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Cardiovascular Imaging: The Past and the Future, Perspectives in Computed Tomography and Magnetic Resonance Imaging. Invest Radiol 2016; 50:557-70. [PMID: 25985464 DOI: 10.1097/rli.0000000000000164] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Today's noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CT applications. Within the past 10-15 years, MR and CT technologies have pushed each other in cardiac applications; and without the "rival" modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today.
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Bindschadler M, Modgil D, Branch KR, La Riviere PJ, Alessio AM. Evaluation of static and dynamic perfusion cardiac computed tomography for quantitation and classification tasks. J Med Imaging (Bellingham) 2016; 3:024001. [PMID: 27175377 DOI: 10.1117/1.jmi.3.2.024001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
Abstract
Cardiac computed tomography (CT) acquisitions for perfusion assessment can be performed in a dynamic or static mode. Either method may be used for a variety of clinical tasks, including (1) stratifying patients into categories of ischemia and (2) using a quantitative myocardial blood flow (MBF) estimate to evaluate disease severity. In this simulation study, we compare method performance on these classification and quantification tasks for matched radiation dose levels and for different flow states, patient sizes, and injected contrast levels. Under conditions simulated, the dynamic method has low bias in MBF estimates (0 to [Formula: see text]) compared to linearly interpreted static assessment (0.45 to [Formula: see text]), making it more suitable for quantitative estimation. At matched radiation dose levels, receiver operating characteristic analysis demonstrated that the static method, with its high bias but generally lower variance, had superior performance ([Formula: see text]) in stratifying patients, especially for larger patients and lower contrast doses [area under the curve [Formula: see text] to 96 versus 0.86]. We also demonstrate that static assessment with a correctly tuned exponential relationship between the apparent CT number and MBF has superior quantification performance to static assessment with a linear relationship and to dynamic assessment. However, tuning the exponential relationship to the patient and scan characteristics will likely prove challenging. This study demonstrates that the selection and optimization of static or dynamic acquisition modes should depend on the specific clinical task.
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Affiliation(s)
- Michael Bindschadler
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
| | - Dimple Modgil
- The University of Chicago , Department of Radiology, Chicago, Illinois 60637, United States
| | - Kelley R Branch
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
| | - Patrick J La Riviere
- The University of Chicago , Department of Radiology, Chicago, Illinois 60637, United States
| | - Adam M Alessio
- University of Washington , Department of Radiology, Seattle, Washington 98195, United States
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Mor-Avi V, Kachenoura N, Maffessanti F, Bhave NM, Port S, Lodato JA, Chandra S, Freed BH, Lang RM, Patel AR. Three-dimensional quantification of myocardial perfusion during regadenoson stress computed tomography. Eur J Radiol 2016; 85:885-92. [PMID: 27130047 DOI: 10.1016/j.ejrad.2016.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/15/2016] [Accepted: 02/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is no accepted methodology for CT-based vasodilator stress myocardial perfusion imaging and analysis. We developed a technique for quantitative 3D analysis of CT images, which provides several indices of myocardial perfusion. We sought to determine the ability of these indices during vasodilator stress to identify segments supplied by coronary arteries with obstructive disease and to test the accuracy of the detection of perfusion abnormalities against SPECT. METHODS We studied 93 patients referred for CT coronary angiography (CTCA) who underwent regadenoson stress. 3D analysis of stress CT images yielded segmental perfusion indices: mean X-ray attenuation, severity of defect and relative defect volume. Each index was averaged for myocardial segments, grouped by severity of stenosis: 0%, <50%, 50-70%, and >70%. Objective detection of perfusion abnormalities was optimized in 47 patients and then independently tested in the remaining 46 patients. RESULTS CTCA depicted normal coronary arteries or non-obstructive disease in 62 patients and stenosis of >50% in 31. With increasing stenosis, segmental attenuation showed a 7% decrease, defect severity increased 11%, but relative defect volume was 7-fold higher in segments with obstructive disease (p<0.001). In the test group, detection of perfusion abnormalities associated with stenosis >50% showed sensitivity 0.78, specificity 0.54, accuracy 0.59. When compared to SPECT in a subset of 21 patients (14 with abnormal SPECT), stress CT perfusion analysis showed sensitivity 0.79, specificity 0.71, accuracy 0.76. CONCLUSIONS 3D analysis of vasodilator stress CT images provides quantitative indices of myocardial perfusion, of which relative defect volume was most robust in identifying segments supplied by arteries with obstructive disease. This study may have implications on how CT stress perfusion imaging is performed and analyzed.
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Affiliation(s)
- Victor Mor-Avi
- University of Chicago Medical Center, Chicago, IL, United States.
| | - Nadjia Kachenoura
- University of Chicago Medical Center, Chicago, IL, United States; Sorbonne Universités, UPMC University Paris 06, CNRS 7371, INSERM 1146, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France
| | | | - Nicole M Bhave
- University of Chicago Medical Center, Chicago, IL, United States
| | - Steven Port
- Aurora Health Care, Milwaukee, WI, United States
| | - Joseph A Lodato
- University of Chicago Medical Center, Chicago, IL, United States
| | - Sonal Chandra
- University of Chicago Medical Center, Chicago, IL, United States
| | - Benjamin H Freed
- University of Chicago Medical Center, Chicago, IL, United States
| | - Roberto M Lang
- University of Chicago Medical Center, Chicago, IL, United States
| | - Amit R Patel
- University of Chicago Medical Center, Chicago, IL, United States
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Técnica de imagen de perfusión miocárdica con tomografía computarizada de estrés: un nuevo tema en cardiología. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Stress Computed Tomography Myocardial Perfusion Imaging: A New Topic in Cardiology. ACTA ACUST UNITED AC 2016; 69:188-200. [PMID: 26774540 DOI: 10.1016/j.rec.2015.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023]
Abstract
Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed.
