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Branch K, Alessio A. Fractal Analysis in Myocardial Computed Tomography Perfusion: All That One Cannot See. JACC Cardiovasc Imaging 2022; 15:1602-1603. [PMID: 36075620 DOI: 10.1016/j.jcmg.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Kelley Branch
- University of Washington, Division of Cardiology, Seattle, Washington, USA.
| | - Adam Alessio
- Michigan State University, East Lansing, Michigan, USA
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Omarov YA, Sukhinina TS, Veselova TN, Shakhnovich RM, Zhukova NS, Merkulova IN, Pevzner DV, Ternovoy SK, Staroverov II. [Possibilities of Stress Computed Tomography Myocardial Perfusion Imaging in the Diagnosis of Ischemic Heart Disease]. ACTA ACUST UNITED AC 2020; 60:122-131. [PMID: 33228515 DOI: 10.18087/cardio.2020.10.n1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
Computed tomography angiography (CT-angiography, CTA) allows noninvasive visualization of coronary arteries (CA). This method is highly sensitive in detecting coronary atherosclerosis. However, standard CTA does not allow evaluation of the hemodynamic significance of found CA stenoses, which requires additional functional tests for detection of myocardial ischemia. This review focuses on possibilities of clinical use, limitations, technical aspects, and prospects of a combination of CT-angiography and CT myocardial perfusion imaging in diagnostics of ischemic heart disease.
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Affiliation(s)
- Y A Omarov
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - T S Sukhinina
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - T N Veselova
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - R M Shakhnovich
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - N S Zhukova
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - I N Merkulova
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - D V Pevzner
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
| | - S K Ternovoy
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow; First Moscow State Medical University, Sechenov Moscow State Medical University (Sechenov University), Moscow
| | - I I Staroverov
- National Medical Research Center of Cardiology" of the Ministry of Health of Russia, Moscow
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Branch KR. Incremental Benefit of CT Perfusion to CT Coronary Angiography: Another Step to the One-Stop-Shop? JACC Cardiovasc Imaging 2018; 12:350-352. [PMID: 29454771 DOI: 10.1016/j.jcmg.2017.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kelley R Branch
- Department of Cardiology, University of Washington, Seattle, Washington.
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Kofoed KF, Sørgaard MH, Linde JJ. Functional Information in Coronary Artery Disease: The Case of Computed Tomography Myocardial Perfusion. Curr Cardiol Rep 2017; 19:126. [PMID: 29071430 DOI: 10.1007/s11886-017-0937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW To review methodological and logistical aspects of CT myocardial perfusion, current clinical evidence and possible future directions, with specific focus on use in patients with coronary artery disease (CAD). RECENT FINDINGS CT myocardial perfusion imaging may be performed as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already clinically available perfusion imaging methods. Combining CCTA and CT myocardial perfusion imaging increases the diagnostic accuracy to identify patients with CAD associated with ischemia. In patients suspected of CAD, CCTA frequently detects coronary atherosclerotic lesions, in which revascularization could be clinically beneficial. CT myocardial perfusion imaging may be helpful to identify coronary lesions associated with myocardial ischemia, and thus potentially suitable for coronary intervention.
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Affiliation(s)
- Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Department of Cardiology 2014, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias H Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Myocardial blood flow quantification for evaluation of coronary artery disease by positron emission tomography, cardiac magnetic resonance imaging, and computed tomography. Curr Cardiol Rep 2014; 16:483. [PMID: 24718671 DOI: 10.1007/s11886-014-0483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The noninvasive detection of the presence and functional significance of coronary artery stenosis is important in the diagnosis, risk assessment, and management of patients with known or suspected coronary artery disease. Quantitative assessment of myocardial perfusion can provide an objective and reproducible estimate of myocardial ischemia and risk prediction. Positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography perfusion are modalities capable of measuring myocardial blood flow and coronary flow reserve. In this review, we will discuss the technical aspects of quantitative myocardial perfusion imaging with positron emission tomography, cardiac magnetic resonance imaging, and computed tomography, and its emerging clinical applications.
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van Werkhoven JM, Schuijf JD, Bax JJ. Myocardial perfusion imaging to assess ischemia using multislice computed tomography. Expert Rev Cardiovasc Ther 2014; 7:49-56. [DOI: 10.1586/14779072.7.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress Myocardial Perfusion: Imaging with Multidetector CT. Radiology 2014; 270:25-46. [DOI: 10.1148/radiol.13112739] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Dual Energy CT of the Heart: Current Status and Future Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE Interest in dual-energy CT (DECT) for evaluating the myocardial blood supply, as an addition to coronary artery assessment, is increasing. Although it is still in the early clinical phase, assessment of myocardial ischemia and infarction by DECT constitutes a promising step toward comprehensive evaluation of coronary artery disease with a single noninvasive modality. CONCLUSION Compared with dynamic CT approaches, DECT has advantages regarding radiation dose and clinical applicability. In this review, the literature on DECT of the heart is discussed.
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Rumberger JA. CT Defined Atherosclerotic Plaque Type and Severity. JACC Cardiovasc Imaging 2012; 5:1000-2. [DOI: 10.1016/j.jcmg.2012.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/17/2012] [Indexed: 11/25/2022]
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12
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Rossi A, Uitterdijk A, Dijkshoorn M, Klotz E, Dharampal A, van Straten M, van der Giessen WJ, Mollet N, van Geuns RJ, Krestin GP, Duncker DJ, de Feyter PJ, Merkus D. Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve. Eur Heart J Cardiovasc Imaging 2012; 14:331-8. [DOI: 10.1093/ehjci/jes150] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability. AJR Am J Roentgenol 2012; 198:531-47. [PMID: 22357992 DOI: 10.2214/ajr.11.7082] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature. CONCLUSION Rapid advances in CT technology not only have improved visualization of coronary arteries but also increasingly enable noncoronary myocardial applications, including analysis of wall motion and the state of the myocardial blood supply. These advancements hold promise for eventually accomplishing the goal of comprehensively evaluating coronary heart disease with a single noninvasive modality.
