1
|
Sliwicka O, Oostveen LJ, Swiderska Chadaj Z, van Everdingen WM, Michielsen K, Gommers J, Brink M, Snoeren M, Salah K, Peters-Bax L, Stille T, Habets J, Sechopoulos I. Radiation dose reduction of 50% in dynamic myocardial CT perfusion with skipped beat acquisition: a retrospective study. Acta Radiol 2024; 65:724-734. [PMID: 38630492 DOI: 10.1177/02841851241240446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Dynamic myocardial computed tomography perfusion (CTP) is a novel imaging technique that increases the applicability of CT for cardiac imaging; however, the scanning requires a substantial radiation dose. PURPOSE To investigate the feasibility of dose reduction in dynamic CTP by comparing all-heartbeat acquisitions to periodic skipping of heartbeats. MATERIAL AND METHODS We retrieved imaging data of 38 dynamic CTP patients and created new datasets with every fourth, third or second beat (Skip1:4, Skip1:3, Skip1:2, respectively) removed. Seven observers evaluated the resulting images and perfusion maps for perfusion deficits. The mean blood flow (MBF) in each of the 16 myocardial segments was compared per skipped-beat level, normalized by the respective MBF for the full dose, and averaged across patients. The number of segments/cases whose MBF was <1.0 mL/g/min were counted. RESULTS Out of 608 segments in 38 cases, the total additional number of false-negative (FN) segments over those present in the full-dose acquisitions and the number of additional false-positive cases were shown as acquisition (segment [%], case): Skip1:4: 7 (1.2%, 1); Skip1:3: 12 (2%, 3), and Skip1:2: 5 (0.8%, 2). The variability in quantitative MBF analysis in the repeated analysis for the reference condition resulted in 8 (1.3%) additional FN segments. The normalized results show a comparable MBF across all segments and patients, with relative mean MBFs as 1.02 ± 0.16, 1.03 ± 0.25, and 1.06 ± 0.30 for the Skip1:4, Skip1:3, and Skip1:2 protocols, respectively. CONCLUSION Skipping every second beat acquisition during dynamic myocardial CTP appears feasible and may result in a radiation dose reduction of 50%. Diagnostic performance does not decrease after removing 50% of time points in dynamic sequence.
Collapse
Affiliation(s)
- Olga Sliwicka
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luuk J Oostveen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Koen Michielsen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessie Gommers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique Brink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miranda Snoeren
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Khibar Salah
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth Peters-Bax
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tip Stille
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesse Habets
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Technical Medicine Center, University of Twente, Enschede, The Netherlands
| |
Collapse
|
2
|
Møller MB, Linde JJ, Fuchs A, Køber LV, Nordestgaard BG, Kofoed KF. Normal values of myocardial blood flow measured with dynamic myocardial computed tomography perfusion. Eur Heart J Cardiovasc Imaging 2024; 25:986-995. [PMID: 38376985 DOI: 10.1093/ehjci/jeae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
AIMS Dynamic myocardial computed tomography (CT) perfusion (DM-CTP) can, in combination with coronary CT angiography (CCTA), provide anatomical and functional evaluation of coronary artery disease (CAD). However, normal values of myocardial blood flow (MBF) are needed to identify impaired myocardial blood supply in patients with suspected CAD. We aimed to establish normal values for MBF measured using DM-CTP, to assess the effects of age and sex, and to assess regional distribution of MBF. METHODS AND RESULTS A total of 82 healthy individuals (46 women) aged 45-78 years with normal coronary arteries by CCTA underwent either rest and adenosine stress DM-CTP (n = 30) or adenosine-induced stress DM-CTP only (n = 52). Global and segmental MBF were assessed. Global MBF at rest and during stress were 0.93 ± 0.42 and 3.58 ± 1.14 mL/min/g, respectively. MBF was not different between the sexes (P = 0.88 at rest and P = 0.61 during stress), and no correlation was observed between MBF and age (P = 0.08 at rest and P = 0.82 during stress). Among the 16 myocardial segments, significant intersegmental differences were found (P < 0.01), which was not related to age, sex, or coronary dominance. CONCLUSION MBF assessed by DM-CTP in healthy individuals with normal coronary arteries displays significant intersegmental heterogeneity which does not seem to be affected by age, sex, or coronary dominance. Normal values of MBF may be helpful in the clinical evaluation of suspected myocardial ischaemia using DM-CTP.
Collapse
Affiliation(s)
- Mathias B Møller
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Opgang 7, Herlev 2730, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
- Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| |
Collapse
|
3
|
Yuan M, Zhang J. Image and Clinical Characteristics of the Right Coronary Artery Originating From the Left Coronary Sinus: A Database Review. Cardiol Rev 2024:00045415-990000000-00216. [PMID: 38363130 DOI: 10.1097/crd.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
This article systematically explores the imaging and clinical characteristics of a relatively rare cardiac anomaly: the right coronary artery originating from the left coronary sinus. Through a comprehensive analysis of existing literature, this study aims to provide a comprehensive understanding of the prevalence, diagnostic methods, and potential clinical implications of this anatomical variation. Anatomical classification is introduced, along with clinical imaging diagnostic methods, including coronary angiography, computed tomography, and magnetic resonance imaging. Additionally, the review delves into the clinical significance of this anomaly, including its potential associations with myocardial ischemia, arrhythmias, and acute cardiac events, outlining clinical approaches to diagnosing myocardial ischemia. The study results consolidate current knowledge about this cardiac variation, emphasizing the importance of recognizing and appropriately managing it in clinical practice.
Collapse
Affiliation(s)
- Mingyuan Yuan
- From the Department of Radiology, Affiliated Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | | |
Collapse
|
4
|
Wu X, Yang F, Sun L. Computed tomography myocardial perfusion imaging of patients with left ventricular hypertrophy in hypertension: A retrospective study. Clin Exp Hypertens 2023; 45:2159426. [PMID: 36594488 DOI: 10.1080/10641963.2022.2159426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Left ventricular hypertrophy (LVH) is a strong predictor of adverse cardiovascular outcomes including heart failure. This study evaluated characteristics and the influencing factors of computed tomography myocardial perfusion imaging (CT-MPI) of patients with LVH in hypertension. METHODS A total of 65 patients with stable chest pain and confirmed coronary stenosis <50% by coronary computed tomography angiography (cCTA) from September 2019 to February 2021 were recruited. According to the results of echocardiography, patients were divided into the LVH group (n = 33) and control group (patients without LVH, n = 32). The general data of all study subjects were collected, and the body mass index (BMI) and body surface area (BSA) were calculated. Myocardial blood flow (MBF), myocardial blood volume (MBV), and echocardiographic parameters were recorded. Spearman correlation analyses were conducted to analyze the relationship between MBF, MBV, and echocardiographic parameters. RESULTS The LVH group had significantly higher left ventricular end diastolic distance (LVEDd), septal wall thickness diastole (SWTd), and post wall thickness diastole (PWTd) than the control group, resulting in higher left ventricular mass index (LVMI) (P < .05). The LVH group showed significantly lower MBF than the control group (P < .05), but there was no significant difference in MBV between two groups (P > .05). Spearman correlation analysis demonstrated that MBF was negatively correlated with SWTd and LVMI (P < .05). CONCLUSIONS CT-MPI, as a new noninvasive modality to evaluate myocardial perfusion in hypertensive patients, revealed that MBF is reduced in patients with LVH, while MBV remains unchanged. In hypertensive patients, decreased MBF is significantly correlated with increased LVMI.