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The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT. Eur J Radiol 2015; 84:2411-20. [DOI: 10.1016/j.ejrad.2014.12.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/21/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
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Cabeda EV, Falcão AMG, Soares J, Rochitte CE, Nomura CH, Ávila LFR, Parga JR. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block. Arq Bras Cardiol 2015; 105:614-24. [PMID: 26421532 PMCID: PMC4693666 DOI: 10.5935/abc.20150117] [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: 01/25/2015] [Accepted: 04/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Functional tests have limited accuracy for identifying myocardial ischemia in
patients with left bundle branch block (LBBB). Objective To assess the diagnostic accuracy of dipyridamole-stress myocardial computed
tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive
quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to
investigate the advantage of adding CTP to coronary computed tomography
angiography (CTA) and compare the results with those of single photon emission
computed tomography (SPECT) myocardial perfusion scintigraphy. Methods Thirty patients with LBBB who had undergone SPECT for the investigation of
coronary artery disease were referred for stress tomography. Independent examiners
performed per-patient and per-coronary territory assessments. All patients gave
written informed consent to participate in the study that was approved by the
institution’s ethics committee. Results The patients’ mean age was 62 ± 10 years. The mean dose of radiation for
the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the
per-patient values for sensitivity, specificity, positive and negative predictive
values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001).
The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p <
0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic
accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion The use of the stress tomography protocol is feasible and has good diagnostic
accuracy for assessing myocardial ischemia in patients with LBBB.
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Affiliation(s)
- Estêvan Vieira Cabeda
- Departamento de Tomografia e Ressonância Cardiovascular, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andréa Maria Gomes Falcão
- Departamento de Medicina Nuclear, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Soares
- Departamento de Medicina Nuclear, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos Eduardo Rochitte
- Departamento de Tomografia e Ressonância Cardiovascular, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
| | - César Higa Nomura
- Departamento de Tomografia e Ressonância Cardiovascular, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Francisco Rodrigues Ávila
- Departamento de Tomografia e Ressonância Cardiovascular, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Rodrigues Parga
- Departamento de Tomografia e Ressonância Cardiovascular, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
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Truong QA, Knaapen P, Pontone G, Andreini D, Leipsic J, Carrascosa P, Lu B, Branch K, Raman S, Bloom S, Min JK. Rationale and design of the dual-energy computed tomography for ischemia determination compared to "gold standard" non-invasive and invasive techniques (DECIDE-Gold): A multicenter international efficacy diagnostic study of rest-stress dual-energy computed tomography angiography with perfusion. J Nucl Cardiol 2015; 22:1031-40. [PMID: 25549826 PMCID: PMC4490157 DOI: 10.1007/s12350-014-0035-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dual-energy CT (DECT) has potential to improve myocardial perfusion for physiologic assessment of coronary artery disease (CAD). Diagnostic performance of rest-stress DECT perfusion (DECTP) is unknown. OBJECTIVE DECIDE-Gold is a prospective multicenter study to evaluate the accuracy of DECT to detect hemodynamic (HD) significant CAD, as compared to fractional flow reserve (FFR) as a reference standard. METHODS Eligible participants are subjects with symptoms of CAD referred for invasive coronary angiography (ICA). Participants will undergo DECTP, which will be performed by pharmacological stress, and participants will subsequently proceed to ICA and FFR. HD-significant CAD will be defined as FFR ≤ 0.80. In those undergoing myocardial stress imaging (MPI) by positron emission tomography (PET), single photon emission computed tomography (SPECT) or cardiac magnetic resonance (CMR) imaging, ischemia will be graded by % ischemic myocardium. Blinded core laboratory interpretation will be performed for CCTA, DECTP, MPI, ICA, and FFR. RESULTS Primary endpoint is accuracy of DECTP to detect ≥1 HD-significant stenosis at the subject level when compared to FFR. Secondary and tertiary endpoints are accuracies of combinations of DECTP at the subject and vessel levels compared to FFR and MPI. CONCLUSION DECIDE-Gold will determine the performance of DECTP for diagnosing ischemia.
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Affiliation(s)
- Quynh A Truong
- Departments of Radiology, Weill Cornell Medical College, 413 E. 69th Street, Suite 108, New York, NY, 10021, USA
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, NY, USA
| | - Paul Knaapen
- Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands
| | | | | | - Jonathon Leipsic
- Providence Health Care-St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kelley Branch
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Subha Raman
- Division of Cardiology, Department of Medicine, Wexner Heart and Vascular Institute, The Ohio State University, Columbus, OH, USA
| | - Stephen Bloom
- Midwest Heart & Vascular Associates, Kansas City, MO, USA
| | - James K Min
- Departments of Radiology, Weill Cornell Medical College, 413 E. 69th Street, Suite 108, New York, NY, 10021, USA.
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, NY, USA.
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President's page - The definition of Cardiac CT = Resilience. J Cardiovasc Comput Tomogr 2015; 9:370-2. [DOI: 10.1016/j.jcct.2015.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Measuring myocardial perfusion: the role of PET, MRI and CT. Clin Radiol 2015; 70:576-84. [DOI: 10.1016/j.crad.2014.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
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Carrascosa PM, Cury RC, Deviggiano A, Capunay C, Campisi R, López de Munain M, Vallejos J, Tajer C, Rodriguez-Granillo GA. Comparison of myocardial perfusion evaluation with single versus dual-energy CT and effect of beam-hardening artifacts. Acad Radiol 2015; 22:591-9. [PMID: 25680523 DOI: 10.1016/j.acra.2014.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES We sought to explore the feasibility and diagnostic performance of dual-energy computed tomography (DECT) versus single-energy computed tomography (SECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease. MATERIALS AND METHODS The present prospective study involved patients with known or suspected coronary artery disease referred for myocardial perfusion imaging by single-photon emission computed tomography. Forty patients were included in the study protocol and scanned using DECT imaging (n = 20) or SECT imaging (n = 20). The same pharmacologic stress was used for DECT, SECT, and single-photon emission computed tomography scans. RESULTS A total of 1360 left ventricular segments were evaluated by DECT and SECT. The contrast-to-noise ratio was similar between groups (DECT 8.8 ± 2.9 vs. SECT 7.7 ± 4.2; P = .22). The diagnostic performance of DECT was greater than that of SECT in identifying perfusion defects (area under the receiver operating characteristic curve of DECT 0.90 [0.86-0.94] vs SECT 0.80 [0.76-0.84]; P = .0004) and remained unaffected when including only segments affected by beam-hardening artifacts (area under the receiver operating characteristic curve = DECT 0.90 [0.84-0.96) vs. SECT 0.77 [0.69-0.84]; P = .007). CONCLUSIONS Our results suggest that myocardial perfusion by DECT imaging is feasible and might have improved diagnostic performance compared to SECT imaging for the assessment of myocardial CT perfusion. Furthermore, the diagnostic performance of DECT remained unaffected by the presence of beam-hardening artifacts.