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Dwivedi G, Dowsley TF, Chow BJW. Assessment of cardiac computed tomography-myocardial perfusion imaging - promise and challenges - . Circ J 2012; 76:544-52. [PMID: 22327029 DOI: 10.1253/circj.cj-11-1427] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiac computed tomography (CT) has evolved rapidly over the last decade into a reliable imaging modality for the non-invasive assessment of coronary artery disease. With the advancement in multi-detector CT technology, there has developed an increasing body of evidence that suggests that the role of cardiac CT can be extended to include functional assessment of the myocardium not only at rest but also during stress. Simultaneous anatomical and functional assessment approaches will have a number of advantages such as evaluation of the transmural extent of myocardial perfusion defects (including small subendocardial perfusion defects), reduced risk associated with multiple sources of radiation, and short image acquisition time. Although initial results hold some promise, CT myocardial perfusion imaging is a modality in the early stages of development and further work and studies are required to define, validate, and optimize this technique. This review will provide an overview of this novel perfusion imaging method, its underlying principles, evolution, limitations and future directions.
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Affiliation(s)
- Girish Dwivedi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Canada
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16
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Brands J, Vink H, Van Teeffelen JWGE. Comparison of four mathematical models to analyze indicator-dilution curves in the coronary circulation. Med Biol Eng Comput 2011; 49:1471-9. [PMID: 22095316 PMCID: PMC3223587 DOI: 10.1007/s11517-011-0845-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/07/2011] [Indexed: 12/01/2022]
Abstract
While several models have proven to result in accurate estimations when measuring cardiac output using indicator dilution, the mono-exponential model has primarily been chosen for deriving coronary blood/plasma volume. In this study, we compared four models to derive coronary plasma volume using indicator dilution; the mono-exponential, power-law, gamma-variate, and local density random walk (LDRW) model. In anesthetized goats (N = 14), we determined the distribution volume of high molecular weight (2,000 kDa) dextrans. A bolus injection (1.0 ml, 0.65 mg/ml) was given intracoronary and coronary venous blood samples were taken every 0.5–1.0 s; outflow curves were analyzed using the four aforementioned models. Measurements were done at baseline and during adenosine infusion. Absolute coronary plasma volume estimates varied by ~25% between models, while the relative volume increase during adenosine infusion was similar for all models. The gamma-variate, LDRW, and mono-exponential model resulted in volumes corresponding with literature, whereas the power-model seemed to overestimate the coronary plasma volume. The gamma-variate and LDRW model appear to be suitable alternative models to the mono-exponential model to analyze coronary indicator-dilution curves, particularly since these models are minimally influenced by outliers and do not depend on data of the descending slope of the curve only.
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Affiliation(s)
- Judith Brands
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Beyer AM, Gutterman DD. Regulation of the human coronary microcirculation. J Mol Cell Cardiol 2011; 52:814-21. [PMID: 22033434 DOI: 10.1016/j.yjmcc.2011.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/16/2011] [Accepted: 10/04/2011] [Indexed: 01/17/2023]
Abstract
Atherosclerosis of conduit epicardial arteries is the principal culprit behind the complications of coronary heart disease, but a growing body of literature indicates that the coronary microcirculation also contributes substantially to the pathophysiology of cardiovascular disease. An understanding of mechanisms regulating microvascular function in humans is an essential foundation for understanding the role in disease, especially since these regulatory mechanisms vary substantially across species and vascular beds. In fact all subjects whose coronary tissue was used in the studies described have medical conditions that warrant cardiac surgery, thus relevance to the normal human must be inferential and is based on tissue from subjects without known arteriosclerotic disease. This review will focus on recent advances in the physiological and pathological mechanisms of coronary microcirculatory control, describing a robust plasticity in maintaining endothelial control over dilation, including mechanisms that are most relevant to the human heart. This article is part of a Special Issue entitled "Coronary Blood Flow".
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Affiliation(s)
- Andreas M Beyer
- Department of Medicine, Cardiology Division Medical College of Wisconsin, Milwaukee, WI 53226, United States.
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Mehra VC, Ambrose M, Valdiviezo-Schlomp C, Schuleri KH, Lardo AC, Lima JAC, George RT. CT-Based Myocardial Perfusion Imaging-Practical Considerations: Acquisition, Image Analysis, Interpretation, and Challenges. J Cardiovasc Transl Res 2011; 4:437-48. [DOI: 10.1007/s12265-011-9286-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 05/06/2011] [Indexed: 12/19/2022]
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Malyar NM, Lerman LO, Gössl M, Beighley PE, Ritman EL. Relationship between surface area of nonperfused myocardium and extravascular extraction of contrast agent following coronary microembolization. Am J Physiol Regul Integr Comp Physiol 2011; 301:R430-7. [PMID: 21543631 DOI: 10.1152/ajpregu.00428.2010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Myocardial microvascular permeability and coronary sinus concentration of muscle metabolites have been shown to increase after myocardial ischemia due to epicardial coronary artery occlusion and reperfusion. However, their association with coronary microembolization is not well defined. This study tested the hypothesis that acute coronary microembolization increases microvascular permeability in the porcine heart. The left anterior descending perfusion territories of 34 anesthetized pigs (32 ± 3 kg) were embolized with equal volumes of microspheres of one of three diameters (10, 30, or 100 μm) and at three different doses for each size. Electron beam computed tomography (EBCT) was used to assess in vivo, microvascular extraction of a nonionic contrast agent (an index of microvascular permeability) before and after microembolization with microspheres at baseline and during adenosine infusion. A high-resolution three-dimensional microcomputed tomography (micro-CT) scanner was subsequently used to obtain ex vivo, the volume and corresponding surface area of the embolized myocardial islands within the perfusion territories of the microembolized coronary artery. EBCT-derived microvascular extraction of contrast agent increased within minutes after coronary microembolization (P < 0.001 vs. baseline and vs. control values). The increase in coronary microvascular permeability was highly correlated to the micro-CT-derived total surface area of the nonperfused myocardium (r = 0.83, P < 0.001). In conclusion, myocardial extravascular accumulation of contrast agent is markedly increased after coronary microembolization and its magnitude is in proportion to the surface area of the interface between the nonperfused and perfused territories.