Collapse
Affiliation(s)
- Xia Wu
- Department of Cardiac Rehabilitation, Daqing Oilfield General Hospital, Daqing City, China
| | - Fei Yang
- Department of Geriatrics, Daqing Oilfield General Hospital, Daqing City, China
| | - Lili Sun
- Department of Geriatrics, Daqing Oilfield General Hospital, Daqing City, China
| |
Collapse
|
5
|
Yamamoto Y, Tanabe Y, Kurata A, Yamamoto S, Kido T, Uetani T, Ikeda S, Nakano S, Yamaguchi O, Kido T. Feasibility of four-dimensional similarity filter for radiation dose reduction in dynamic myocardial computed tomography perfusion imaging. FRONTIERS IN RADIOLOGY 2023; 3:1214521. [PMID: 38105799 PMCID: PMC10722229 DOI: 10.3389/fradi.2023.1214521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Rationale and objectives We aimed to evaluate the impact of four-dimensional noise reduction filtering using a four-dimensional similarity filter (4D-SF) on radiation dose reduction in dynamic myocardial computed tomography perfusion (CTP). Materials and methods Forty-three patients who underwent dynamic myocardial CTP using 320-row computed tomography (CT) were included in the study. The original images were reconstructed using iterative reconstruction (IR). Three different CTP datasets with simulated noise, corresponding to 25%, 50%, and 75% reduction of the original dose (300 mA), were reconstructed using a combination of IR and 4D-SF. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were assessed, and CT-derived myocardial blood flow (CT-MBF) was quantified. The results were compared between the original and simulated images with radiation dose reduction. Results The median SNR (first quartile-third quartile) at the original, 25%-, 50%-, and 75%-dose reduced-simulated images with 4D-SF was 8.3 (6.5-10.2), 16.5 (11.9-21.7), 15.6 (11.0-20.1), and 12.8 (8.8-18.1) and that of CNR was 4.4 (3.2-5.8), 6.7 (4.6-10.3), 6.6 (4.3-10.1), and 5.5 (3.5-9.1), respectively. All the dose-reduced-simulated CTPs with 4D-SF had significantly higher image quality scores in SNR and CNR than the original ones (25%-, 50%-, and 75%-dose reduced vs. original images, p < 0.05, in each). The CT-MBF in 75%-dose reduced-simulated CTP was significantly lower than 25%-, 50%- dose-reduced-simulated, and original CTPs (vs. 75%-dose reduced-simulated images, p < 0.05, in each). Conclusion 4D-SF has the potential to reduce the radiation dose associated with dynamic myocardial CTP imaging by half, without impairing the robustness of MBF quantification.
Collapse
Affiliation(s)
- Yuta Yamamoto
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Cardiology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shuhei Yamamoto
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shota Nakano
- Canon Medical Systems Corporation, Otawara, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| |
Collapse
|
6
|
Zdanowicz A, Guzinski M, Pula M, Witkowska A, Reczuch K. Dynamic CT Myocardial Perfusion: The Role of Functional Evaluation in the Diagnosis of Coronary Artery Disease. J Clin Med 2023; 12:7062. [PMID: 38002675 PMCID: PMC10672614 DOI: 10.3390/jcm12227062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Coronary computed tomography angiography (CTA) is a widely accepted, non-invasive diagnostic modality for the evaluation of patients with suspected coronary artery disease (CAD). However, a limitation of CTA is its inability to provide information on the hemodynamic significance of the coronary lesion. The recently developed stress dynamic CT perfusion technique has emerged as a potential solution to this diagnostic challenge. Dynamic CT myocardial perfusion provides information on the hemodynamic consequences of coronary stenosis and is used to detect myocardial ischemia. The combination of stress dynamic CT myocardial perfusion with CTA provides a comprehensive assessment that integrates anatomical and functional information. CT myocardial perfusion has been validated in several clinical studies and has shown comparable accuracy to Positron Emission Tomography (PET) and stress magnetic resonance imaging (MRI) in the diagnosis of hemodynamically significant coronary stenosis and superior performance to Single Photon Emission Computed Tomography (SPECT). More importantly, CTP-derived myocardial perfusion has been shown to have a strong correlation with FFR, and the use of CTP results in a reduction of negative catheterizations. In the context of suspected stable coronary artery disease, the CT protocol with dynamic perfusion imaging combined with CTA eliminates the need for additional testing, making it a convenient "one-stop-shop" method and an effective gatekeeper to an invasive approach.
Collapse
Affiliation(s)
- Agata Zdanowicz
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Maciej Guzinski
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Michal Pula
- Lower Silesian Oncology, Pulmonology and Hematology Center, Hirszfelda Square 12, 53-413 Wroclaw, Poland
| | - Agnieszka Witkowska
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Borowska 213, 50-556 Wroclaw, Poland (K.R.)
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Clinical Hospital in Wroclaw, Borowska 213, 50-556 Wroclaw, Poland (K.R.)
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| |
Collapse
|
7
|
Sliwicka O, Sechopoulos I, Baggiano A, Pontone G, Nijveldt R, Habets J. Dynamic myocardial CT perfusion imaging-state of the art. Eur Radiol 2023; 33:5509-5525. [PMID: 36997751 PMCID: PMC10326111 DOI: 10.1007/s00330-023-09550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/01/2023]
Abstract
In patients with suspected coronary artery disease (CAD), dynamic myocardial computed tomography perfusion (CTP) imaging combined with coronary CT angiography (CTA) has become a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information on myocardial blood flow, and the presence and grading of stenosis. Recently, CTP imaging has been proven to have good diagnostic accuracy for detecting myocardial ischemia, comparable to stress magnetic resonance imaging and positron emission tomography perfusion, while being superior to single photon emission computed tomography. Dynamic CTP accompanied by coronary CTA can serve as a gatekeeper for invasive workup, as it reduces unnecessary diagnostic invasive coronary angiography. Dynamic CTP also has good prognostic value for the prediction of major adverse cardiovascular events. In this article, we will provide an overview of dynamic CTP, including the basics of coronary blood flow physiology, applications and technical aspects including protocols, image acquisition and reconstruction, future perspectives, and scientific challenges. KEY POINTS: • Stress dynamic myocardial CT perfusion combined with coronary CTA is a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information. • Dynamic CTP imaging has good diagnostic accuracy for detecting myocardial ischemia comparable to stress MRI and PET perfusion. • Dynamic CTP accompanied by coronary CTA may serve as a gatekeeper for invasive workup and can guide treatment in obstructive coronary artery disease.
Collapse
Affiliation(s)
- Olga Sliwicka
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea Baggiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesse Habets
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| |
Collapse
|
8
|
Møller MB, Hasbak P, Linde JJ, Sigvardsen PE, Køber LV, Kofoed KF. Quantification of myocardial blood flow using dynamic myocardial CT perfusion compared with 82Rb PET. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00093-X. [PMID: 37024395 DOI: 10.1016/j.jcct.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Absolute measures of myocardial blood flow (MBF) obtained with dynamic myocardial CT perfusion (DM-CTP) are underestimated when compared with reference standards. This is to some extent explained by incomplete extraction of iodinated contrast agent (iCA) to the myocardial tissue. We aimed to establish an extraction function for iCA, use the function to calculate MBFCT and to compare this with MBF measured with 82Rb positron emission tomography (PET). MATERIALS AND METHODS Healthy individuals without coronary artery disease (CAD) were examined with 82Rb PET and DM-CTP. The factors a and β of the generalized Renkin-Crone model were estimated using a non-linear least squares model. The factors providing the best fit for the data were subsequently used to calculate MBFCT. RESULTS Of consecutive 91 individuals examined, 79 were eligible for analysis. The factors a and β providing the best fit of the nonlinear least-squares model to the data were a = 0.614 and β = 0.218 (R-squared = 0.81). Conversion of the CT inflow parameter (K1) values using the derived extraction function resulted in a significant correlation between MBF measured during stress using CT and PET (P = 0.039). CONCLUSION In healthy individuals, flow estimates obtained with dynamic myocardial CT perfusion during stress were, after conversion to MBF using the extraction of iodinated CT contrast agent, correlated with absolute MBF quantified with 82Rb PET.
Collapse
Affiliation(s)
- Mathias B Møller
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Philip Hasbak
- Department of Nuclear Medicine, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| |
Collapse
|
9
|
Gao X, Wang R, Sun Z, Zhang H, Bo K, Xue X, Yang J, Xu L. A Novel CT Perfusion-Based Fractional Flow Reserve Algorithm for Detecting Coronary Artery Disease. J Clin Med 2023; 12:jcm12062154. [PMID: 36983156 PMCID: PMC10058085 DOI: 10.3390/jcm12062154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Background: The diagnostic accuracy of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR-CT) needs to be further improved despite promising results available in the literature. While an innovative myocardial computed tomographic perfusion (CTP)-derived fractional flow reserve (CTP-FFR) model has been initially established, the feasibility of CTP-FFR to detect coronary artery ischemia in patients with suspected coronary artery disease (CAD) has not been proven. Methods: This retrospective study included 93 patients (a total of 103 vessels) who received CCTA and CTP for suspected CAD. Invasive coronary angiography (ICA) was performed within 2 weeks after CCTA and CTP. CTP-FFR, CCTA (stenosis ≥ 50% and ≥70%), ICA, FFR-CT and CTP were assessed by independent laboratory experts. The diagnostic ability of the CTP-FFR grouped by quantitative coronary angiography (QCA) in mild (30–49%), moderate (50–69%) and severe stenosis (≥70%) was calculated. The effect of calcification of lesions, grouped by FFR on CTP-FFR measurements, was also assessed. Results: On the basis of per-vessel level, the AUCs for CTP-FFR, CTP, FFR-CT and CCTA were 0.953, 0.876, 0.873 and 0.830, respectively (all p < 0.001). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CTP-FFR for per-vessel level were 0.87, 0.88, 0.87, 0.85 and 0.89 respectively, compared with 0.87, 0.54, 0.69, 0.61, 0.83 and 0.75, 0.73, 0.74, 0.70, 0.77 for CCTA ≥ 50% and ≥70% stenosis, respectively. On the basis of per-vessel analysis, CTP-FFR had higher specificity, accuracy and AUC compared with CCTA and also higher AUC compared with FFR-CT or CTP (all p < 0.05). The sensitivity and accuracy of CTP-FFR + CTP + FFR-CT were also improved over FFR-CT alone (both p < 0.05). It also had improved specificity compared with FFR-CT or CTP alone (p < 0.01). A strong correlation between CTP-FFR and invasive FFR values was found on per-vessel analysis (Pearson’s correlation coefficient 0.89). The specificity of CTP-FFR was higher in the severe calcification group than in the low calcification group (p < 0.001). Conclusions: A novel CTP-FFR model has promising value to detect myocardial ischemia in CAD, particularly in mild-to-moderate stenotic lesions.