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Affiliation(s)
- Patricia M Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina.
| | - Ricardo C Cury
- Baptist Hospital of Miami, Miami, Florida; Baptist Cardiac and Vascular Institute, Miami, Florida
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Roxana Campisi
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Marina López de Munain
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Javier Vallejos
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Carlos Tajer
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
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Ko SM, Hwang HK, Kim SM, Cho IH. Multi-modality imaging for the assessment of myocardial perfusion with emphasis on stress perfusion CT and MR imaging. Int J Cardiovasc Imaging 2015; 31 Suppl 1:1-21. [PMID: 25809387 DOI: 10.1007/s10554-015-0645-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 01/29/2023]
Abstract
High-quality and non-invasive diagnostic tools for assessing myocardial ischemia are necessary for therapeutic decisions regarding coronary artery disease. Myocardial perfusion has been studied using myocardial contrast echo perfusion, single-photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and, more recently, computed tomography. The addition of coronary computed tomography angiography to myocardial perfusion imaging improves the specificity and overall diagnostic accuracy of detecting the hemodynamic significance of coronary artery stenosis. This study reviews the benefits, limitations, and imaging findings of various imaging modalities for assessing myocardial perfusion, with particular emphasis on stress perfusion computed tomography and cardiovascular magnetic resonance imaging.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea,
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Magalhães TA, Kishi S, George RT, Arbab-Zadeh A, Vavere AL, Cox C, Matheson MB, Miller JM, Brinker J, Di Carli M, Rybicki FJ, Rochitte CE, Clouse ME, Lima JAC. Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study: An integrated analysis of CT coronary angiography and myocardial perfusion. J Cardiovasc Comput Tomogr 2015; 9:438-45. [PMID: 25977111 DOI: 10.1016/j.jcct.2015.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary. OBJECTIVES To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference. METHODS Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP. RESULTS Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P < .0001 for difference). CONCLUSIONS Combining coronary CTA and myocardial CTP findings through a comprehensive protocol is feasible. Although sensitivity is lower, specificity and overall accuracy are higher than assessment by coronary CTA when compared against a reference standard of stenosis with an associated perfusion defect.
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Affiliation(s)
- Tiago A Magalhães
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil; Department of Radiology, Division of Cardiovascular CT/MR, Heart Hospital (HCOR), São Paulo, Sao Paulo, Brazil
| | - Satoru Kishi
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Richard T George
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Armin Arbab-Zadeh
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Andrea L Vavere
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie M Miller
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Jeffrey Brinker
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Marcelo Di Carli
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank J Rybicki
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carlos E Rochitte
- Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil; Department of Radiology, Division of Cardiovascular CT/MR, Heart Hospital (HCOR), São Paulo, Sao Paulo, Brazil
| | - Melvin E Clouse
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - João A C Lima
- Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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A randomized, multicenter, multivendor study of myocardial perfusion imaging with regadenoson CT perfusion vs single photon emission CT. J Cardiovasc Comput Tomogr 2015; 9:103-12.e1-2. [DOI: 10.1016/j.jcct.2015.01.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/04/2014] [Accepted: 01/02/2015] [Indexed: 01/19/2023]
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Pursnani A, Lee AM, Mayrhofer T, Ahmed W, Uthamalingam S, Ferencik M, Puchner SB, Bamberg F, Schlett CL, Udelson J, Hoffmann U, Ghoshhajra BB. Early resting myocardial computed tomography perfusion for the detection of acute coronary syndrome in patients with coronary artery disease. Circ Cardiovasc Imaging 2015; 8:e002404. [PMID: 25752898 PMCID: PMC5996992 DOI: 10.1161/circimaging.114.002404] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50% stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. METHODS AND RESULTS In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%. CONCLUSIONS Early rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00990262.
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Affiliation(s)
- Amit Pursnani
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
| | - Ashley M Lee
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Thomas Mayrhofer
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Waleed Ahmed
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Shanmugam Uthamalingam
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Maros Ferencik
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Stefan B Puchner
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Fabian Bamberg
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Christopher L Schlett
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - James Udelson
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Udo Hoffmann
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
| | - Brian B Ghoshhajra
- From the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.)
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Coenen A, Lubbers MM, Kurata A, Kono A, Dedic A, Chelu RG, Dijkshoorn ML, Gijsen FJ, Ouhlous M, van Geuns RJM, Nieman K. Fractional Flow Reserve Computed from Noninvasive CT Angiography Data: Diagnostic Performance of an On-Site Clinician-operated Computational Fluid Dynamics Algorithm. Radiology 2015; 274:674-83. [DOI: 10.1148/radiol.14140992] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI. AJR Am J Roentgenol 2015; 203:W605-13. [PMID: 25415725 DOI: 10.2214/ajr.14.12644] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic performance of stress perfusion dual-energy CT (DECT) and its incremental value when used with coronary CT angiography (CTA) for identifying hemodynamically significant coronary artery disease. SUBJECTS AND METHODS One hundred patients with suspected or known coronary artery disease without chronic myocardial infarction detected with coronary CTA underwent stress perfusion DECT, stress cardiovascular perfusion MRI, and invasive coronary angiography (ICA). Stress perfusion DECT and cardiovascular stress perfusion MR images were used for detecting perfusion defects. Coronary CTA and ICA were evaluated in the detection of ≥50% coronary stenosis. The diagnostic performance of coronary CTA for detecting hemo-dynamically significant stenosis was assessed before and after stress perfusion DECT on a per-vessel basis with ICA and cardiovascular stress perfusion MRI as the reference standard. RESULTS The performance of stress perfusion DECT compared with cardiovascular stress perfusion MRI on a per-vessel basis in the detection of perfusion defects was sensitivity, 89%; specificity, 74%; positive predictive value, 73%; negative predictive value, 90%. Per segment, these values were sensitivity, 76%; specificity, 80%; positive predictive value, 63%; and negative predictive value, 88%. Compared with ICA and cardiovascular stress perfusion MRI per vessel territory the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA were 95%, 61%, 61%, and 95%. The values for stress perfusion DECT were 92%, 72%, 68%, and 94%. The values for coronary CTA and stress perfusion DECT were 88%, 79%, 73%, and 91%. The ROC AUC increased from 0.78 to 0.84 (p=0.02) with the use of coronary CTA and stress perfusion DECT compared with coronary CTA alone. CONCLUSION Stress perfusion DECT plays a complementary role in enhancing the accuracy of coronary CTA for identifying hemodynamically significant coronary stenosis.