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Affiliation(s)
- Nasser M Malyar
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, USA
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20
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Nasis A, Seneviratne S, DeFrance T. Advances in Contrast-Enhanced Cardiovascular CT for the Evaluation of Myocardial Perfusion. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Valdiviezo C, Ambrose M, Mehra V, Lardo AC, Lima JAC, George RT. Quantitative and qualitative analysis and interpretation of CT perfusion imaging. J Nucl Cardiol 2010; 17:1091-100. [PMID: 20924735 DOI: 10.1007/s12350-010-9291-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Coronary artery disease (CAD) remains the leading cause of death in the United States. Rest and stress myocardial perfusion imaging has an important role in the non-invasive risk stratification of patients with CAD. However, diagnostic accuracies have been limited, which has led to the development of several myocardial perfusion imaging techniques. Among them, myocardial computed tomography perfusion imaging (CTP) is especially interesting as it has the unique capability of providing anatomic- as well as coronary stenosis-related functional data when combined with computed tomography angiography (CTA). The primary aim of this article is to review the qualitative, semi-quantitative, and quantitative analysis approaches to CTP imaging. In doing so, we will describe the image data required for each analysis and discuss the advantages and disadvantages of each approach.
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Affiliation(s)
- Carolina Valdiviezo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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Nikolaou K, Alkadhi H, Bamberg F, Leschka S, Wintersperger BJ. MRI and CT in the diagnosis of coronary artery disease: indications and applications. Insights Imaging 2010; 2:9-24. [PMID: 22347932 PMCID: PMC3259311 DOI: 10.1007/s13244-010-0049-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 09/27/2010] [Accepted: 10/19/2010] [Indexed: 01/16/2023] Open
Abstract
In recent years, technical advances and improvements in cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease (CAD) and correct patient selection for these emerging imaging techniques. In the primary detection or exclusion of significant CAD, e.g. in the patient with unspecific thoracic complaints, and also in patients with known CAD or advanced stages of CAD, both CT and MRI yield specific advantages. In this review, the major aspects of non-invasive MR and CT imaging in the diagnosis of CAD will be discussed. The first part describes the clinical value of contrast-enhanced non-invasive CT coronary angiography (CTCA), including the diagnostic accuracy of CTCA for the exclusion or detection of significant CAD with coronary artery stenoses that may require angioplastic intervention, as well as potentially valuable information on the coronary artery vessel wall. In the second section, the potential of CT for the imaging of myocardial viability and perfusion will be highlighted. In the third and final part, the range of applications of cardiac MRI in CAD patients will be outlined.
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Ambrose MS, Valdiviezo C, Mehra V, Lardo AC, Lima JAC, George RT. CT Perfusion: Ready for Prime Time. Curr Cardiol Rep 2010; 13:57-66. [DOI: 10.1007/s11886-010-0152-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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In vitro measurements of flow using multislice computed tomography (MSCT). Int J Cardiovasc Imaging 2010; 27:795-804. [DOI: 10.1007/s10554-010-9728-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 10/07/2010] [Indexed: 12/26/2022]
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Mahnken AH, Klotz E, Pietsch H, Schmidt B, Allmendinger T, Haberland U, Kalender WA, Flohr T. Quantitative Whole Heart Stress Perfusion CT Imaging as Noninvasive Assessment of Hemodynamics in Coronary Artery Stenosis. Invest Radiol 2010; 45:298-305. [PMID: 20421799 DOI: 10.1097/rli.0b013e3181dfa3cf] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience. Eur Radiol 2010; 20:1168-73. [DOI: 10.1007/s00330-010-1715-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/07/2009] [Accepted: 11/28/2009] [Indexed: 10/19/2022]
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Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, Costello P, Zwerner PL. Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am J Cardiol 2009; 104:318-26. [PMID: 19616661 DOI: 10.1016/j.amjcard.2009.03.051] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 03/15/2009] [Accepted: 03/17/2009] [Indexed: 01/03/2023]
Abstract
To evaluate the performance of dual-energy computed tomography (CT) for integrative imaging of the coronary artery morphology and the myocardial blood supply, 36 patients (15 women, mean age 57 +/- 11 years) with equivocal or incongruous single photon emission CT (SPECT) results were investigated by a single-contrast medium-enhanced, retrospectively electrocardiographic-gated dual-energy CT (DECT) scan with simultaneous acquisition of high and low x-ray spectra. Thirteen patients subsequently underwent invasive coronary angiography (ICA). The DECT data were used to reconstruct anatomic coronary CT angiographic images and to map the myocardial iodine distribution within the left ventricular myocardium. Two independent observers analyzed all DECT studies for stenosis and myocardial iodine defects. A segmental comparison was performed between the stress/rest SPECT perfusion defects and DECT iodine defects and between the ICA and coronary CT angiographic findings for stenosis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were estimated, along with the kappa statistics. Overall, DECT had 92% sensitivity and 93% specificity, with 93% accuracy for detecting any type of myocardial perfusion defect seen on SPECT. Contrast defects at DECT correctly identified 85 (96%) of 89 fixed and 60 (88%) of 68 reversible myocardial perfusion defects. The interobserver agreement was very good (weighted kappa = 0.87). Compared with ICA, coronary CT angiography had 90% sensitivity, 94% specificity, and 93% accuracy for the detection of >50% stenosis. In conclusion, our initial experience suggests that DECT, as a single examination, might be promising for the integrative analysis of the coronary artery morphology and the myocardial blood supply and is in good agreement with ICA and SPECT.
