.jcmg.2019.02.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/22/2019] [Accepted: 02/01/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aims of the study were to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus fractional flow reserve computed tomography derived (FFRCT) by using a whole-heart coverage computed tomography (CT) scanner as compared with clinically indicated invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). BACKGROUND Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experiences with this technique were associated with high radiation exposure. METHODS Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant coronary artery disease (CAD) in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP, or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. RESULTS The prevalence of obstructive CAD and functionally significant CAD was 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT, and cCTA+CTP were 83% and 66%, 86% and 75%, and 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared with cCTA alone (0.826; p < 0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919; p < 0.05) as compared with all other strategies. The mean effective radiation dose (ED) for cCTA and stress CTP was 2.8 ± 1.2 mSv and 5.3 ± 0.7 mSv, respectively. CONCLUSIONS The addition of dynamic stress CTP on top of cCTA and FFRCT provides additional diagnostic accuracy with acceptable radiation exposure.
Collapse
|
26
|
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: 69] [Impact Index Per Article: 13.8] [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]
|
27
|
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]
|
28
|
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.
Collapse
|
29
|
Eck BL, Muzic RF, Levi J, Wu H, Fahmi R, Li Y, Fares A, Vembar M, Dhanantwari A, Bezerra HG, Wilson DL. The role of acquisition and quantification methods in myocardial blood flow estimability for myocardial perfusion imaging CT. Phys Med Biol 2018; 63:185011. [PMID: 30113311 PMCID: PMC6264889 DOI: 10.1088/1361-6560/aadab6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work, we clarified the role of acquisition parameters and quantification methods in myocardial blood flow (MBF) estimability for myocardial perfusion imaging using CT (MPI-CT). We used a physiologic model with a CT simulator to generate time-attenuation curves across a range of imaging conditions, i.e. tube current-time product, imaging duration, and temporal sampling, and physiologic conditions, i.e. MBF and arterial input function width. We assessed MBF estimability by precision (interquartile range of MBF estimates) and bias (difference between median MBF estimate and reference MBF) for multiple quantification methods. Methods included: six existing model-based deconvolution models, such as the plug-flow tissue uptake model (PTU), Fermi function model, and single-compartment model (SCM); two proposed robust physiologic models (RPM1, RPM2); model-independent singular value decomposition with Tikhonov regularization determined by the L-curve criterion (LSVD); and maximum upslope (MUP). Simulations show that MBF estimability is most affected by changes in imaging duration for model-based methods and by changes in tube current-time product and sampling interval for model-independent methods. Models with three parameters, i.e. RPM1, RPM2, and SCM, gave least biased and most precise MBF estimates. The average relative bias (precision) for RPM1, RPM2, and SCM was ⩽11% (⩽10%) and the models produced high-quality MBF maps in CT simulated phantom data as well as in a porcine model of coronary artery stenosis. In terms of precision, the methods ranked best-to-worst are: RPM1 > RPM2 > Fermi > SCM > LSVD > MUP [Formula: see text] other methods. In terms of bias, the models ranked best-to-worst are: SCM > RPM2 > RPM1 > PTU > LSVD [Formula: see text] other methods. Models with four or more parameters, particularly five-parameter models, had very poor precision (as much as 310% uncertainty) and/or significant bias (as much as 493%) and were sensitive to parameter initialization, thus suggesting the presence of multiple local minima. For improved estimates of MBF from MPI-CT, it is recommended to use reduced models that incorporate prior knowledge of physiology and contrast agent uptake, such as the proposed RPM1 and RPM2 models.
Collapse
Affiliation(s)
- Brendan L Eck
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
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]
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Tomizawa N, Fujino Y, Kamitani M, Chou S, Yamamoto K, Inoh S, Nojo T, Nakamura S. Longer diabetes duration reduces myocardial blood flow in remote myocardium assessed by dynamic myocardial CT perfusion. J Diabetes Complications 2018; 32:609-615. [PMID: 29627375 DOI: 10.1016/j.jdiacomp.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/04/2018] [Accepted: 03/11/2018] [Indexed: 01/30/2023]
Abstract
AIMS To investigate the relationship of type 2 diabetes duration and myocardial blood flow (MBF) assessed by myocardial CT perfusion. MATERIALS AND METHODS We prospectively included 140 patients with type 2 diabetes who underwent dynamic myocardial CT perfusion exam. MBF of the remote myocardium was calculated using the deconvolution technique and the Voronoi method. The relationships of MBF and diabetic duration, diabetic complications, conventional risk factors, coronary calcium, and coronary stenosis were assessed by logistic regression analysis. RESULTS A weak but significantly negative relationship was present between diabetes duration and MBF (R2 = 0.05, p < 0.01). The average MBF of patients with a duration of >8 years was 13% lower than that of the remaining patients (1.11 ± 0.35 vs 1.28 ± 0.27 ml min-1 g-1, p < 0.01). Duration of one year was associated with a 6% increased risk for low MBF (<1.18 ml min-1 g-1) (odds ratio 1.06, 95% confidence interval 1.01-1.12, p < 0.05). Calcium score was also a significant factor for low MBF (odds ratio 1.08 (per 100 Agatston units), 95% confidence interval 1.01-1.17, p < 0.05). CONCLUSION Longer diabetes duration is associated with lower MBF independent of conventional cardiac risk factors or the presence of coronary stenosis.