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Abstract
OBJECTIVE. The purpose of this study was to comprehensively study estimated radiation doses for subjects included in the main analysis of the Combined Non-invasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography (CORE320) study ( ClinicalTrials.gov identifier NCT00934037), a clinical trial comparing combined CT angiography (CTA) and perfusion CT with the reference standard catheter angiography plus myocardial perfusion SPECT. SUBJECTS AND METHODS. Prospectively acquired data on 381 CORE320 subjects were analyzed in four groups of testing related to radiation exposure. Radiation dose estimates were compared between modalities for combined CTA and perfusion CT with respect to covariates known to influence radiation exposure and for the main clinical outcomes defined by the trial. The final analysis assessed variations in radiation dose with respect to several factors inherent to the trial. RESULTS. The mean radiation dose estimate for the combined CTA and perfusion CT protocol (8.63 mSv) was significantly (p < 0.0001 for both) less than the average dose delivered from SPECT (10.48 mSv) and the average dose from diagnostic catheter angiography (11.63 mSv). There was no significant difference in estimated CTA-perfusion CT radiation dose for subjects who had false-positive or false-negative results in the CORE320 main analyses in a comparison with subjects for whom the CTA-perfusion CT findings were in accordance with the reference standard SPECT plus catheter angiographic findings. CONCLUSION. Radiation dose estimates from CORE320 support clinical implementation of a combined CT protocol for assessing coronary anatomy and myocardial perfusion.
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Tao Y, Chen GH, Hacker TA, Raval AN, Van Lysel MS, Speidel MA. Low dose dynamic CT myocardial perfusion imaging using a statistical iterative reconstruction method. Med Phys 2015; 41:071914. [PMID: 24989392 DOI: 10.1118/1.4884023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Dynamic CT myocardial perfusion imaging has the potential to provide both functional and anatomical information regarding coronary artery stenosis. However, radiation dose can be potentially high due to repeated scanning of the same region. The purpose of this study is to investigate the use of statistical iterative reconstruction to improve parametric maps of myocardial perfusion derived from a low tube current dynamic CT acquisition. METHODS Four pigs underwent high (500 mA) and low (25 mA) dose dynamic CT myocardial perfusion scans with and without coronary occlusion. To delineate the affected myocardial territory, an N-13 ammonia PET perfusion scan was performed for each animal in each occlusion state. Filtered backprojection (FBP) reconstruction was first applied to all CT data sets. Then, a statistical iterative reconstruction (SIR) method was applied to data sets acquired at low dose. Image voxel noise was matched between the low dose SIR and high dose FBP reconstructions. CT perfusion maps were compared among the low dose FBP, low dose SIR and high dose FBP reconstructions. Numerical simulations of a dynamic CT scan at high and low dose (20:1 ratio) were performed to quantitatively evaluate SIR and FBP performance in terms of flow map accuracy, precision, dose efficiency, and spatial resolution. RESULTS Forin vivo studies, the 500 mA FBP maps gave -88.4%, -96.0%, -76.7%, and -65.8% flow change in the occluded anterior region compared to the open-coronary scans (four animals). The percent changes in the 25 mA SIR maps were in good agreement, measuring -94.7%, -81.6%, -84.0%, and -72.2%. The 25 mA FBP maps gave unreliable flow measurements due to streaks caused by photon starvation (percent changes of +137.4%, +71.0%, -11.8%, and -3.5%). Agreement between 25 mA SIR and 500 mA FBP global flow was -9.7%, 8.8%, -3.1%, and 26.4%. The average variability of flow measurements in a nonoccluded region was 16.3%, 24.1%, and 937.9% for the 500 mA FBP, 25 mA SIR, and 25 mA FBP, respectively. In numerical simulations, SIR mitigated streak artifacts in the low dose data and yielded flow maps with mean error <7% and standard deviation <9% of mean, for 30 × 30 pixel ROIs (12.9 × 12.9 mm(2)). In comparison, low dose FBP flow errors were -38% to +258%, and standard deviation was 6%-93%. Additionally, low dose SIR achieved 4.6 times improvement in flow map CNR(2) per unit input dose compared to low dose FBP. CONCLUSIONS SIR reconstruction can reduce image noise and mitigate streaking artifacts caused by photon starvation in dynamic CT myocardial perfusion data sets acquired at low dose (low tube current), and improve perfusion map quality in comparison to FBP reconstruction at the same dose.
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Affiliation(s)
- Yinghua Tao
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705
| | - Guang-Hong Chen
- Department of Medical Physics and Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin 53705
| | - Timothy A Hacker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792
| | - Amish N Raval
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792
| | - Michael S Van Lysel
- Department of Medical Physics and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705
| | - Michael A Speidel
- Department of Medical Physics and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705
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Cannaò PM, Schoepf UJ, Muscogiuri G, Wichmann JL, Fuller SR, Secchi F, Varga-Szemes A, De Cecco CN. Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging. Eur J Radiol 2015; 84:2401-10. [PMID: 25779223 DOI: 10.1016/j.ejrad.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/15/2015] [Indexed: 12/14/2022]
Abstract
Coronary CT angiography (CCTA) is an established imaging technique used for the non-invasive morphological assessment of coronary artery disease. As in invasive coronary angiography, CCTA anatomical assessment of coronary stenosis does not adequately predict hemodynamic relevance. However, recent technical improvements provide the possibility of CT myocardial perfusion imaging (CTMPI). Two distinct CT techniques are currently available for myocardial perfusion assessment: static CT myocardial perfusion imaging (sCTMPI), with single- or dual-energy modality, and dynamic CT myocardial perfusion imaging (dCTMPI). The combination of CCTA morphological assessment and CTMPI functional evaluation holds promise for achieving a comprehensive assessment of coronary artery anatomy and myocardial perfusion using a single image modality.