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Primak AN, Dong Y, Dzyubak OP, Jorgensen SM, McCollough CH, Ritman EL. A technical solution to avoid partial scan artifacts in cardiac MDCT. Med Phys 2008; 34:4726-37. [PMID: 18196800 DOI: 10.1118/1.2805476] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Quantitative evaluation of cardiac image data obtained using multidetector row computed tomography (CT) is compromised by partial scan reconstructions, which improve the temporal resolution but significantly increase image-to-image CT number variations for a fixed region of interest compared to full reconstruction images. The feasibility of a new approach to solve this problem is assessed. An anthropomorphic cardiac phantom and an anesthetized pig were scanned on a dual-source CT scanner using both full and partial scan acquisition modes under different conditions. Additional scans were conducted with the electrocardiogram (ECG) signal being in synchrony with the gantry rotation. In the animal study, a simple x-ray detector was used to generate a signal once per gantry rotation. This signal was then used to pace the pig's heart. Phantom studies demonstrated that partial scan artifacts are strongly dependent on the rotational symmetry of angular projections, which is determined by the object shape and composition and its position with respect to the isocenter. The degree of partial scan artifacts also depends on the location of the region of interest with respect to highly attenuating materials (bones, iodine, etc.) within the object. Single-source partial scan images (165 ms temporal resolution) were significantly less affected by partial scan artifacts compared to dual-source partial scan images (82 ms temporal resolution). When the ECG signal was in synchrony with the gantry rotation, the same cardiac phase always corresponded to the same positions of the x-ray tube(s) and, hence, the same scattering and beam hardening geometry. As a result, the range of image-to-image CT number variations for partial scan reconstruction images acquired in synchronized mode was decreased to that achieved using full reconstruction image data. The success of the new approach, which synchronizes the ECG signal with the position of the x-ray tube(s), was demonstrated both in the phantom and animal experiments.
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Affiliation(s)
- A N Primak
- CT Clinical Innovation Center, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Groves AM, Goh V, Rajasekharan S, Kayani I, Endozo R, Dickson JC, Menezes LJ, Shastry M, Habib SB, Ell PJ, Hutton BF. CT coronary angiography: quantitative assessment of myocardial perfusion using test bolus data-initial experience. Eur Radiol 2008; 18:2155-63. [PMID: 18465134 DOI: 10.1007/s00330-008-0987-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 03/22/2008] [Indexed: 01/28/2023]
Abstract
The aim of this study is to quantify myocardial perfusion during coronary CT angiography using data from a modified timing test-bolus acquisition. Institutional review board approval and informed consent were obtained. Nineteen patients with suspected coronary artery disease underwent combined coronary CT angiography and cardiac (82)Rubidium-PET perfusion. Prior to the CT angiogram a retrospectively ECG-gated dynamic test bolus was obtained following 25 mls of IV contrast medium injected at 5 ml/s. Images were acquired every 1.5 s for 30 s using 4 x 1.25-mm slices at 120 kV, 35 mAs. Regions of interest were drawn to delineate the myocardium and aorta on the resulting transaxial images. Time density curves were created and perfusion calculated using two simple approaches: maximum-slope method and peak method. In patients with normal PET myocardial perfusion, the mean (SD) resting myocardial perfusion estimated by CT using the maximum-slope method was 0.89 (+/-0.27) ml/min/g and 0.93 (+/-0.21) ml/min/g at end-systole and end-diastole, respectively, and 0.69 (+/-0.11) ml/min/g and 0.79 (+/-0.19) at end-systole and end-diastole, respectively, for the peak method. Thus quantification of myocardial perfusion from a routine coronary CT angiography test bolus is possible. CT-derived myocardial perfusion values are consistent with published values derived from other techniques.
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Affiliation(s)
- Ashley M Groves
- Institute of Nuclear Medicine, University College Hospital, UCLH NHS Foundation Trust, London, UK.
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Affiliation(s)
- Ilan Gottlieb
- Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA
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Abstract
OBJECTIVES The purpose of this study was to determine the ability of dynamic 64 slice multidetector computed tomography (d-MDCT) to provide an accurate measurement of myocardial blood flow (MBF) during first-pass d-MDCT using semiquantitative and quantitative analysis methods. MATERIALS AND METHODS Six dogs with a moderate to severe left-anterior descending artery stenosis underwent adenosine (0.14 mL . kg-1 . min-1) stress d-MDCT imaging according to the following imaging protocol: iopamidol 10 mL/s for 3 seconds, 8 mm x 4 collimation, 400 milliseconds gantry rotation time, 120 kV, and 60 mAs. Images were reconstructed at 1-second intervals. Regions of interest were drawn in the LAD and remote territories, and time-attenuation curves were constructed. Myocardial perfusion was analyzed using a model-based deconvolution method and 2 upslope methods and compared with the microsphere MBF measurements. RESULTS The myocardial upslope-to-LV-upslope and myocardial upslope-to-LV-max ratio strongly correlated with MBF (R2 = 0.92, P < 0.0001 and R2 = 0.87, P < 0.0001, respectively). Absolute MBF derived by model-based deconvolution analysis modestly overestimated MBF compared with microsphere MBF (3.0 +/- 2.5 mL . g-1 . min-1 vs. 2.6 +/- 2.7 mL . g-1 . min-1, respectively). Overall, MDCT-derived MBF strongly correlated with microspheres (R = 0.91, P < 0.0001, mean difference: 0.45 mL . g-1 . min-1, P = NS). CONCLUSIONS d-MDCT MBF measurements using upslope and model-based deconvolution methods correlate well with microsphere MBF. These methods may become clinically applicable in conjunction with coronary angiography and next generation MDCT scanners with larger detector arrays and full cardiac coverage.