Collapse
Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
| | - Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan; Department of Diabetes, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Masaru Kamitani
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shengpu Chou
- Department of Diabetes, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Kodai Yamamoto
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shinichi Inoh
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Takeshi Nojo
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| |
Collapse
|
34
|
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]
|
35
|
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
| |
Collapse
|
36
|
Johnston CM, Krafft AJ, Russe MF, Rog-Zielinska EA. A new look at the heart-novel imaging techniques. Herzschrittmacherther Elektrophysiol 2017; 29:14-23. [PMID: 29242981 DOI: 10.1007/s00399-017-0546-7] [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: 10/06/2017] [Accepted: 11/24/2017] [Indexed: 01/20/2023]
Abstract
The development and successful implementation of cutting-edge imaging technologies to visualise cardiac anatomy and function is a key component of effective diagnostic efforts in cardiology. Here, we describe a number of recent exciting advances in the field of cardiology spanning from macro- to micro- to nano-scales of observation, including magnetic resonance imaging, computed tomography, optical mapping, photoacoustic imaging, and electron tomography. The methodologies discussed are currently making the transition from scientific research to routine clinical use, albeit at different paces. We discuss the most likely trajectory of this transition into clinical research and standard diagnostics, and highlight the key challenges and opportunities associated with each of the methodologies.
Collapse
Affiliation(s)
- C M Johnston
- Institute for Experimental Cardiovascular Medicine, University Heart Center, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A J Krafft
- Department of Radiology, Medical Physics, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M F Russe
- Department of Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E A Rog-Zielinska
- Institute for Experimental Cardiovascular Medicine, University Heart Center, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
37
|
Evaluation of an adaptive detector collimation for prospectively ECG-triggered coronary CT angiography with third-generation dual-source CT. Eur Radiol 2017; 28:2143-2150. [DOI: 10.1007/s00330-017-5177-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
|
38
|
Kofoed KF, Sørgaard MH, Linde JJ. Functional Information in Coronary Artery Disease: The Case of Computed Tomography Myocardial Perfusion. Curr Cardiol Rep 2017; 19:126. [PMID: 29071430 DOI: 10.1007/s11886-017-0937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW To review methodological and logistical aspects of CT myocardial perfusion, current clinical evidence and possible future directions, with specific focus on use in patients with coronary artery disease (CAD). RECENT FINDINGS CT myocardial perfusion imaging may be performed as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already clinically available perfusion imaging methods. Combining CCTA and CT myocardial perfusion imaging increases the diagnostic accuracy to identify patients with CAD associated with ischemia. In patients suspected of CAD, CCTA frequently detects coronary atherosclerotic lesions, in which revascularization could be clinically beneficial. CT myocardial perfusion imaging may be helpful to identify coronary lesions associated with myocardial ischemia, and thus potentially suitable for coronary intervention.
Collapse
Affiliation(s)
- Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Department of Cardiology 2014, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias H Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
39
|
Rajiah P, Maroules CD. Myocardial ischemia testing with computed tomography: emerging strategies. Cardiovasc Diagn Ther 2017; 7:475-488. [PMID: 29255691 DOI: 10.21037/cdt.2017.09.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although cardiac computed tomography (CT) has high negative predictive value to exclude obstructive coronary artery disease (CAD), particularly in the low to intermediate risk population, it has low specificity in the diagnosis of ischemia-inducing lesions. This inability to predict hemodynamically significant stenosis hampers the ability of CT to be an effective gatekeeper for invasive angiography and to guide appropriate revascularization. Recent advances in CT technology have resulted in the development of multiple techniques to provide hemodynamic information and detect lesion-specific ischemia, namely CT perfusion (CTP), CT-derived fractional flow reserve (CT-FFR) and coronary transluminal attenuation gradient (TAG). In this article, we provide a perspective on these emerging CT techniques in the evaluation of myocardial ischemia.