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Affiliation(s)
- Paola M Cannaò
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Scuola di Specializzazione di Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Giuseppe Muscogiuri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Julian L Wichmann
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephen R Fuller
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
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Fahmi R, Eck BL, Fares A, Levi J, Wu H, Vembar M, Dhanantwari A, Bezerra HG, Wilson DL. Dynamic Myocardial Perfusion in a Porcine Balloon-induced Ischemia Model using a Prototype Spectral Detector CT. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9417:94170Y. [PMID: 31942087 PMCID: PMC6961835 DOI: 10.1117/12.2081547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Myocardial CT perfusion (CTP) imaging is an application that should greatly benefit from spectral CT through the significant reduction of beam hardening (BH) artifacts using mono-energetic (monoE) image reconstructions. We used a prototype spectral detector CT (SDCT) scanner (Philips Healthcare) and developed advanced processing tools (registration, segmentation, and deconvolution-based flow estimation) for quantitative myocardial CTP in a porcine ischemia model with different degrees of coronary occlusion using a balloon catheter. The occlusion severity was adjusted with fractional flow reserve (FFR) measurements. The SDCT scanner is a single source, dual-layer detector system, which allows simultaneous acquisitions of low and high energy projections, hence enabling accurate projection-based material decomposition and effective reduction of BH-artifacts. In addition, the SDCT scanner eliminates partial scan artifacts with fast (0.27s), full gantry rotation acquisitions. We acquired CTP data under different hemodynamic conditions and reconstructed conventional 120kVp images and projection-based monoenergetic (monoE) images for energies ranging from 55keV-to-120keV. We computed and compared myocardial blood flow (MBF) between different reconstructions. With balloon completely deflated (FFR=1), we compared the mean attenuation in a myocardial region of interest before iodine arrival and at peak iodine enhancement in the left ventricle (LV), and we found that monoE images at 70keV effectively minimized the difference in attenuation, due to BH, to less than 1 HU compared to 14 HU with conventional 120kVp images. Flow maps under baseline condition (FFR=1) were more uniform throughout the myocardial wall at 70keV, whereas with 120kVp data about 12% reduction in blood flow was noticed on BH-hypoattenuated areas compared to other myocardial regions. We compared MBF maps at different keVs under an ischemic condition (FFR < 0.7), and we found that flow-contrast-to-noise-ratio (CNR f ) between LAD ischemic and remote healthy territories attains its maximum (2.87 ± 0.7) at 70keV. As energies diverge from 70keV, we noticed a steady decrease in CNRf and an overestimation of mean-MBF. Flow overestimation was also noticed for conventional 120kVp images in different myocardial regions.
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Affiliation(s)
- Rachid Fahmi
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Brendan L Eck
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Anas Fares
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Jacob Levi
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hao Wu
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mani Vembar
- Philips Healthcare, Cleveland, OH, 44143, USA
| | | | - Hiram G Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L Wilson
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Eck BL, Fahmi R, Fuqua C, Vembar M, Dhanantwari A, Bezerra HG, Wilson DL. Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9417:94170Z. [PMID: 32210494 PMCID: PMC7093059 DOI: 10.1117/12.2081418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dynamic myocardial CT perfusion (CTP) can provide quantitative functional information for the assessment of coronary artery disease. However, x-ray dose in dynamic CTP is high, typically from 10mSv to >20mSv. We compared the dose reduction potential of advanced iterative reconstruction, Iterative Model Reconstruction (IMR, Philips Healthcare, Cleveland, Ohio) to hybrid iterative reconstruction (iDose4) and filtered back projection (FBP). Dynamic CTP scans were obtained using a porcine model with balloon-induced ischemia in the left anterior descending coronary artery to prescribed fractional flow reserve values. High dose dynamic CTP scans were acquired at 100kVp/100mAs with effective dose of 23mSv. Low dose scans at 75mAs, 50mAs, and 25mAs were simulated by adding x-ray quantum noise and detector electronic noise to the projection space data. Images were reconstructed with FBP, iDose4, and IMR at each dose level. Image quality in static CTP images was assessed by SNR and CNR. Blood flow was obtained using a dynamic CTP analysis pipeline and blood flow image quality was assessed using flow-SNR and flow-CNR. IMR showed highest static image quality according to SNR and CNR. Blood flow in FBP was increasingly over-estimated at reduced dose. Flow was more consistent for iDose4 from 100mAs to 50mAs, but was over-estimated at 25mAs. IMR was most consistent from 100mAs to 25mAs. Static images and flow maps for 100mAs FBP, 50mAs iDose4, and 25mAs IMR showed comparable, clear ischemia, CNR, and flow-CNR values. These results suggest that IMR can enable dynamic CTP at significantly reduced dose, at 5.8mSv or 25% of the comparable 23mSv FBP protocol.
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Affiliation(s)
- Brendan L Eck
- 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
| | - Christopher Fuqua
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mani Vembar
- Philips Healthcare, Cleveland, OH 44143, 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
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Functional relevance of coronary artery disease by cardiac magnetic resonance and cardiac computed tomography: myocardial perfusion and fractional flow reserve. BIOMED RESEARCH INTERNATIONAL 2015; 2015:297696. [PMID: 25692133 PMCID: PMC4323071 DOI: 10.1155/2015/297696] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/31/2014] [Indexed: 01/17/2023]
Abstract
Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.
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Myocardial blood flow quantification for evaluation of coronary artery disease by positron emission tomography, cardiac magnetic resonance imaging, and computed tomography. Curr Cardiol Rep 2014; 16:483. [PMID: 24718671 DOI: 10.1007/s11886-014-0483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The noninvasive detection of the presence and functional significance of coronary artery stenosis is important in the diagnosis, risk assessment, and management of patients with known or suspected coronary artery disease. Quantitative assessment of myocardial perfusion can provide an objective and reproducible estimate of myocardial ischemia and risk prediction. Positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography perfusion are modalities capable of measuring myocardial blood flow and coronary flow reserve. In this review, we will discuss the technical aspects of quantitative myocardial perfusion imaging with positron emission tomography, cardiac magnetic resonance imaging, and computed tomography, and its emerging clinical applications.