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Daghini E, Primak AN, Chade AR, Zhu X, Ritman EL, McCollough CH, Lerman LO. Evaluation of porcine myocardial microvascular permeability and fractional vascular volume using 64-slice helical computed tomography (CT). Invest Radiol 2007; 42:274-82. [PMID: 17414522 DOI: 10.1097/01.rli.0000258086.78179.90] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Myocardial microvascular permeability-surface area product (MPSP) and fractional vascular volume (FVV), indices of endothelial function and microvascular perfusion, can be noninvasively evaluated by electron beam computed tomography (EBCT), but it remains unknown whether comparable assessments can be obtained with 64-slice multidetector CT (CT-64). METHODS We studied 12 pigs with both EBCT and CT-64 in randomized order 1 week apart, before and during IV adenosine infusion. Myocardial attenuation changes in the cardiac wall were assessed after a central-venous injection of iopamidol. Time-attenuation curves were analyzed using both indicator-dilution and Patlak models to calculate MPSP and FVV. RESULTS CT-64 and EBCT assessments of basal MPSP obtained by the Patlak method were similar (0.37 +/- 0.03 vs. 0.37 +/- 0.04 mL/min/g), as was its response to adenosine, and correlated significantly (r = 0.87). Patlak FVV was also similar between CT-64 and EBCT at baseline (0.08 +/- 0.02 vs. 0.07 +/- 0.02 mL blood/mL) and during adenosine, and correlated well (r = 0.93). MPSP and FVV estimated by the indicator-dilution method were not significantly correlated. CONCLUSIONS CT-64 assessments of myocardial MPSP and FVV may not be reliable when using indicator-dilution analysis, likely due to its sensitivity to scan duration. However, CT-64 assessments obtained using the Patlak model are feasible.
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Affiliation(s)
- Elena Daghini
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Daghini E, Lerman LO. Assessment of Myocardial Microvascular Function: New Opportunities in Fast Computed Tomography. Trends Cardiovasc Med 2007; 17:14-9. [PMID: 17210473 DOI: 10.1016/j.tcm.2006.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 10/18/2006] [Accepted: 10/23/2006] [Indexed: 01/29/2023]
Abstract
It has been increasingly recognized that the initial site of cardiac damage in several forms of cardiovascular disease resides in the microcirculation. Noninvasive or minimally invasive evaluation of myocardial microvascular functional attributes, such as myocardial perfusion or microvascular permeability, could be an invaluable tool in the clinical practice. Advances in the field of computed tomography over the past three decades culminated in the advent of fast scanners, which show promise to provide both fine cardiac anatomic detail and quantification of the function of the myocardial microcirculation. This review describes the approach and utility of measurements of myocardial microvascular function obtained with state-of-the-art cardiac computed tomography.
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Affiliation(s)
- Elena Daghini
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Daghini E, Ritman EL, Lerman LO. Examine thy heart with all diligence: evaluation of cardiac function using fast computed tomography. Hypertension 2006; 49:249-56. [PMID: 17159086 DOI: 10.1161/01.hyp.0000253086.74365.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elena Daghini
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JAC, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006; 114:1761-91. [PMID: 17015792 DOI: 10.1161/circulationaha.106.178458] [Citation(s) in RCA: 994] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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George RT, Silva C, Cordeiro MAS, DiPaula A, Thompson DR, McCarthy WF, Ichihara T, Lima JAC, Lardo AC. Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 2006; 48:153-60. [PMID: 16814661 DOI: 10.1016/j.jacc.2006.04.014] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 02/28/2006] [Accepted: 03/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study is to validate the accuracy of multidetector computed tomography (MDCT) to measure differences in regional myocardial perfusion during adenosine stress in a canine model of left anterior descending (LAD) artery stenosis, during first-pass, contrast-enhanced helical MDCT. BACKGROUND Myocardial perfusion imaging by MDCT may have significant implications in the diagnosis and treatment of coronary artery disease. METHODS Eight dogs were prepared with a LAD stenosis, and contrast-enhanced MDCT imaging was performed 5 min into adenosine infusion (0.14 to 0.21 mg/kg/min). Images were analyzed using a semiautomated approach to define the regional signal density (SD) ratio (myocardial SD/left ventricular blood pool SD) in stenosed and remote territories, and then compared with microsphere myocardial blood flow (MBF) measurements. RESULTS Mean MBF in stenosed versus remote territories was 1.37 +/- 0.46 ml/g/min and 1.29 +/- 0.48 ml/g/min at baseline (p = NS) and 2.54 +/- 0.93 ml/g/min and 8.94 +/- 5.74 ml/g/min during adenosine infusion, respectively (p < 0.05). Myocardial SD was 92.3 +/- 39.5 HU in stenosed versus 180.4 +/- 41.9 HU in remote territories (p < 0.001). There was a significant linear association of the SD ratio with MBF in the stenosed territory (R = 0.98, p = 0.001) and between regional myocardial SD ratio and MBF <8 ml/g/min, slope = 0.035, SE = 0.007, p < 0.0001. Overall, there was a significant non-linear relationship over the range of flows studied (LR chi-square [2 degrees of freedom] = 31.8, p < 0.0001). CONCLUSIONS Adenosine-augmented MDCT myocardial perfusion imaging provides semiquantitative measurements of myocardial perfusion during first-pass MDCT imaging in a canine model of LAD stenosis.