Collapse
Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | | |
Collapse
|
40
|
Rief M, Chen MY, Vavere AL, Kendziora B, Miller JM, Bandettini WP, Cox C, George RT, Lima J, Di Carli M, Plotkin M, Zimmermann E, Laule M, Schlattmann P, Arai AE, Dewey M. Coronary Artery Disease: Analysis of Diagnostic Performance of CT Perfusion and MR Perfusion Imaging in Comparison with Quantitative Coronary Angiography and SPECT-Multicenter Prospective Trial. Radiology 2017; 286:461-470. [PMID: 28956734 DOI: 10.1148/radiol.2017162447] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To compare the diagnostic performance of stress myocardial computed tomography (CT) perfusion with that of stress myocardial magnetic resonance (MR) perfusion imaging in the detection of coronary artery disease (CAD). Materials and Methods All patients gave written informed consent prior to inclusion in this institutional review board-approved study. This two-center substudy of the prospective Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) multicenter trial included 92 patients (mean age, 63.1 years ± 8.1 [standard deviation]; 73% male). All patients underwent perfusion CT and perfusion MR imaging with either adenosine or regadenoson stress. The predefined reference standards were combined quantitative coronary angiography (QCA) and single-photon emission CT (SPECT) or QCA alone. Results from coronary CT angiography were not included, and diagnostic performance was evaluated with the Mantel-Haenszel test stratified by disease status. Results The prevalence of CAD was 39% (36 of 92) according to QCA and SPECT and 64% (59 of 92) according to QCA alone. When compared with QCA and SPECT, per-patient diagnostic accuracy of perfusion CT and perfusion MR imaging was 63% (58 of 92) and 75% (69 of 92), respectively (P = .11); sensitivity was 92% (33 of 36) and 83% (30 of 36), respectively (P = .45); and specificity was 45% (25 of 56) and 70% (39 of 56), respectively (P < .01). When compared with QCA alone, diagnostic accuracy of CT perfusion and MR perfusion imaging was 82% (75 of 92) and 74% (68 of 92), respectively (P = .27); sensitivity was 90% (53 of 59) and 69% (41 of 59), respectively (P < .01); and specificity was 67% (22 of 33) and 82% (27 of 33), respectively (P = .27). Conclusion This multicenter study shows that the diagnostic performance of perfusion CT is similar to that of perfusion MR imaging in the detection of CAD. © RSNA, 2017 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Matthias Rief
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Marcus Y Chen
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Andrea L Vavere
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Benjamin Kendziora
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Julie M Miller
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - W Patricia Bandettini
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Christopher Cox
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Richard T George
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - João Lima
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Marcelo Di Carli
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Michail Plotkin
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Elke Zimmermann
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Michael Laule
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Peter Schlattmann
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Andrew E Arai
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| | - Marc Dewey
- From the Departments of Radiology (M.R., B.K., E.Z., M.D.), Nuclear Medicine (M.P.), and Cardiology (M.L.), Charité-Universitätsmedizin Berlin, Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Health and Human Services, National Institutes of Health, Bethesda, Md (M.Y.C., W.P.B., A.E.A.); Department of Medicine, Johns Hopkins University, Baltimore, Md (A.L.V., J.M.M., R.T.G., J.L.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (C.C.); Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (M.D.C.); and Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany (P.S.)
| |
Collapse
|
41
|
|
42
|
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]
|
43
|
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.
Collapse
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.
| |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
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.
Collapse
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.).
| |
Collapse
|
46
|
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.
Collapse
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.
| |
Collapse
|
47
|
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: 33] [Impact Index Per Article: 4.7] [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.
Collapse
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
| |
Collapse
|
48
|
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.
Collapse
Affiliation(s)
- Changfei Gong
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
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.
Collapse
|
50
|
Funama Y, Utsunomiya D, Oda S, Shimonobo T, Nakaura T, Mukunoki T, Kidoh M, Yuki H, Yamashita Y. Transluminal attenuation-gradient coronary CT angiography on a 320-MDCT volume scanner: Effect of scan timing, coronary artery stenosis, and cardiac output using a contrast medium flow phantom. Phys Med 2016; 32:1415-1421. [DOI: 10.1016/j.ejmp.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
|