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Carmona-Rubio AE, Lee AM, Puchner S, Ghoshhajra B, Sharma UC. A review of adherence to the guidelines for coronary CT angiography quantitative stenosis grading thresholds in published research. Postgrad Med 2014; 127:194-201. [PMID: 25540988 DOI: 10.1080/00325481.2015.995065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The degree of coronary stenosis of potential hemodynamic significance is central to the interpretation of coronary computed tomography angiography (CCTA), but has been variably defined in the literature. Societal guidelines have attempted to address this issue via recommended thresholds. OBJECTIVES We surveyed the various thresholds for defining significant coronary stenosis reported in research published since the introduction of the Society for Cardiovascular Computed Tomography guidelines regarding the interpretation and reporting of CCTA. METHODS We systematically reviewed the results of bibliographic searches of all original research articles on CCTA, focusing on studies reporting > 25 subjects, to assess the definitions of severity of coronary lesions as found on CCTA. To enable comparisons, we stratified the methods of reporting lesion severity into ≥ 50%, 50% to 69%, and "others" (including infrequent reporting methods). RESULTS Fifty-nine11 published studies were identified and met inclusion criteria. Eighteen studies reported the severity of coronary stenosis using a definition of 50% to 69% as moderate stenosis; 35 studies defined ≥ 50% coronary stenosis as "stenosis," "significant stenosis," or "obstructive lesion" without distinguishing a threshold for moderate versus severe stenosis. Six studies utilized other thresholds, such as 20% to 75%, 40% to 69%, 40% to 70%, 40% to 79%, and 50% to 75% to define moderate coronary stenosis. CONCLUSIONS Fifty-three of 59 studies were graded in accordance with the recommended threshold of ≥ 50% defining potentially significant stenosis, with 18 studies reporting precisely in accordance with the guidelines-recommended thresholds of ≥ 50% narrowing as defining moderate stenosis and ≥ 70% narrowing as defining severe stenosis. Six studies were reported using alternative thresholds for significant stenosis. However, a majority of research studies published since 2009 do not follow the societal guidelines for stenosis grading, since these studies do not clearly describe the degree of coronary stenosis.
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Affiliation(s)
- Andres E Carmona-Rubio
- Department of Medicine, University at Buffalo, State University of New York, School of Medicine , Buffalo, NY
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Beyond stenosis detection: computed tomography approaches for determining the functional relevance of coronary artery disease. Radiol Clin North Am 2014; 53:317-34. [PMID: 25726997 DOI: 10.1016/j.rcl.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary computed tomography angiography (CCTA) is an established imaging technique for the noninvasive assessment of coronary arteries. However, CCTA remains a morphologic technique with the same limitations as invasive coronary angiography in evaluating the hemodynamic significance of coronary stenosis. Different computed tomography (CT) techniques for the functional analysis of coronary lesions have recently emerged, including static and dynamic CT myocardial perfusion imaging and CT-based fractional flow reserve and transluminal attenuation gradient methods. These techniques hold promise for achieving a comprehensive appraisal of anatomic and functional aspects of coronary heart disease with a single modality.
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78
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President's page: Coronary CT angiography as a gatekeeper to the catheterization laboratory. J Cardiovasc Comput Tomogr 2014; 8:480-2. [DOI: 10.1016/j.jcct.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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79
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Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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80
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Muenzel D, Noël PB, Gramer BM, Leber V, Schneider A, Leber A, Vembar M, Fingerle AA, Rummeny EJ, Huber A. Dynamic CT perfusion imaging of the myocardium using a wide-detector scanner: a semiquantitative analysis in an animal model. Clin Imaging 2014; 38:675-80. [DOI: 10.1016/j.clinimag.2014.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/16/2014] [Accepted: 05/20/2014] [Indexed: 12/25/2022]
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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82
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Raff GL, Chinnaiyan KM, Cury RC, Garcia MT, Hecht HS, Hollander JE, O'Neil B, Taylor AJ, Hoffmann U. SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: A Report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8:254-71. [DOI: 10.1016/j.jcct.2014.06.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 02/06/2023]
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83
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Physiologic evaluation of ischemia using cardiac CT: current status of CT myocardial perfusion and CT fractional flow reserve. J Cardiovasc Comput Tomogr 2014; 8:272-81. [PMID: 25151919 DOI: 10.1016/j.jcct.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/07/2014] [Accepted: 06/13/2014] [Indexed: 01/09/2023]
Abstract
Cardiac CT, specifically coronary CT angiography (CTA), is an established technology which detects anatomically significant coronary artery disease with a high sensitivity and negative predictive value compared with invasive coronary angiography. However, the limited ability of CTA to determine the physiologic significance of intermediate coronary stenoses remains a shortcoming compared with other noninvasive methods such as single-photon emission CT, stress echocardiography, and stress cardiac magnetic resonance. Two methods have been investigated recently: (1) myocardial CT perfusion and (2) fractional flow reserve (FFR) computed from CT (FFRCT). Improving diagnostic accuracy by combining the anatomic aspects of coronary CTA with a physiologic assessment via CT perfusion or FFRCT may reduce the need for additional testing to evaluate for ischemia, reduce downstream costs and risks associated with an invasive procedure, and lead to improved patient outcomes. Given a rapidly expanding body of research in this field, this comparative review summarizes the present literature while contrasting the benefits, limitations, and future directions in myocardial CT perfusion and FFRCT imaging.
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84
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Chang SA, Kim SM, Choi SH, Choe YH, Kim YW, Kim DK. Clinical Utility of Coronary CT Angiography with Stress Perfusion CT in Preoperative Cardiac Risk Evaluation. Korean Circ J 2014; 44:170-6. [PMID: 24876858 PMCID: PMC4037639 DOI: 10.4070/kcj.2014.44.3.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 02/11/2014] [Accepted: 03/18/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation. SUBJECTS AND METHODS Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month. RESULTS Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction. CONCLUSION We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.
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Affiliation(s)
- Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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85
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George RT, Mehra VC, Chen MY, Kitagawa K, Arbab-Zadeh A, Miller JM, Matheson MB, Vavere AL, Kofoed KF, Rochitte CE, Dewey M, Yaw TS, Niinuma H, Brenner W, Cox C, Clouse ME, Lima JAC, Di Carli M. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study. Radiology 2014; 272:407-16. [PMID: 24865312 DOI: 10.1148/radiol.14140806] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. MATERIALS AND METHODS This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. RESULTS CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis ≥50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with Az values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single- and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. CONCLUSION The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.