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Affiliation(s)
- Richard T George
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Budoff MJ, Cohen MC, Garcia MJ, Hodgson JM, Hundley WG, Lima JAC, Manning WJ, Pohost GM, Raggi PM, Rodgers GP, Rumberger JA, Taylor AJ, Creager MA, Hirshfeld JW, Lorell BH, Merli G, Rodgers GP, Tracy CM, Weitz HH. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol 2005; 46:383-402. [PMID: 16022977 DOI: 10.1016/j.jacc.2005.04.033] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Hecht HS. Computed tomographic angiography coming of age. Am J Cardiol 2005; 95:838-42. [PMID: 15781011 DOI: 10.1016/j.amjcard.2004.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Revised: 11/24/2004] [Accepted: 11/24/2004] [Indexed: 11/18/2022]
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Eusemann CD, Breen JF, Robb RA. Statistical assessment of regional time-density measurement of myocardial perfusion. Acad Radiol 2004; 11:516-25. [PMID: 15147616 DOI: 10.1016/j.acra.2003.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Revised: 10/22/2003] [Accepted: 12/11/2003] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The measurement of time-density relationships of the myocardium in studies of magnetic resonance perfusion images is a clinical technique used in assessing myocardial perfusion. This article presents a new technique, allowing regional time-density measurement and display of myocardial perfusion with improved accuracy compared with traditional manual trace techniques. Moreover, a method using statistical methods to discriminate relative decreased perfusion regions that differ significantly from the normally perfused myocardial tissue is introduced. MATERIALS AND METHODS Human datasets were obtained using a 1.5 T Signa Echospeed system (GE Medical Systems, Milwaukee, WI). The perfusion sequence was a 2D cardiac-gated fast gradient echo sequence with echo train readout, generating an in-plane pixel size of 1.46 mm2. Seven 10-mm-thick contiguous short axis tomographic slice images were obtained during a prolonged single breathhold. Data was collected at 30 time phases per slice image level during passage of 20 cc gadolinium contrast injected at a rate of 4-5 cc/sec into an antecubital vein. RESULTS Dilution properties can be determined and displayed as color-encoded regions superimposed on the myocardial slice according to the area of interest. Time-density curves throughout the perfusion study can be generated. Moreover, displays of normal and decreased perfusion areas can be used as statistically enhanced diagnosis guides. CONCLUSION This measurement, display, and diagnosis technique adds diagnostically important information to previous measurement and visualization techniques, providing enhanced detection and quantitative evaluation of regional deficits in myocardial contractility and perfusion, providing improved reliability and reproducibility of clinical diagnoses from MR-perfusion data.
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Hoffmann U, Millea R, Enzweiler C, Ferencik M, Gulick S, Titus J, Achenbach S, Kwait D, Sosnovik D, Brady TJ. Acute myocardial infarction: contrast-enhanced multi-detector row CT in a porcine model. Radiology 2004; 231:697-701. [PMID: 15118118 DOI: 10.1148/radiol.2313030132] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the role of contrast material-enhanced retrospectively electrocardiographically (ECG) gated multi-detector row computed tomography (CT) in the detection of acute myocardial infarction in a porcine model of total coronary occlusion. MATERIALS AND METHODS Seven Yorkshire farm pigs were studied with contrast-enhanced retrospectively ECG-gated multi-detector row CT 3 hours after total occlusion of the distal left anterior descending artery (n = 5) or the second diagonal branch (n = 2). Reformatted short-axis end-systolic and end-diastolic CT data sets were assessed for myocardial perfusion deficits, coronary occlusion, and abnormal myocardial wall motion. Perfusion deficits were compared with microsphere-determined blood flow and triphenyltetrazolium chloride (TTC)-stained tissue samples for infarct assessment by using Bland-Altman analysis and analysis of variance. RESULTS Myocardial perfusion deficits, occlusion of the left anterior descending artery or second diagonal branch, and akinesis of the infarcted segment were identified in all five animals that completed the study. One animal died, and one data set had nondiagnostic image quality. The CT end-diastolic (mean, 16.1% +/- 4.8 [SD]; range, 8.6%-22.2%) and end-systolic (mean, 17.0% +/- 6.4; range, 8.7%-26.8%) volume of perfusion deficit was similar to that of infarcted tissue at TTC staining (mean, 13.6% +/- 6.0; range, 7.8%-30.9%). Infarcted myocardium at CT demonstrated a 76.1% reduction in microsphere-determined blood flow and a significant reduction of myocardial CT attenuation compared with normal myocardium (P <.01). Myocardial wall motion analysis demonstrated absence of systolic wall thickening in infarcted myocardium. CONCLUSION Multi-detector row CT with retrospective ECG gating permits the detection and further characterization of acute myocardial infarction in a porcine model of complete coronary occlusion.
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Affiliation(s)
- Udo Hoffmann
- Department of Radiology, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 100 Charles River Plaza, Suite 400, Boston, MA 02114, USA.
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Rodriguez-Porcel M, Herrman J, Chade AR, Krier JD, Breen JF, Lerman A, Lerman LO. Long-term antioxidant intervention improves myocardial microvascular function in experimental hypertension. Hypertension 2004; 43:493-8. [PMID: 14718362 DOI: 10.1161/01.hyp.0000111834.03000.e4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypertension increases oxidative stress, which can impair myocardial microvascular function and integrity. However, it is yet unclear whether long-term antioxidant intervention in early hypertension would preserve myocardial perfusion and vascular permeability responses to challenge. Pigs were studied after 12 weeks of renovascular hypertension without (n=8) or with daily supplementation of antioxidants (100 IU/kg vitamin E and 1 g vitamin C, n=6), and compared with normal controls (n=7). Myocardial perfusion and microvascular permeability were measured in vivo by electron beam computed tomography before and after 2 cardiac challenges (intravenous adenosine and dobutamine). Basal left ventricular muscle mass was also obtained. Mean arterial pressure was significantly increased in both groups of hypertensive animals (without and with antioxidants, 123+/-9 and 126+/-4 mm Hg, respectively, versus normal, 101+/-4 mm Hg; both P<0.05), but muscle mass was not different among the groups. The impaired myocardial perfusion response to adenosine observed in hypertensives (normal, +51+/-14%; P<0.05 versus baseline; hypertension, +14+/-15%; P=0.3 versus baseline) was preserved in hypertensive pigs that received antioxidants (+44+/-15%; P=0.01 compared with baseline). Long-term antioxidant intervention also preserved subendocardial microvascular permeability responses in hypertension. On the other hand, antioxidant intervention had little effect on the hypertension-induced myocardial vascular dysfunction observed in response to dobutamine. This study demonstrates that the impaired myocardial perfusion and permeability responses to increased cardiac demand in early hypertension are significantly improved by long-term antioxidant intervention. These results support the involvement of oxidative stress in myocardial vascular dysfunction in hypertension and suggest a role for antioxidant strategies to preserve the myocardial microvasculature.