Collapse
Affiliation(s)
- Xuelian Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Kairui Bo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiaofei Xue
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Junjie Yang
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
- Correspondence: (J.Y.); (L.X.)
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Correspondence: (J.Y.); (L.X.)
| |
Collapse
|
10
|
Kim YC, Choe YH. Automated identification of myocardial perfusion defects in dynamic cardiac computed tomography using deep learning. Phys Med 2023; 107:102555. [PMID: 36878134 DOI: 10.1016/j.ejmp.2023.102555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023] Open
Abstract
PURPOSE The purpose of this study was to develop and evaluate deep convolutional neural network (CNN) models for quantifying myocardial blood flow (MBF) as well as for identifying myocardial perfusion defects in dynamic cardiac computed tomography (CT) images. METHODS Adenosine stress cardiac CT perfusion data acquired from 156 patients having or being suspected with coronary artery disease were considered for model development and validation. U-net-based deep CNN models were developed to segment the aorta and myocardium and to localize anatomical landmarks. Color-coded MBF maps were obtained in short-axis slices from the apex to the base level and were used to train a deep CNN classifier. Three binary classification models were built for the detection of perfusion defect in the left anterior descending artery (LAD), the right coronary artery (RCA), and the left circumflex artery (LCX) territories. RESULTS Mean Dice scores were 0.94 (±0.07) and 0.86 (±0.06) for the aorta and myocardial deep learning-based segmentations, respectively. With the localization U-net, mean distance errors were 3.5 (±3.5) mm and 3.8 (±2.4) mm for the basal and apical center points, respectively. The classification models identified perfusion defects with the accuracy of mean area under the receiver operating curve (AUROC) values of 0.959 (±0.023) for LAD, 0.949 (±0.016) for RCA, and 0.957 (±0.021) for LCX. CONCLUSION The presented method has the potential to fully automate the quantification of MBF and subsequently identify the main coronary artery territories with myocardial perfusion defects in dynamic cardiac CT perfusion.
Collapse
Affiliation(s)
- Yoon-Chul Kim
- Division of Digital Healthcare, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
11
|
Møller MB, Schuijf JD, Oyama-Manabe N, Linde JJ, Kühl JT, Lima JAC, Kofoed KF. Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography. J Thorac Imaging 2023; 38:54-68. [PMID: 36044617 DOI: 10.1097/rti.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality.
Collapse
Affiliation(s)
- Mathias B Møller
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Joanne D Schuijf
- Global Research and Development Center, Canon Medical Systems Europe, Zoetermeer, The Netherlands
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Jørgen T Kühl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Joao A C Lima
- Departments of Medicine and Radiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
- Department of Radiology, Rigshospitalet, University of Copenhagen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Michallek F, Nakamura S, Kurita T, Ota H, Nishimiya K, Ogawa R, Shizuka T, Nakashima H, Wang Y, Ito T, Sakuma H, Dewey M, Kitagawa K. Fractal Analysis of Dynamic Stress CT-Perfusion Imaging for Detection of Hemodynamically Relevant Coronary Artery Disease. JACC Cardiovasc Imaging 2022; 15:1591-1601. [PMID: 36075619 DOI: 10.1016/j.jcmg.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Combined computed tomography-derived myocardial blood flow (CTP-MBF) and computed tomography angiography (CTA) has shown good diagnostic performance for detection of coronary artery disease (CAD). However, fractal analysis might provide additional insight into ischemia pathophysiology by characterizing multiscale perfusion patterns and, therefore, may be useful in diagnosing hemodynamically significant CAD. OBJECTIVES The purpose of this study was to investigate, in a multicenter setting, whether fractal analysis of perfusion improves detection of hemodynamically relevant CAD over myocardial blood flow quantification (CTP-MBF) using dynamic, 4-dimensional, dynamic stress myocardial computed tomography perfusion (CTP) imaging. METHODS In total, 7 centers participating in the prospective AMPLIFiED (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored with Dual-source CT) study acquired CTP and CTA data in patients with suspected or known CAD. Hemodynamically relevant CAD was defined as ≥90% stenosis on invasive coronary angiography or fractional flow reserve <0.80. Both fractal analysis and CTP-MBF quantification were performed on CTP images and were combined with CTA results. RESULTS This study population included 127 participants, among them 61 patients, or 79 vessels, with CAD as per invasive reference standard. Compared with the combination of CTP-MBF and CTA, combined fractal analysis and CTA improved sensitivity on the per-patient level from 84% (95% CI: 72%-92%) to 95% (95% CI: 86%-99%; P = 0.01) and specificity from 70% (95% CI: 57%-82%) to 89% (95% CI: 78%-96%; P = 0.02). The area under the receiver-operating characteristic curve improved from 0.83 (95% CI: 0.75-0.90) to 0.92 (95% CI: 0.86-0.98; P = 0.01). CONCLUSIONS Fractal analysis constitutes a quantitative and pathophysiologically meaningful approach to myocardial perfusion analysis using dynamic stress CTP, which improved diagnostic performance over CTP-MBF when combined with anatomical information from CTA.
Collapse
Affiliation(s)
- Florian Michallek
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany.
| | - Satoshi Nakamura
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideki Ota
- Department of Advanced MRI Collaborative Research, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ogawa
- Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | - Hitoshi Nakashima
- National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yining Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Tatsuro Ito
- Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Marc Dewey
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
13
|
Takafuji M, Kitagawa K, Mizutani S, Oka R, Kisou R, Sakaguchi S, Ichikawa K, Izumi D, Sakuma H. Deep-learning reconstruction to improve image quality of myocardial dynamic CT perfusion: comparison with hybrid iterative reconstruction. Clin Radiol 2022; 77:e771-e775. [PMID: 35853777 DOI: 10.1016/j.crad.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
- M Takafuji
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan; Department of Radiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - K Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - S Mizutani
- Department of Radiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - R Oka
- Department of Radiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - R Kisou
- Department of Radiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - S Sakaguchi
- Department of Cardiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - K Ichikawa
- Department of Cardiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - D Izumi
- Department of Cardiology, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - H Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
14
|
Static CT myocardial perfusion imaging: image quality, artifacts including distribution and diagnostic performance compared to 82Rb PET. Eur J Hybrid Imaging 2022; 6:1. [PMID: 34981241 PMCID: PMC8724508 DOI: 10.1186/s41824-021-00118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rubidium-82 positron emission tomography (82Rb PET) MPI is considered a noninvasive reference standard for the assessment of myocardial perfusion in coronary artery disease (CAD) patients. Our main goal was to compare the diagnostic performance of static rest/ vasodilator stress CT myocardial perfusion imaging (CT-MPI) to stress/ rest 82Rb PET-MPI for the identification of myocardial ischemia.
Methods Forty-four patients with suspected or diagnosed CAD underwent both static CT-MPI and 82Rb PET-MPI at rest and during pharmacological stress. The extent and severity of perfusion defects on PET-MPI were assessed to obtain summed stress score, summed rest score, and summed difference score. The extent and severity of perfusion defects on CT-MPI was visually assessed using the same grading scale. CT-MPI was compared with PET-MPI as the gold standard on a per-territory and a per-patient basis.