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Affiliation(s)
- Richard T George
- From the School of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524D2, Baltimore, MD 21287 (R.T.G., V.C.M., A.A.Z., J.M.M., A.L.V., J.A.C.L.); Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.D.C.); Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (V.C.M., M.Y.C.); Department of Radiology, Iwate Medical University, Morioka, Japan (H.N.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.E.C.); Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Cardiology, National Heart Center, Singapore, Singapore (T.S.Y.); and Departments of Radiology (M.D.C.) and Nuclear Medicine (W.B.), Charité-University Medicine Berlin, Berlin, Germany
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86
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Analysis of myocardial perfusion from vasodilator stress computed tomography: Does improvement in image quality by iterative reconstruction lead to improved diagnostic accuracy? J Cardiovasc Comput Tomogr 2014; 8:238-45. [DOI: 10.1016/j.jcct.2014.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/18/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
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87
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Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect. Int J Cardiovasc Imaging 2014; 30 Suppl 1:41-53. [DOI: 10.1007/s10554-014-0410-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
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88
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Walther S, Schueler S, Tackmann R, Schuetz GM, Schlattmann P, Dewey M. Compliance with STARD Checklist among Studies of Coronary CT Angiography: Systematic Review. Radiology 2014; 271:74-86. [DOI: 10.1148/radiol.13121720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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89
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90
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Bindschadler M, Modgil D, Branch KR, La Riviere PJ, Alessio AM. Comparison of blood flow models and acquisitions for quantitative myocardial perfusion estimation from dynamic CT. Phys Med Biol 2014; 59:1533-56. [PMID: 24614352 DOI: 10.1088/0031-9155/59/7/1533] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Myocardial blood flow (MBF) can be estimated from dynamic contrast enhanced (DCE) cardiac CT acquisitions, leading to quantitative assessment of regional perfusion. The need for low radiation dose and the lack of consensus on MBF estimation methods motivates this study to refine the selection of acquisition protocols and models for CT-derived MBF. DCE cardiac CT acquisitions were simulated for a range of flow states (MBF = 0.5, 1, 2, 3 ml (min g)(-1), cardiac output = 3, 5, 8 L min(-1)). Patient kinetics were generated by a mathematical model of iodine exchange incorporating numerous physiological features including heterogenenous microvascular flow, permeability and capillary contrast gradients. CT acquisitions were simulated for multiple realizations of realistic x-ray flux levels. CT acquisitions that reduce radiation exposure were implemented by varying both temporal sampling (1, 2, and 3 s sampling intervals) and tube currents (140, 70, and 25 mAs). For all acquisitions, we compared three quantitative MBF estimation methods (two-compartment model, an axially-distributed model, and the adiabatic approximation to the tissue homogeneous model) and a qualitative slope-based method. In total, over 11 000 time attenuation curves were used to evaluate MBF estimation in multiple patient and imaging scenarios. After iodine-based beam hardening correction, the slope method consistently underestimated flow by on average 47.5% and the quantitative models provided estimates with less than 6.5% average bias and increasing variance with increasing dose reductions. The three quantitative models performed equally well, offering estimates with essentially identical root mean squared error (RMSE) for matched acquisitions. MBF estimates using the qualitative slope method were inferior in terms of bias and RMSE compared to the quantitative methods. MBF estimate error was equal at matched dose reductions for all quantitative methods and range of techniques evaluated. This suggests that there is no particular advantage between quantitative estimation methods nor to performing dose reduction via tube current reduction compared to temporal sampling reduction. These data are important for optimizing implementation of cardiac dynamic CT in clinical practice and in prospective CT MBF trials.
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Affiliation(s)
- Michael Bindschadler
- Department of Bioengineering University of Washington, Seattle, WA 98195, US. Department of Radiology, University of Washington, Seattle, WA 98195, US
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91
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Buss SJ, Schulz F, Mereles D, Hosch W, Galuschky C, Schummers G, Stapf D, Hofmann N, Giannitsis E, Hardt SE, Kauczor HU, Katus HA, Korosoglou G. Quantitative analysis of left ventricular strain using cardiac computed tomography. Eur J Radiol 2014; 83:e123-30. [DOI: 10.1016/j.ejrad.2013.11.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/21/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022]
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92
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Feasibility of dynamic CT-based adenosine stress myocardial perfusion imaging to detect and differentiate ischemic and infarcted myocardium in an large experimental porcine animal model. Int J Cardiovasc Imaging 2014; 30:803-12. [PMID: 24570085 DOI: 10.1007/s10554-014-0390-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/18/2014] [Indexed: 12/21/2022]
Abstract
The purpose of the study is feasibility of dynamic CT perfusion imaging to detect and differentiate ischemic and infarcted myocardium in a large porcine model. 12 Country pigs completed either implantation of a 75 % luminal coronary stenosis in the left anterior descending coronary artery simulating ischemia or balloon-occlusion inducing infarction. Dynamic CT-perfusion imaging (100 kV, 300 mAs), fluorescent microspheres, and histopathology were performed in all models. CT based myocardial blood flow (MBFCT), blood volume (MBVCT) and transit constant (Ktrans), as well as microsphere's based myocardial blood flow (MBFMic) were derived for each myocardial segment. According to histopathology or microsphere measurements, 20 myocardial segments were classified as infarcted and 23 were ischemic (12 and 14 %, respectively). Across all perfusion states, MBFCT strongly predicted MBFMic (β 0.88 ± 0.12, p < 0.0001). MBFCT, MBVCT, and Ktrans were significantly lower in ischemic/infarcted when compared to reference myocardium (all p < 0.01). Relative differences of all CT parameters between affected and non-affected myocardium were higher for infarcted when compared to ischemic segments under rest (48.4 vs. 22.6 % and 46.1 vs. 22.9 % for MBFCT, MBVCT, respectively). Under stress, MBFCT was significantly lower in infarcted than in ischemic myocardium (67.8 ± 26 vs. 88.2 ± 22 ml/100 ml/min, p = 0.002). In a large animal model, CT-derived parameters of myocardial perfusion may enable detection and differentiation of ischemic and infarcted myocardium.
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93
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Fahmi R, Eck BL, Vembar M, Bezerra HG, Wilson DL. Dynamic CT Myocardial Perfusion Imaging: Detection of Ischemia in a Porcine Model with FFR Verification. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2014; 9038:90380O. [PMID: 33953455 PMCID: PMC8095716 DOI: 10.1117/12.2043800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Dynamic cardiac CT perfusion (CTP) is a high resolution, non-invasive technique for assessing myocardial blood flow (MBF), which in concert with coronary CT angiography enable CT to provide a unique, comprehensive, fast analysis of both coronary anatomy and functional flow. We assessed perfusion in a porcine model with and without coronary occlusion. To induce occlusion, each animal underwent left anterior descending (LAD) stent implantation and angioplasty balloon insertion. Normal flow condition was obtained with balloon completely deflated. Partial occlusion was induced by balloon inflation against the stent with FFR used to assess the extent of occlusion. Prospective ECG-triggered partial scan images were acquired at end systole (45% R-R) using a multi-detector CT (MDCT) scanner. Images were reconstructed using FBP and a hybrid iterative reconstruction (iDose 4, Philips Healthcare). Processing included: beam hardening (BH) correction, registration of image volumes using 3D cubic B-spline normalized mutual-information, and spatio-temporal bilateral filtering to reduce partial scan artifacts and noise variation. Absolute blood flow was calculated with a deconvolution-based approach using singular value decomposition (SVD). Arterial input function was estimated from the left ventricle (LV) cavity. Regions of interest (ROIs) were identified in healthy and ischemic myocardium and compared in normal and occluded conditions. Under-perfusion was detected in the correct LAD territory and flow reduction agreed well with FFR measurements. Flow was reduced, on average, in LAD territories by 54%.