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Affiliation(s)
- Martin Rodriguez-Porcel
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, Minn 55905, USA
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Rumberger JA. Transitions: noninvasive coronary angiography using electron beam computed tomography: technique, clinical application, future prospective. THE AMERICAN HEART HOSPITAL JOURNAL 2004; 2:153-64. [PMID: 15805766 DOI: 10.1111/j.1541-9215.2004.03358.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Electron beam computed tomography has been available clinically for 20 years. It is the only computed tomography scanner specifically developed for cardiac imaging. Over the past decade, with improvements in methodology and computer software, electron beam computed tomography has been shown to provide an excellent method to perform noninvasive coronary angiography. This article looks at the historical aspects of electron beam computed tomography and comments on how to perform and interpret electron beam angiography studies. The expanding development of noninvasive coronary and peripheral angiography methods using computed tomography will have a significant influence on cardiovascular specialists and their practices.
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Kantor B, Möhlenkamp S. Imaging of myocardial microvasculature using fast computed tomography and three-dimensional microscopic computed tomography. Cardiol Clin 2003; 21:587-605, ix. [PMID: 14719570 DOI: 10.1016/s0733-8651(03)00110-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the past, much attention in imaging research was focused on the macroscopic morphology and patency of arteries. Only recently, research and clinical interest have shifted to the microcirculation and its impact on the long-term prognosis in patients with vascular diseases. This focus and newly developed therapeutic strategies require high-resolution imaging modalities, which do not focus exclusively on the macroscopic aspects of the arterial tree. Provided here is a comprehensive perspective of using computed tomography technology to image and quantify the function and morphology of myocardial and vascular adventitial microvessels in normal and disease states.
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Affiliation(s)
- Birgit Kantor
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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Abstract
EBT has undergone rigorous testing for reliability and validity of CAC measurements, and has been proven to be useful in identifying individuals with, or at risk for, coronary heart disease. Although MDCT is a promising tool for coronary calcium scoring, more studies are needed that compare EBT and MDCT scans in the same patients, especially with calcium scores of less than 100. Further radiation dose reduction strategies for MDCT are currently being evaluated. MDCT studies of progression, reproducibility, and outcomes are needed to fully evaluate its potential to measure and serially follow atherosclerosis compared to EBT. Studies examining the benefit of serial coronary calcium scoring to non-invasively assess the progression or regression of coronary calcium are currently underway. EBT is a method that can be used to estimate the overall coronary atherosclerotic plaque burden. It can be used to diagnose the presence and determine the extent of coronary atherosclerosis; furthermore, the calcium score information can be used to assess the likelihood of advanced obstructive disease and to provide prognostic information. Finally, serial CAC measurements by EBT have the potential to determine the efficacy of therapeutic interventions by demonstrating progression, stabilization, or regression of coronary atherosclerotic disease during therapy.
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Affiliation(s)
- John A Rumberger
- Division of Cardiovascular Diseases, The Ohio State University, Columbus, Ohio 43210, USA.
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Bonetti PO, Best PJM, Rodriguez-Porcel M, Holmes DR, Lerman LO, Lerman A. Endothelin type A receptor antagonism restores myocardial perfusion response to adenosine in experimental hypercholesterolemia. Atherosclerosis 2003; 168:367-73. [PMID: 12801621 DOI: 10.1016/s0021-9150(03)00141-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Experimental hypercholesterolemia is characterized by increased endothelin-1 (ET-1) activity and is associated with an attenuated myocardial perfusion response and an inappropriate increase in coronary microvascular permeability during episodes of increased myocardial demand. This study was designed to determine the effect of chronic selective ET type A (ET(A)) receptor antagonism on coronary vascular response to simulated cardiac stress in experimental hypercholesterolemia. Twenty-one pigs were randomized to three groups: normal diet (N), high-cholesterol diet (HC), and HC diet plus ABT-627, a selective ET(A) receptor antagonist, (HC+ABT-627). After 12 weeks, cardiac electron beam computed tomography (EBCT) was performed before and during intravenous infusion of adenosine, and myocardial perfusion (ml/min per g) and coronary microvascular permeability index (arbitrary units) were calculated. Basal myocardial perfusion was similar in all groups (N: 0.91+/-0.10; HC: 0.95+/-0.08; HC+ABT-627: 1.03+/-0.09; P=0.64). Adenosine infusion led to a significant increase in myocardial perfusion in the N (1.32+/-0.15; P<0.001) but not in the HC (0.95+/-0.07) group. However, in the HC+ABT-627 group, adenosine also significantly increased myocardial perfusion (1.33+/-0.12; P=0.001). Basal permeability index did not differ between the groups (N: 1.56+/-0.13; HC: 1.34+/-0.19; HC+ABT-627: 1.62+/-0.10; P=0.38). Adenosine infusion significantly increased permeability index in HC pigs (2.29+/-0.22; P<0.001) but not in N (1.71+/-0.21) and HC+ABT-627 (1.82+/-0.08) pigs. We conclude that chronic selective ET(A) receptor antagonism preserves myocardial perfusion response and coronary microvascular integrity during episodes of increased myocardial demand in experimental hypercholesterolemia, indicating an important role for the endogenous endothelin system in this disorder.
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Affiliation(s)
- Piero O Bonetti
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Bonetti PO, Wilson SH, Rodriguez-Porcel M, Holmes DR, Lerman LO, Lerman A. Simvastatin preserves myocardial perfusion and coronary microvascular permeability in experimental hypercholesterolemia independent of lipid lowering. J Am Coll Cardiol 2002; 40:546-54. [PMID: 12142124 DOI: 10.1016/s0735-1097(02)01985-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED OBJECTIVES; This study was designed to assess the lipid-independent effects of simvastatin on myocardial perfusion (MP) and coronary microvascular permeability index (PI) at baseline and during episodes of increased cardiac demand in experimental hypercholesterolemia. BACKGROUND Simvastatin preserves coronary endothelial function in experimental hypercholesterolemia independent of its lipid-lowering effect. However, the functional significance of this observation is unknown. METHODS Pigs were randomized to three groups: normal diet (N), high-cholesterol diet (HC) and HC diet plus simvastatin (HC+S) for 12 weeks. Subsequently, cardiac electron beam computed tomography was performed before and during intravenous infusion of adenosine and dobutamine, and MP and PI were calculated. RESULTS Total and low density lipoprotein cholesterol levels were similarly and significantly increased in HC and HC+S animals compared with N. Basal MP was similar in all groups. Myocardial perfusion significantly increased in response to either adenosine or dobutamine in N and HC+S animals. Dobutamine also significantly increased MP in HC animals. However, the changes of MP in response to either drug were significantly lower in the HC group compared with the other two groups (p < 0.01 for adenosine and p < 0.05 for dobutamine vs. N and HC+S). Basal PI was similar in all groups and was not altered by either drug in N and HC+S animals. In contrast, PI significantly increased in HC pigs during infusion of either adenosine (p < 0.001) or dobutamine (p < 0.05). CONCLUSIONS These findings demonstrate that chronic administration of simvastatin preserves myocardial perfusion response and coronary microvascular integrity during cardiac stress in experimental hypercholesterolemia independent of lipid lowering.