Results On a per-patient basis, there was moderate agreement between CT-MPI and PET-MPI with a weighted 0.49 for detection of stress induced perfusion abnormalities. Using PET-MPI as a reference, static CT-MPI had 89% sensitivity (SS), 58% specificity (SP), 71% accuracy (AC), 88% negative predictive value (NPV), and 59% positive predictive value (PPV) to diagnose stress-rest perfusion deficits on a per-patient basis. On a per-territory analysis, CT-MPI had 73% SS, 65% SP, 67% AC, 90.8% NPV, and 34% PPV to diagnose perfusion deficits. Conclusions CT-MPI has high sensitivity and good overall accuracy for the diagnosis of functionally significant CAD using 82Rb PET-MPI as the reference standard. CT-MPI may play an important role in assessing the functional significance of CAD especially in combination with CCTA.
Collapse
|
15
|
Kim MY, Yang DH, Choo KS, Lee W. Beyond Coronary CT Angiography: CT Fractional Flow Reserve and Perfusion. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:3-27. [PMID: 36237355 PMCID: PMC9238199 DOI: 10.3348/jksr.2021.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
심장 전산화단층촬영은 비약적인 기술발전과 다양한 연구 결과를 바탕으로 심혈관위험 계층화와 치료 결정을 위한 관상동맥 질환의 진단과 예후 평가성능이 입증되었다. 전산화단층촬영 관상동맥조영술은 폐쇄성 관상동맥 질환에 대한 음성 예측도가 높아서 침습적 혈관조영술의 빈도를 줄일 수 있는 관상동맥 질환 관련 검사의 관문으로 부상했지만, 진단특이도가 상대적으로 낮다. 하지만 심장 전산화단층촬영을 이용한 분획혈류예비력과 심근관류를 분석하여 관상동맥 질환의 혈역학적 유의성을 확인하는 기능적 평가를 통해 그 한계를 극복할 수 있다. 최근에는 이를 보다 객관적이고 재현 가능하도록 인공지능을 접목하는 연구들이 활발히 진행되고 있다. 본 종설에서는 심장 전산화단층촬영의 기능적 영상화 기법들에 대해 알아보고자 한다.
Collapse
Affiliation(s)
- Moon Young Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Tarkowski P, Czekajska-Chehab E. Dual-Energy Heart CT: Beyond Better Angiography-Review. J Clin Med 2021; 10:jcm10215193. [PMID: 34768713 PMCID: PMC8584316 DOI: 10.3390/jcm10215193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/30/2022] Open
Abstract
Heart CT has undergone substantial development from the use of calcium scores performed on electron beam CT to modern 256+-row CT scanners. The latest big step in its evolution was the invention of dual-energy scanners with much greater capabilities than just performing better ECG-gated angio-CT. In this review, we present the unique features of dual-energy CT in heart diagnostics.
Collapse
|
17
|
Takafuji M, Kitagawa K, Ishida M, Ichikawa Y, Nakamura S, Nakamori S, Kurita T, Dohi K, Sakuma H. Clinical Validation of the Accuracy of Absolute Myocardial Blood Flow Quantification with Dual-Source CT Using 15O-Water PET. Radiol Cardiothorac Imaging 2021; 3:e210060. [PMID: 34778781 PMCID: PMC8581586 DOI: 10.1148/ryct.2021210060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the fitting equation that can correct for the underestimation of myocardial blood flow (MBF) measurement by using dynamic CT perfusion (CTP) with dual-source CT (MBFCT), using MBF with oxygen 15-labeled water (15O-water) PET (MBFPET) as a reference, and to determine the accuracy of corrected MBFCT (MBFCT-corrected) compared with MBFPET in a separate set of participants. MATERIALS AND METHODS In this prospective study (reference no. 2466), 34 participants (mean age, 70 years ± 8 [standard deviation]; 27 men) known or suspected to have coronary artery disease underwent dynamic stress CTP and stress 15O-water PET between January 2014 and December 2018. The participants were randomly assigned to either a pilot group (n = 17), to determine the fitting equation on the basis of the generalized Renkin-Crone model that can explain the relation between MBFCT and MBFPET, or to a validation group (n = 17), to validate MBFCT-corrected compared with MBFPET. The agreement between MBFCT-corrected and MBFPET was evaluated by intraclass correlation and Bland-Altman analysis. RESULTS In the pilot group, MBFCT was lower than MBFPET (1.24 mL/min/g ± 0.28 vs 2.51 mL/min/g ± 0.89, P < .001) at the segment level. The relationship between MBFCT and MBFCT-corrected was represented as MBFCT = MBFCT-corrected × {1-exp[-(0.11 × MBFCT-corrected + 1.54)/MBFCT-corrected]}. In the validation group, MBFCT-corrected was 2.66 mL/min/g ± 1.93, and MBFPET was 2.68 mL/min/g ± 1.87 at the vessel level. MBFCT-corrected showed an excellent agreement with MBFPET (intraclass correlation coefficient = 0.93 [95% CI: 0.87, 0.96]). The measurement bias of MBFCT-corrected and MBFPET was -0.02 mL/min/g ± 0.74. CONCLUSION Underestimation of MBF by CT was successfully corrected with a correction method that was based on contrast kinetics in the myocardium.Keywords: CT, CT-Perfusion, PET, Cardiac, Heart Supplemental material is available for this article. © RSNA, 2021.
Collapse
Affiliation(s)
- Masafumi Takafuji
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kakuya Kitagawa
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masaki Ishida
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yasutaka Ichikawa
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Satoshi Nakamura
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Shiro Nakamori
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Tairo Kurita
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kaoru Dohi
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- From the Department of Radiology (M.T., K.K., M.I., Y.I., S.
Nakamura, H.S.) and Department of Cardiology and Nephrology (S. Nakamori, T.K.,
K.D.), Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| |
Collapse
|
18
|
Nappi C, Gaudieri V, Cuocolo A. Computed tomography calls out nuclear imaging in its field: It doesn't matter how you are searching but what you are looking for. J Nucl Cardiol 2021; 28:1715-1717. [PMID: 31646470 DOI: 10.1007/s12350-019-01926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| |
Collapse
|
19
|
Vattay B, Boussoussou M, Borzsák S, Vecsey-Nagy M, Simon J, Kolossváry M, Merkely B, Szilveszter B. Myocardial perfusion imaging using computed tomography: Current status, clinical value and prognostic implications. IMAGING 2021. [DOI: 10.1556/1647.2020.00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractCombined anatomical and functional evaluation of coronary artery disease (CAD) using computed tomography (CT) has recently emerged as an accurate, robust, and non-invasive tool for the evaluation of ischemic heart disease. Cardiac CT has become a one-stop-shop imaging modality that allows the simultaneous depiction, characterization, and quantification of coronary atherosclerosis and the assessment of myocardial ischemia. Advancements in scanner technology (improvements in spatial and temporal resolution, dual-energy imaging, wide detector panels) and the implementation of iterative reconstruction algorithms enables the detection of myocardial ischemia in both qualitative and quantitative fashion using low-dose scanning protocols. The addition of CT perfusion (CTP) to standard coronary CT angiography is a reliable tool to improve diagnostic accuracy. CTP using static first-pass imaging enables qualitative assessment of the myocardial tissue, whereas dynamic perfusion imaging can also provide quantitative information on myocardial blood flow. Myocardial tissue assessment by CTP holds the potential to refine risk in stable chest pain or microvascular dysfunction. CTP can aid the detection of residual ischemia after coronary intervention. Comprehensive evaluation of CAD using CTP might therefore improve the selection of patients for aggressive secondary prevention therapy or coronary revascularization with high diagnostic certainty. In addition, prognostic information provided by perfusion CT imaging could improve patient outcomes by quantifying the ischemic burden of the left ventricle. The current review focuses on the clinical value of myocardial perfusion imaging by CT, current status of CTP imaging and the use of myocardial CTP in various patient populations for the diagnosis of ischemic heart disease.
Collapse
Affiliation(s)
- Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sarolta Borzsák
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Milán Vecsey-Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
20
|
Optimization of image sampling rate to lower the radiation dose of dynamic myocardial CT perfusion. J Cardiovasc Comput Tomogr 2021; 15:457-460. [PMID: 33896761 DOI: 10.1016/j.jcct.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dynamic myocardial CT perfusion (CTP) has emerged as a potential strategy to combine anatomical and functional evaluation in a single modality. However, this method results in a high radiation dose. METHODS Dynamic CTP was performed in 56 patients with suspected or known ischemic heart disease of whom 48 had complete CT-data. Datasets with reduced sampling rate of 2- and 3 RR-intervals (2RR and 3RR) were constructed post hoc. Myocardial blood flow (MBF) estimates from the 2RR and 3RR datasets were compared with estimates based on the full dataset (1RR) using the two one-sided test of equivalence for paired samples. RESULTS Significant equivalence was found for rest MBFLV (p < 0.001), stress MBFLV (p < 0.001) and for the CFRLV (p = 0.005) when comparing 2RR blood flow estimates with the results based on the 1RR dataset. The 2RR reconstruction protocol led to an estimated reduction in radiation dose of 35.4 ± 3.8%. CONCLUSION MBF can be quantitated with dynamic CTP using a sampling strategy of one volume for every second heartbeat. This strategy could lead to a significant reduction in radiation dose.