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Affiliation(s)
- Rachid Fahmi
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Brendan L Eck
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mani Vembar
- Philips Healthcare, Cleveland, OH, 44143, USA
| | - Hiram G Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L Wilson
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, 44106, USA
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94
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Golder W, Gilet F. Pharmacoangiographie : des techniques anciennes aux applications actuelles et futures. Presse Med 2014; 43:212-4. [DOI: 10.1016/j.lpm.2013.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/09/2013] [Accepted: 07/24/2013] [Indexed: 10/25/2022] Open
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95
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Abstract
Antiphospholipid antibody syndrome (APS) or Hughes syndrome is a multisystem autoimmune disorder that is characterized by venous and arterial thrombosis and/or pregnancy complications (miscarriage and fetal death, preeclampsia, placental insufficiency, and fetal growth restriction), and positive serologic tests for anticardiolipin antibodies (aCL), lupus anticoagulant (LA), or antibodies against beta2-glycoprotein I (anti-ß2GPI) either of IgG or IgM isotype. APS is characterized by accelerated atherosclerosis that, together with an increased tendency toward thrombosis, leads to the occurrence of various vascular events. Timely diagnosis of vascular changes, preferably in the subclinical phase, is required both because of their severity and the high mortality rate. Detection of arterial and venous changes is performed by various invasive and noninvasive diagnostic methods. Computed tomographic angiography (CTA) seems to be the most precise method with low exposure time, giving clinicians an opportunity for early diagnosis and timely treatment of APS patients.
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Affiliation(s)
- L Stojanovich
- Internal Medicine, “Bezanijska Kosa,” University Medical Center, Belgrade, Serbia
| | - A Djokovic
- Internal Medicine, “Bezanijska Kosa,” University Medical Center, Belgrade, Serbia
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96
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Kazmi MH, Small G, Sleiman L, Chow BJW. Determining patient prognosis using computed tomography coronary angiography. Expert Rev Med Devices 2014; 8:647-57. [DOI: 10.1586/erd.11.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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97
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Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress Myocardial Perfusion: Imaging with Multidetector CT. Radiology 2014; 270:25-46. [DOI: 10.1148/radiol.13112739] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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98
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Additional value of adenosine-stress dynamic CT myocardial perfusion imaging in the reclassification of severity of coronary artery stenosis at coronary CT angiography. Clin Radiol 2013; 68:e659-68. [DOI: 10.1016/j.crad.2013.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/08/2013] [Accepted: 07/15/2013] [Indexed: 01/18/2023]
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99
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Evaluación de la isquemia miocárdica con tomografía computarizada de doble fuente: comparación con la resonancia magnética. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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100
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Schwarz F, Hinkel R, Baloch E, Marcus RP, Hildebrandt K, Sandner TA, Kupatt C, Hoffmann V, Wintersperger BJ, Reiser MF, Theisen D, Nikolaou K, Bamberg F. Myocardial CT perfusion imaging in a large animal model: comparison of dynamic versus single-phase acquisitions. JACC Cardiovasc Imaging 2013; 6:1229-38. [PMID: 24269264 DOI: 10.1016/j.jcmg.2013.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/02/2013] [Accepted: 05/23/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to compare dynamic versus single-phase high-pitch computed tomography (CT) acquisitions for the assessment of myocardial perfusion in a porcine model with adjustable degrees of coronary stenosis. BACKGROUND The incremental value of the 2 different approaches to CT-based myocardial perfusion imaging remains unclear. METHODS Country pigs received stent implantation in the left anterior descending coronary artery, in which an adjustable narrowing (50% and 75% stenoses) was created using a balloon catheter. All animals underwent CT-based rest and adenosine-stress myocardial perfusion imaging using dynamic and single-phase high-pitch acquisitions at both degrees of stenosis. Fluorescent microspheres served as a reference standard for myocardial blood flow. Segmental CT-based myocardial blood flow (MBFCT) was derived from dynamic acquisitions. Segmental single-phase enhancement (SPE) was recorded from high-pitch, single-phase examinations. MBFCT and SPE were compared between post-stenotic and reference segments, and receiver-operating characteristic curve analysis was performed. RESULTS Among 6 animals (28 ± 2 kg), there were significant differences of MBFCT and SPE between post-stenotic and reference segments for all acquisitions at 75% stenosis. By contrast, although for 50% stenosis at rest, MBFCT was lower in post-stenotic than in reference segments (0.65 ± 0.10 ml/g/min vs. 0.75 ± 0.16 ml/g/min, p < 0.05), there was no difference for SPE (128 ± 27 Hounsfield units vs. 137 ± 35 Hounsfield units, p = 0.17), which also did not significantly change under adenosine stress. In receiver-operating characteristic curve analyses, segmental MBFCT showed significantly better performance for ischemia prediction at 75% stenosis and stress (area under the curve: 0.99 vs. 0.89, p < 0.05) as well as for 50% stenosis, regardless of adenosine administration (area under the curve: 0.74 vs. 0.57 and 0.88 vs. 0.61, respectively, both p < 0.05). CONCLUSIONS At higher degrees of coronary stenosis, both MBFCT and SPE permit an accurate prediction of segmental myocardial hypoperfusion. However, accuracy of MBFCT is higher than that of SPE at 50% stenosis and can be increased by adenosine stress at both degrees of stenosis.
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Affiliation(s)
- Florian Schwarz
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Rabea Hinkel
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Elisabeth Baloch
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Roy P Marcus
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Kristof Hildebrandt
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Torleif A Sandner
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Kupatt
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Verena Hoffmann
- Department of Biostatistics, Ludwig-Maximilians-University, Munich, Germany
| | - Bernd J Wintersperger
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maximilian F Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany
| | - Daniel Theisen
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany
| | - Konstantin Nikolaou
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany
| | - Fabian Bamberg
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany.
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