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Affiliation(s)
- Piero O Bonetti
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
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Gerber TC, Kuzo RS, Karstaedt N, Lane GE, Morin RL, Sheedy PF, Safford RE, Blackshear JL, Pietan JH. Current results and new developments of coronary angiography with use of contrast-enhanced computed tomography of the heart. Mayo Clin Proc 2002; 77:55-71. [PMID: 11794459 DOI: 10.4065/77.1.55] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Electron beam computed tomography (EBCT) is the reference standard for x-ray-based tomographic imaging of the heart because of its high temporal resolution, but it is available in only a few centers. Quantification of coronary calcium is the most widely recognized use of EBCT for cardiac imaging. This technique requires no contrast media and provides an accurate assessment of overall plaque burden in the coronary tree; however, it does not directly identify or localize coronary stenoses. Multislice spiral (helical) CT (MSCT) is a new technology that provides images of the beating heart in diagnostic quality under many circumstances and may facilitate the broader application of cardiac and coronary CT. Currently, for imaging of the heart, much more experience exists with EBCT than with MSCT. Contrast-enhanced CT coronary angiography (CTCA) can be done with EBCT or MSCT to obtain images of the major branches of the coronary tree and to define luminal narrowing. Studies at experienced centers performed with small numbers of patients show that sensitivity, specificity, and negative predictive value are good with CTCA in the assessment of obstructive coronary artery disease, but CTCA remains an investigational technique for these applications. Computed tomographic coronary angiography can be clinically useful for assessing coronary artery bypass graft patency and congenital coronary abnormalities.
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Affiliation(s)
- Thomas C Gerber
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA.
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Abstract
Since its anatomic discovery in the 19th century, the endothelium was considered to fulfill no other purpose than that of a physical barrier between blood and tissue, until Furchgott and colleagues defined endothelium-dependent vasoreactivity in the late 1970s. Henceforth, a functional paradigm defined the balance between endothelium-derived relaxing factors and endothelium-derived contracting factors as the hallmark of endothelial cell integrity. As a consequence, any reflection of a deviation from this state was defined as endothelial dysfunction, most notably the impairment of vasorelaxation in response to pharmacologic stimuli such as acetylcholine or nonpharmacologic stimuli such as shear stress and cold pressor. Within the coronary artery tree these alterations have been recognized before the development of obstructive coronary artery disease, affecting the microcirculation before the epicardial conduit vessel. Furthermore, recent clinical trials outlined the prognostic significance of these changes, whereby impairment of increase in coronary blood flow in response to endothelium-dependent stimuli seemed to be of utmost importance. Thus it is intriguing to speculate on the evolving role of myocardial perfusion imaging in combination with pharmacologic and nonpharmacologic stimuli for the noninvasive assessment of coronary endothelial dysfunction in patients at risk for future adverse events. At a minimum, this review aims to put endothelial dysfunction into an imaging perspective beyond the scope of the conventional approach.
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Affiliation(s)
- J Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Rodriguez-Porcel M, Lerman A, Best PJ, Krier JD, Napoli C, Lerman LO. Hypercholesterolemia impairs myocardial perfusion and permeability: role of oxidative stress and endogenous scavenging activity. J Am Coll Cardiol 2001; 37:608-15. [PMID: 11216987 DOI: 10.1016/s0735-1097(00)01139-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We intended to study the effect of hypercholesterolemia (HC) on myocardial perfusion and permeability response to increased cardiac demand. BACKGROUND Hypercholesterolemia is associated with increased incidence of cardiac events and characterized by impaired coronary vascular function, possibly mediated partly through increased pro-oxidative conditions in plasma and tissue. However, it is yet unclear whether HC is also associated with impaired myocardial perfusion and vascular permeability responses in vivo. METHODS For 12 weeks pigs were fed a normal, HC or HC diet supplemented daily with antioxidants (HC + AO, 100 IU/kg vitamin E and 1 g vitamin C). Myocardial perfusion and vascular permeability were measured in vivo using electron beam computed tomography before and after cardiac challenge with intravenous adenosine. Plasma and tissue oxidative status was determined ex vivo. RESULTS Plasma cholesterol increased in all cholesterol-fed pigs but was associated with increased markers of oxidative stress only in HC pigs. Myocardial perfusion increased in response to adenosine in normal and HC + AO (+37 +/- 13% and +58 +/- 22%, respectively, p < 0.05 vs. baseline) but not in HC, whereas vascular permeability index increased only in HC pigs (+ 92 +/- 25%, p = 0.002). In HC animals, tissue endogenous oxygen radical scavengers and antioxidant vitamins were depleted and LDL oxidizability enhanced, but both were normalized in HC + AO pigs. Myocardial perfusion response was directly, and permeability inversely, associated with plasma and tissue vitamin concentrations. CONCLUSIONS This study demonstrates that experimental HC is associated with blunted myocardial perfusion and increased vascular permeability responses in vivo to increased cardiac demand, which may be partly mediated by a shift in oxidative status.
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Affiliation(s)
- M Rodriguez-Porcel
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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