Collapse
|
21
|
Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | | |
Collapse
|
22
|
From Inception to 2020: a Review of Dynamic Myocardial CT Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-020-09551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Sugisawa J, Matsumoto Y, Takeuchi M, Suda A, Tsuchiya S, Ohyama K, Nishimiya K, Akizuki M, Sato K, Ohura S, Ota H, Ikeda S, Shindo T, Kikuchi Y, Hao K, Shiroto T, Takahashi J, Miyata S, Sakata Y, Takase K, Kohzuki M, Shimokawa H. Beneficial effects of exercise training on physical performance in patients with vasospastic angina. Int J Cardiol 2020; 328:14-21. [PMID: 33309635 DOI: 10.1016/j.ijcard.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/04/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022]
Abstract
AIMS In vasospastic angina (VSA), coronary vasomotion abnormalities could develop not only in epicardial coronary arteries but also in coronary microvessels, where calcium channel blockers (CCBs) have limited efficacy. However, efficacy of exercise training for VSA remains to be elucidated. We thus aimed to examine whether vasodilator capacity of coronary microvessels is impaired in VSA patients, and if so, whether exercise exerts beneficial effects on the top of CCBs. METHODS We performed 2 clinical protocols. In the protocol 1, we measured myocardial blood flow (MBF) using adenosine-stress dynamic computed tomography perfusion (CTP) in 38 consecutive VSA patients and 17 non-VSA controls. In the protocol 2, we conducted randomized controlled trial, where 20 VSA patients were randomly assigned to either 3-month exercise training group (Exercise group) or Non-Exercise group (n= 10 each). RESULTS In the protocol 1, MBF on CTP was significantly decreased in the VSA group compared with the Non-VSA group (138 ± 6 vs 166 ± 10 ml/100 g/min, P = 0.02). In the protocol 2, exercise capacity was significantly increased in the Exercise group than in the Non-Exercise group (11.5 ± 0.5 to 15.4 ± 1.8 vs 12.6 ± 0.7 to 14.0 ± 0.8 ml/min/kg, P < 0.01). MBF was also significantly improved after 3 months only in the Exercise group (Exercise group, 145 ± 12 to 172 ± 8 ml/100 g/min, P < 0.04; Non-Exercise group, 143 ± 14 to 167 ± 8 ml/100 g/min, P = 0.11), although there were no significant between-group differences. CONCLUSIONS These results provide the first evidence that, in VSA patients, exercise training on the top of CCBs treatment may be useful to improve physical performance, although its effect on MBF may be minimal.
Collapse
Affiliation(s)
- Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Takeuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mina Akizuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shoko Ohura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| |
Collapse
|
24
|
Chen X, Wang G, Zhao L, Zhao J, Liu T, Zhao G, Han W. The value of coronary computed tomography angiography in assessing the cardiac circulation of an outpatient-based population. Medicine (Baltimore) 2020; 99:e23148. [PMID: 33181686 PMCID: PMC7668512 DOI: 10.1097/md.0000000000023148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the perfusion of coronary circulation and its related factors and the difference in the peak filling times in aortic sinus and coronary sinus by coronary computed tomography angiography (CCTA).From January 1 to August 1, 2018, 61 outpatients with angina pectoris were recruited, completed a questionnaire about risk factors and underwent CCTA, which was also used to assess the stenosis of different coronary artery segments.The duration of circulation was 9.50 ± 2.43 seconds in patients with flat T wave, which was shorter than the duration in normal subjects (P = .021). However, other cardiovascular risk factors showed no effect on the duration of circulation. In addition, the duration of circulation was closely related to the peak filling time of coronary sinus [r(s) = 0.681]. We further divided the circulation time difference (delta) values into 3 levels (<6, 6-12, and ≥12 seconds).It showed that the circulation duration (Y) was associated with:Therefore, the cardiac circulation duration was negatively related to the degree of stenosis in the 1 diagonal and proximal LCA.It compensates for the inability of CCTA to assess circulation at rest simply by determining the peak filling time in the aortic sinus and the coronary sinus. Moderate cardiac microcirculation duration was related to a low incidence of clinical symptoms and electrocardiogram disorders, which was determined mainly by the diagonal and left circumflex branch 1 of LCA.
Collapse
|
25
|
Manabe O, Naya M, Aikawa T, Tamaki N. Recent advances in cardiac positron emission tomography for quantitative perfusion analyses and molecular imaging. Ann Nucl Med 2020; 34:697-706. [DOI: 10.1007/s12149-020-01519-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
|
26
|
Detailed CAD Phenotyping by Angiography, Dynamic Perfusion and Scar Imaging Sharpens CT Prognostic Power. JACC Cardiovasc Imaging 2020; 13:1735-1738. [DOI: 10.1016/j.jcmg.2020.03.007] [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: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 11/21/2022]
|
27
|
Mushtaq S, Conte E, Pontone G, Baggiano A, Annoni A, Formenti A, Mancini ME, Guglielmo M, Muscogiuri G, Tanzilli A, Nicoli F, Bartorelli AL, Pepi M, Andreini D. State-of-the-art-myocardial perfusion stress testing: Static CT perfusion. J Cardiovasc Comput Tomogr 2020; 14:294-302. [DOI: 10.1016/j.jcct.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/27/2019] [Accepted: 09/07/2019] [Indexed: 01/06/2023]
|
28
|
Tsuneta S, Oyama-Manabe N, Kameda H, Harada T, Kato F, Smit EJ, Prokop M, Kudo K. Improvement of image quality on low-dose dynamic myocardial perfusion computed tomography with a novel 4-dimensional similarity filter. Medicine (Baltimore) 2020; 99:e20804. [PMID: 32590765 PMCID: PMC7328929 DOI: 10.1097/md.0000000000020804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The aim of this study was to evaluate the effect of a novel 4-dimensional similarity filter (4DSF) on quantitative and qualitative parameters of low-dose dynamic myocardial computed tomography perfusion (CTP) images.In this retrospective study, medical records of 32 patients with suspected or known coronary artery disease who underwent dynamic myocardial CTP at 80 kV were included. The 4DSF reduces noise by averaging voxels that have similar dynamic behavior after adaptive iterative dose reduction 3D (AIDR3D) and deformable image registration were applied. Qualitative (artefact, contour sharpness, and myocardial homogeneity [1 = poor; 2 = intermediate; 3 = good]) and quantitative measurement (standard deviation [SD] and signal-to-noise ratio [SNR]) were compared between the 4DSF and AIDR3D. Contrast-to-noise ratio (CNR) between ischemic and normal remote myocardium was also assessed using myocardial perfusion magnetic resonance imaging as the reference standard in seven patients.The 4DSF was successfully applied to all the images. Improvement in subjective image quality yielded by 4DSF was higher than that yielded by AIDR3D (homogeneity, 1.0 [3 vs 2]; artefact, 1.5 [3 vs 1.5]; P < .001) in all patients. The 4DSF significantly decreased the SD by 59% (AIDR3D vs 4DSF: 33.5 ± 0.4 vs 13.8 ± 0.4, P < .001), increased the SNR by 134% (AIDR3D vs 4DSF: 4.4 ± 0.2 vs 10.3 ± 0.2, P < .001), and increased the CNR by 131% (AIDR3D vs 4DSF: 1.6 ± 0.2 vs 3.7 ± 0.2, P < .001).The 4DSF improved the qualitative and quantitative parameters of low-dose dynamic myocardial CTP images.
Collapse
Affiliation(s)
- Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido
| | - Noriko Oyama-Manabe
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama-shi, Saitama
| | - Hiroyuki Kameda
- Department of Dental Radiology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido, Japan
| | - Taisuke Harada
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido
| | - Ewoud J. Smit
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido
| |
Collapse
|
29
|
Clinical application of four-dimensional noise reduction filtering with a similarity algorithm in dynamic myocardial computed tomography perfusion imaging. Int J Cardiovasc Imaging 2020; 36:1781-1789. [PMID: 32399762 DOI: 10.1007/s10554-020-01878-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
We aimed to evaluate the effects of four-dimensional noise reduction filtering using a similarity algorithm (4D-SF) on the image quality and hemodynamic parameter of dynamic myocardial computed tomography perfusion (CTP). Sixty-eight patients who underwent dynamic myocardial CTP for the assessment of coronary artery disease were enrolled. Dynamic CTP was performed using a 320-row CT with low tube voltage scan (80 kVp). Two different datasets of dynamic CTP were reconstructed using iterative reconstruction (IR) alone and a combination of IR and 4D-SF. Qualitative (5-grade scale) and quantitative image quality scores were assessed, and the CT-derived myocardial blood flow (CT-MBF) was quantified. These results were compared between the two different CTP images. The qualitative image quality in CTP images reconstructed with IR and 4D-SF was significantly higher than that with IR alone (noise score: 4.7 vs. 3.4, p < 0.05). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in CTP images reconstructed with IR and 4D-SF were significantly higher than those with IR alone (SNR: 20.6 vs. 9.7; CNR: 7.9 vs. 3.9, respectively; p < 0.05). There was no significant difference in mean CT-MBF between the two sets of CTP images (3.01 vs. 3.03 mL/g/min, p = 0.1081). 4D-SF showed incremental value in improving image quality in combination with IR without altering CT-MBF quantification in dynamic myocardial CTP imaging with a low tube potential.
Collapse
|
30
|
Tanabe Y, Kurata A, Matsuda T, Yoshida K, Baruah D, Kido T, Mochizuki T, Rajiah P. Computed tomographic evaluation of myocardial ischemia. Jpn J Radiol 2020; 38:411-433. [PMID: 32026226 PMCID: PMC7186254 DOI: 10.1007/s11604-020-00922-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 01/02/2023]
Abstract
Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CT-fractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.
Collapse
Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takuya Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Dhiraj Baruah
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
- Department of Radiology, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, Moscow, Russia
| | | |
Collapse
|
31
|
Kono T, Uetani T, Inoue K, Nagai T, Nishimura K, Suzuki J, Tanabe Y, Kido T, Kurata A, Mochizuki T, Ogimoto A, Okura T, Higaki J, Yamaguchi O, Ikeda S. Diagnostic accuracy of stress myocardial computed tomography perfusion imaging to detect myocardial ischemia: a comparison with coronary flow velocity reserve derived from transthoracic Doppler echocardiography. J Cardiol 2020; 76:251-258. [PMID: 32354493 DOI: 10.1016/j.jjcc.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our aim was to evaluate the ability of adenosine triphosphate (ATP)-stress myocardial computed tomography perfusion (CTP) imaging to detect myocardial ischemia in the left anterior descending artery (LAD) territory, and to compare this method with coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE). METHODS ATP-stress CTP and CFVR were performed in 50 patients with stable angina pectoris. Myocardial ischemia assessed from CTP imaging was defined as qualitative visual perfusion defects and reduced myocardial blood flow (MBF) based on quantitative assessment. A cut-off value of CFVR of 2.0 was used. RESULTS The mean CFVR was 1.9 ± 0.6 in ischemic regions by CTP, whereas it was 2.9 ± 0.8 in non-ischemic regions (p < 0.001). CTP imaging could accurately predict CFVR <2.0 with 84.0% diagnostic accuracy (94.7% sensitivity, 77.4% specificity, 72.0% positive predictive value, and 96.0% negative predictive value). When receiver operating characteristic curve analysis of the MBF data was performed to detect CFVR <2.0, the area under the curve was 0.89, and the optimal MBF cut-off value was 1.43 mL/g/min. CONCLUSIONS This study suggests that qualitative and quantitative assessment of ATP-stress CTP exhibits a good correlation with CFVR for evaluation of myocardial ischemia.
Collapse
Affiliation(s)
- Tamami Kono
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Suzuki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | | | - Takafumi Okura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jitsuo Higaki
- Department of Cardiology, South Matsuyama Hospital, Matsuyama, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| |
Collapse
|
32
|
Society of cardiovascular computed tomography expert consensus document on myocardial computed tomography perfusion imaging. J Cardiovasc Comput Tomogr 2020; 14:87-100. [DOI: 10.1016/j.jcct.2019.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
|
33
|
Schuijf JD, Matheson MB, Ostovaneh MR, Arbab-Zadeh A, Kofoed KF, Scholte AJHA, Dewey M, Steveson C, Rochitte CE, Yoshioka K, Cox C, Di Carli MF, Lima JAC. Ischemia and No Obstructive Stenosis (INOCA) at CT Angiography, CT Myocardial Perfusion, Invasive Coronary Angiography, and SPECT: The CORE320 Study. Radiology 2020; 294:61-73. [DOI: 10.1148/radiol.2019190978] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Mizusaki T, Imai S, Kajiura R, Nakashima Y, Kondo T, Tachiki S, Ichihara T, Hemachandra N, Mase T, Matsuo H. [The Optimal Start Timing of Helical Scan for Coronary CT Angiography and CT Myocardial Perfusion Scan Using 64-MDCT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1141-1149. [PMID: 31631107 DOI: 10.6009/jjrt.2019_jsrt_75.10.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Ichihara et al. (Fujita Med J 2015; 1(1): 9-14) developed a method to simultaneously obtain both coronary computed tomography (CT) angiography and CT myocardial perfusion (CTP) using 64-multi detector CT (MDCT). An input-function (time enhancement curve, TEC) of the ascending aorta (Ao) and myocardial CT density are necessary to calculate absolute myocardial blood flow (ml/g/min) using a two-compartment model. Helical scan starting timing is important to capture the peak (P) of Ao time enhancement curve (TEC). The purpose is to search the optimal timing of starting helical scan to capture the P. METHODS We performed 14 CTPs using Definition AS+ (SIEMENS). A dynamic scan at the Ao level was started at 7 s after contrast injection and helical scan was started at various trigger on bolus tracking. Definition AS+ needs 2 s (other scanner may need 4 s) for changing from a dynamic to helical scan mode. We created TECs of pulmonary artery (PA) and Ao using the fifth function fitting. We measured the time from trigger point to the P (t200, t250, t300 and tCP). RESULTS Mean t200, t250, t300 and tCP were 9.1±1.9, 7.9±2.0, 6.6±1.9 and 3.9±1.2 s, respectively. In additional other 16 CTP studies using the cross point method, we can capture the P in all (100%) examinations. CONCLUSION Scan starting at the cross point is best for Definition AS+, and the Ao=300 HU may be best for other scanner that needs 4 s for changing scan mode to obtain a fine input function for calculating absolute myocardial blood flow.
Collapse
Affiliation(s)
| | | | - Ryo Kajiura
- Clinical Radiology Service, Gifu Heart Center
| | | | | | - Shuichi Tachiki
- Department of Radiological Technology, School of Health Sciences, Fujita Health University
| | - Takashi Ichihara
- Research and Development of Medical Imaging using Artificial Intelligence, School of Medicine, Fujita Health University
| | - Nadeeka Hemachandra
- Research and Development of Medical Imaging using Artificial Intelligence, School of Medicine, Fujita Health University
| | - Tsugumi Mase
- Research and Development of Medical Imaging using Artificial Intelligence, School of Medicine, Fujita Health University
| | | |
Collapse
|
35
|
Nieman K, Balla S. Dynamic CT myocardial perfusion imaging. J Cardiovasc Comput Tomogr 2019; 14:303-306. [PMID: 31540820 DOI: 10.1016/j.jcct.2019.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/09/2019] [Accepted: 09/07/2019] [Indexed: 12/30/2022]
Abstract
Cardiac CT offers several approaches to establish the hemodynamic severity of coronary artery obstructions. Dynamic myocardial perfusion CT (MPICT) is based on serial CT imaging to measure the inflow of contrast medium into the myocardium and calculate absolute measures of myocardial perfusion. This review describes the MPICT acquisition protocol, post-image acquisition processing and calculation of quantitative parameters, the diagnostic performance of MPICT and the potential incremental value of this technique in comparison to alternative approaches. Further technical innovation using different scanner platforms and establishment of reproducible diagnostic thresholds to differentiate significant coronary artery disease will be crucial in the path to broader clinical implementation.
Collapse
Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, 94304, USA.
| | - Sujana Balla
- Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, 94304, USA
| |
Collapse
|
36
|
FFR CT and CT perfusion: A review on the evaluation of functional impact of coronary artery stenosis by cardiac CT. Int J Cardiol 2019; 300:289-296. [PMID: 31466886 DOI: 10.1016/j.ijcard.2019.08.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/14/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
Coronary computed tomography angiography (CCTA) is at the frontline of the diagnostic strategies to detect coronary artery disease (CAD). Anatomical information have proven to be insufficient to detect hemodynamic significant epicardial stenosis. In the present invited review we discuss on FFRCT and stress CTP, emerging technologies for an accurate and comprehensive evaluation of patients with suspected CAD, offering both anatomical (i.e. luminal and plaque) and functional assessment in one single technique.
Collapse
|
37
|
Alessio AM, Bindschadler M, Busey JM, Shuman WP, Caldwell JH, Branch KR. Accuracy of Myocardial Blood Flow Estimation From Dynamic Contrast-Enhanced Cardiac CT Compared With PET. Circ Cardiovasc Imaging 2019; 12:e008323. [PMID: 31195817 DOI: 10.1161/circimaging.118.008323] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The accuracy of absolute myocardial blood flow (MBF) from dynamic contrast-enhanced cardiac computed tomography acquisitions has not been fully characterized. We evaluate computed tomography (CT) compared with rubidium-82 positron emission tomography (PET) MBF estimates in a high-risk population. Methods In a prospective trial, patients receiving clinically indicated rubidium-82 PET exams were recruited to receive a dynamic contrast-enhanced cardiac computed tomography exam. The CT protocol included a rest and stress dynamic portion each acquiring 12 to 18 cardiac-gated frames. The global MBF was estimated from the PET and CT exam. Results Thirty-four patients referred for cardiac rest-stress PET were recruited. Of the 68 dynamic contrast-enhanced cardiac computed tomography scans, 5 were excluded because of injection errors or mismatched hemodynamics. The CT-derived global MBF was highly correlated with the PET MBF (r=0.92; P<0.001) with a mean difference of 0.7±26.4%. The CT MBF estimates were within 20% of PET estimates ( P<0.02) with a mean of (1) MBF for resting flow of PET versus CT of 0.9±0.3 versus 1.0±0.2 mL/min per gram and (2) MBF for stress flow of 2.1±0.7 versus 2.0±0.8 mL/min per gram. Myocardial flow reserve was -14±28% underestimated with CT (PET versus CT myocardial flow reserve, 2.5±0.6 versus 2.2±0.6). The proposed rest+stress+computed tomography angiography protocol had a dose length product of 598±76 mGy×cm resulting in an approximate effective dose of 8.4±1.1 mSv. Conclusions In a high-risk clinical population, a clinically practical dynamic contrast-enhanced cardiac computed tomography provided unbiased MBF estimates within 20% of rubidium-82 PET. Although unbiased, the CT estimates contain substantial variance with an standard error of the estimate of 0.44 mL/min per gram. Myocardial flow reserve estimation was not as accurate as individual MBF estimates.
Collapse
Affiliation(s)
- Adam M Alessio
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington.,Computational Mathematics, Biomedical Engineering, and Radiology, Michigan State University (A.M.A.)
| | - Michael Bindschadler
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington
| | - Janet M Busey
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington
| | - William P Shuman
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington
| | - James H Caldwell
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington.,Division of Cardiology, Department of Medicine (J.H.C., K.R.B.), University of Washington
| | - Kelley R Branch
- Division of Cardiology, Department of Medicine (J.H.C., K.R.B.), University of Washington
| |
Collapse
|
38
|
Nishiyama H, Tanabe Y, Kido T, Kurata A, Uetani T, Kido T, Ikeda S, Miyagawa M, Mochizuki T. Incremental diagnostic value of whole-heart dynamic computed tomography perfusion imaging for detecting obstructive coronary artery disease. J Cardiol 2019; 73:425-431. [DOI: 10.1016/j.jjcc.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/19/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
|
39
|
Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived. JACC Cardiovasc Imaging 2019; 12:2460-2471. [PMID: 31005531 DOI: 10.1016/j.jcmg.2019.02.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/22/2019] [Accepted: 02/01/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aims of the study were to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus fractional flow reserve computed tomography derived (FFRCT) by using a whole-heart coverage computed tomography (CT) scanner as compared with clinically indicated invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). BACKGROUND Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experiences with this technique were associated with high radiation exposure. METHODS Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant coronary artery disease (CAD) in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP, or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. RESULTS The prevalence of obstructive CAD and functionally significant CAD was 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT, and cCTA+CTP were 83% and 66%, 86% and 75%, and 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared with cCTA alone (0.826; p < 0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919; p < 0.05) as compared with all other strategies. The mean effective radiation dose (ED) for cCTA and stress CTP was 2.8 ± 1.2 mSv and 5.3 ± 0.7 mSv, respectively. CONCLUSIONS The addition of dynamic stress CTP on top of cCTA and FFRCT provides additional diagnostic accuracy with acceptable radiation exposure.
Collapse
|
40
|
Kikuchi Y, Naya M, Oyama-Manabe N, Manabe O, Sugimori H, Kudo K, Kato F, Aikawa T, Tsutsui H, Tamaki N, Shirato H. Assessment of Coronary Flow Velocity Reserve in the Left Main Trunk Using Phase-contrast MR Imaging at 3T: Comparison with 15O-labeled Water Positron Emission Tomography. Magn Reson Med Sci 2019; 18:134-141. [PMID: 30047496 PMCID: PMC6460128 DOI: 10.2463/mrms.mp.2018-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aim of this study was to verify coronary flow velocity reserve (CFVR) on the left main trunk (LMT) in comparison with myocardial flow reserve (MFR) by 15O-labeled water positron emission tomography (PET) (MFR-PET) in both the healthy adults and the patients with coronary artery disease (CAD), and to evaluate the feasibility of CFVR to detect CAD. Methods: Eighteen healthy adults and 13 patients with CAD were evaluated. CFVR in LMT was estimated by 3T magnetic resonance imaging (MRI) with phase contrast technique. MFR-PET in the LMT territory including anterior descending artery and circumflex artery was calculated as the ratio of myocardial blood flow (MBF)-PET at stress to MBF-PET at rest. Results: There was a significant positive relationship between CFVR and MFR-PET (R = 0.45, P < 0.0001). Inter-observer calculations of CFVR showed good correlation (R2 = 0.93, P < 0.0001). The CFVR in patients with CAD was significantly lower than that in healthy adults (1.90 ± 0.61 vs. 2.77 ± 1.03, respectively, P = 0.01), which were similar to the results of MFR-PET (2.23 ± 0.84 vs. 3.96 ± 1.04, respectively, P < 0.0001). For the detection of patients with CAD, the area under the curve was 0.78 (P = 0.01). The sensitivity was 0.77 and specificity was 0.72 when a cut-off of 2.15 was used. Conclusion: CFVR by 3T was validated with MFR-PET. CFVR could detect the patients with CAD. This method is a simple and reliable index without radiation or contrast material.
Collapse
Affiliation(s)
- Yasuka Kikuchi
- Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine
| | | | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine
| |
Collapse
|
41
|
Kobayashi K, Wakasa S, Sato K, Kanai S, Date H, Kimura S, Oyama-Manabe N, Matsui Y. Quantitative analysis of regional endocardial geometry dynamics from 4D cardiac CT images: endocardial tracking based on the iterative closest point with an integrated scale estimation. ACTA ACUST UNITED AC 2019; 64:055009. [DOI: 10.1088/1361-6560/ab009a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
42
|
Lukas S, Feger S, Rief M, Zimmermann E, Dewey M. Noise reduction and motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP): preliminary clinical evaluation of the ASTRA4D algorithm. Eur Radiol 2019; 29:4572-4582. [DOI: 10.1007/s00330-018-5899-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/15/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
|
43
|
Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT. J Cardiovasc Comput Tomogr 2019; 13:55-61. [DOI: 10.1016/j.jcct.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/17/2018] [Accepted: 10/01/2018] [Indexed: 11/15/2022]
|
44
|
Feger S, Kendziorra C, Lukas S, Shaban A, Bokelmann B, Zimmermann E, Rief M, Dewey M. Effect of iterative reconstruction and temporal averaging on contour sharpness in dynamic myocardial CT perfusion: Sub-analysis of the prospective 4D CT perfusion pilot study. PLoS One 2018; 13:e0205922. [PMID: 30325969 PMCID: PMC6191149 DOI: 10.1371/journal.pone.0205922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose Myocardial computed tomography perfusion (CTP) allows the assessment of the functional relevance of coronary artery stenosis. This study investigates to what extent the contour sharpness of sequences acquired by dynamic myocardial CTP is influenced by the following noise reduction methods: temporal averaging and adaptive iterative dose reduction 3D (AIDR 3D). Materials and methods Dynamic myocardial CT perfusion was conducted in 29 patients at a dose level of 9.5±2.0 mSv and was reconstructed with both filtered back projection (FBP) and strong levels of AIDR 3D. Temporal averaging to reduce noise was performed as a post-processing step by combining two, three, four, six and eight original consecutive 3D datasets. We evaluated the contour sharpness at four distinct edges of the left-ventricular myocardium based on two different approaches: the distance between 25% and 75% of the maximal grey value (d) and the slope in the contour (m). Results Iterative reconstruction reduced contour sharpness: both measures of contour sharpness performed better for FBP than for AIDR 3D (d = 1.7±0.4 mm versus 2.0±0.5 mm, p>0.059 at all edges; m = 255.9±123.9 HU/mm versus 160.6±123.5 HU/mm; p<0.023 for all edges). Increasing levels of temporal averaging degraded contour sharpness. When FBP reconstruction was applied, contour sharpness was best without temporal averaging (d = 1.7±0.4 mm, m = 255.9±123.9 HU/mm) and poorest for the strongest levels of temporal averaging (d = 2.1±0.3 mm, m = 142.2±104.9 HU/mm; comparison between lowest and highest temporal averaging level: for d p>0.052 at all edges and for m p<0.001 at all edges). Conclusion The use of both temporal averaging and iterative reconstruction degrades objective contour sharpness parameters of dynamic myocardial CTP. Thus, further advances in image processing are needed to optimise contour sharpness of 4D myocardial CTP.
Collapse
Affiliation(s)
- Sarah Feger
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Carsten Kendziorra
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Lukas
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed Shaban
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Björn Bokelmann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Zimmermann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
45
|
Obara M, Naya M, Oyama-Manabe N, Aikawa T, Tomiyama Y, Sasaki T, Kikuchi Y, Manabe O, Katoh C, Tamaki N, Tsutsui H. Diagnostic value of quantitative coronary flow reserve and myocardial blood flow estimated by dynamic 320 MDCT scanning in patients with obstructive coronary artery disease. Medicine (Baltimore) 2018; 97:e11354. [PMID: 29979416 PMCID: PMC6076151 DOI: 10.1097/md.0000000000011354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We have developed the method for dynamic 320-row multidetector computed tomography (MDCT)-derived quantitative coronary flow reserve (CFRCT) and hyperemic myocardial blood flow (MBFCT). We evaluated diagnostic value of CFRCT and hyperemic MBFCT for detecting obstructive coronary artery disease (CAD) in per-patient and per-vessel analysis, and their relations with the severity of CAD burden.Adenosine stressed and rest dynamic myocardial perfusion MDCT were prospectively performed in patients with known or suspected CAD. Per-patient and per-vessel MBFCT were estimated from dynamic perfusion images in rest and hyperemic phases, and per-patient and per-vessel CFRCT were calculated from the ratio of rest and hyperemic MBFCT. Degree of stenosis was evaluated by coronary CT angiography (CTA) and invasive coronary angiography (ICA). Obstructive stenosis was defined as ≥70% stenosis in ICA. CAD burden with MDCT was calculated by logarithm transformed coronary artery calcium (CAC) score and the CTA-adapted Leaman risk score (CT-LeSc). A logistic regression analysis was used to measure the receiver-operating characteristic curve and corresponding area under the curve (AUC) for the detection of obstructive CAD.Twenty-seven patients and 81 vessels were eligible for this study. Sixteen patients had obstructive CAD, and 31 vessels had obstructive stenosis. Using an optimal cutoff, the CFRCT and hyperemic MBFCT had the moderate diagnostic values in per-patient (AUC = 0.89 and 0.86, respectively) and per-vessel (AUC = 0.79 and 0.76, respectively). Per-patient CFRCT and hyperemic MBFCT exhibited a moderate inverse correlation with CAC score and the CT-LeSc.Per-patient and per-vessel CFRCT as well as hyperemic MBFCT had moderate diagnostic value for detecting obstructive CAD. These per-patient values exhibited a moderate inverse correlation with CAD burden. CFRCT and hyperemic MBFCT might add quantitative functional information for evaluating patients with CAD.
Collapse
Affiliation(s)
- Masahiko Obara
- Department of Cardiovascular Medicine, Hokkaido Chuo Rosai Hospital, Iwamizawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yuuki Tomiyama
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine
| | | | - Yasuka Kikuchi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
- Center for Cause of Death Investigation, Hokkaido University Graduate School of Medicine
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine
| | - Chietsugu Katoh
- Faculty of Health Science, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido
| | - Nagara Tamaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Science, Fukuoka, Japan
| |
Collapse
|
46
|
Tomizawa N, Fujino Y, Kamitani M, Chou S, Yamamoto K, Inoh S, Nojo T, Nakamura S. Longer diabetes duration reduces myocardial blood flow in remote myocardium assessed by dynamic myocardial CT perfusion. J Diabetes Complications 2018; 32:609-615. [PMID: 29627375 DOI: 10.1016/j.jdiacomp.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/04/2018] [Accepted: 03/11/2018] [Indexed: 01/30/2023]
Abstract
AIMS To investigate the relationship of type 2 diabetes duration and myocardial blood flow (MBF) assessed by myocardial CT perfusion. MATERIALS AND METHODS We prospectively included 140 patients with type 2 diabetes who underwent dynamic myocardial CT perfusion exam. MBF of the remote myocardium was calculated using the deconvolution technique and the Voronoi method. The relationships of MBF and diabetic duration, diabetic complications, conventional risk factors, coronary calcium, and coronary stenosis were assessed by logistic regression analysis. RESULTS A weak but significantly negative relationship was present between diabetes duration and MBF (R2 = 0.05, p < 0.01). The average MBF of patients with a duration of >8 years was 13% lower than that of the remaining patients (1.11 ± 0.35 vs 1.28 ± 0.27 ml min-1 g-1, p < 0.01). Duration of one year was associated with a 6% increased risk for low MBF (<1.18 ml min-1 g-1) (odds ratio 1.06, 95% confidence interval 1.01-1.12, p < 0.05). Calcium score was also a significant factor for low MBF (odds ratio 1.08 (per 100 Agatston units), 95% confidence interval 1.01-1.17, p < 0.05). CONCLUSION Longer diabetes duration is associated with lower MBF independent of conventional cardiac risk factors or the presence of coronary stenosis.
Collapse
Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
| | - Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan; Department of Diabetes, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Masaru Kamitani
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shengpu Chou
- Department of Diabetes, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Kodai Yamamoto
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shinichi Inoh
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Takeshi Nojo
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| |
Collapse
|
47
|
Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: A systematic review and meta-analysis. Int J Cardiol 2018; 258:325-331. [DOI: 10.1016/j.ijcard.2018.01.095] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 01/02/2023]
|
48
|
Yoshinaga K, Manabe O, Tamaki N. Absolute quantification of myocardial blood flow. J Nucl Cardiol 2018; 25:635-651. [PMID: 27444500 DOI: 10.1007/s12350-016-0591-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/01/2016] [Indexed: 12/22/2022]
Abstract
With the increasing availability of positron emission tomography (PET) myocardial perfusion imaging, the absolute quantification of myocardial blood flow (MBF) has become popular in clinical settings. Quantitative MBF provides an important additional diagnostic or prognostic information over conventional visual assessment. The success of MBF quantification using PET/computed tomography (CT) has increased the demand for this quantitative diagnostic approach to be more accessible. In this regard, MBF quantification approaches have been developed using several other diagnostic imaging modalities including single-photon emission computed tomography, CT, and cardiac magnetic resonance. This review will address the clinical aspects of PET MBF quantification and the new approaches to MBF quantification.
Collapse
Affiliation(s)
- Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| |
Collapse
|
49
|
Myocardial perfusion in patients with suspected coronary artery disease: comparison between 320-MDCT and rubidium-82 PET. Eur Radiol 2018; 28:2665-2674. [DOI: 10.1007/s00330-017-5257-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/03/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
|
50
|
Kawaguchi N, Okayama H, Kawamura G, Shigematsu T, Takahashi T, Kawada Y, Hiasa G, Yamada T, Matsuoka H, Kazatani Y, Miyagawa M, Mochizuki T. Clinical Usefulness of Coronary Flow Reserve Ratio for the Detection of Significant Coronary Artery Disease on 13N-Ammonia Positron Emission Tomography. Circ J 2018; 82:486-493. [DOI: 10.1253/circj.cj-17-0745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital
| | - Go Kawamura
- Department of Cardiology, Ehime Prefectural Central Hospital
| | | | | | | | - Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital
| | | | | | - Yukio Kazatani
- Department of Cardiology, Ehime Prefectural Central Hospital
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine
| | | |
Collapse
|