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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.
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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
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Kitagawa K, Nakamura S, Ota H, Ogawa R, Shizuka T, Kubo T, Yi Y, Ito T, Nagasawa N, Omori T, Nakamori S, Kurita T, Sugisawa J, Hatori N, Nakashima H, Wang Y, Kido T, Watanabe K, Matsumoto Y, Dohi K, Sakuma H. Diagnostic Performance of Dynamic Myocardial Perfusion Imaging Using Dual-Source Computed Tomography. J Am Coll Cardiol 2021; 78:1937-1949. [PMID: 34763770 DOI: 10.1016/j.jacc.2021.08.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of coronary artery disease (CAD). OBJECTIVES This prospective multicenter study determined the diagnostic performance of combined coronary computed tomography angiography (CTA) and CTP for detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR). METHODS Seven centers enrolled 174 patients with suspected or known CAD who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT before ICA. FFR was done as part of ICA in the case of 26% to 90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as FFR of <0.8 or >90% stenosis on ICA. RESULTS The study protocol was completed in 157 participants, and hemodynamically significant stenosis was detected in 76 of 157 patients (48%) and 112 of 442 vessels (25%). According to receiver-operating characteristic curve analysis, adding dynamic CTP to CTA significantly increased the area under the curve from 0.65 (95% CI: 0.57-0.72) to 0.74 (95% CI: 0.66-0.81; P = 0.011) on the patient level, with decreased sensitivity (93% vs 72%; P < 0.001), improved specificity (36% vs 75%; P < 0.001), and improved overall accuracy (64% vs 74%; P < 0.001). CONCLUSIONS In this prospective multicenter study on dynamic CTP, the combination of anatomic assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate identification of hemodynamically significant CAD compared with CTA alone. However, the clinical significance of this approach needs to be further investigated, including its usefulness in improving prognosis. (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored With Dual-Source CT [AMPLIFiED]; UMIN000016353).
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Affiliation(s)
- Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan.
| | | | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Ryo Ogawa
- Department of Radiology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Takehito Shizuka
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Tadahiro Kubo
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yan Yi
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tatsuro Ito
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nagasawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Taku Omori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Hatori
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Hitoshi Nakashima
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Kouki Watanabe
- Division of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare, Yaita, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
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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.
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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
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Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Stress Myocardial Blood Flow Ratio by Dynamic CT Perfusion Identifies Hemodynamically Significant CAD. JACC Cardiovasc Imaging 2020; 13:966-976. [DOI: 10.1016/j.jcmg.2019.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
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Abstract
Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.
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Takafuji M, Kitagawa K, Ishida M, Goto Y, Nakamura S, Nagasawa N, Sakuma H. Myocardial Coverage and Radiation Dose in Dynamic Myocardial Perfusion Imaging Using Third-Generation Dual-Source CT. Korean J Radiol 2020; 21:58-67. [PMID: 31920029 PMCID: PMC6960309 DOI: 10.3348/kjr.2019.0323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Third-generation dual-source computed tomography (3rd-DSCT) allows dynamic myocardial CT perfusion imaging (dynamic CTP) with a 10.5-cm z-axis coverage. Although the increased radiation exposure associated with the 50% wider scan range compared to second-generation DSCT (2nd-DSCT) may be suppressed by using a tube voltage of 70 kV, it remains unclear whether image quality and the ability to quantify myocardial blood flow (MBF) can be maintained under these conditions. This study aimed to compare the image quality, estimated MBF, and radiation dose of dynamic CTP between 2nd-DSCT and 3rd-DSCT and to evaluate whether a 10.5-cm coverage is suitable for dynamic CTP. MATERIALS AND METHODS We retrospectively analyzed 107 patients who underwent dynamic CTP using 2nd-DSCT at 80 kV (n = 54) or 3rd-DSCT at 70 kV (n = 53). Image quality, estimated MBF, radiation dose, and coverage of left ventricular (LV) myocardium were compared. RESULTS No significant differences were observed between 3rd-DSCT and 2nd-DSCT in contrast-to-noise ratio (37.4 ± 11.4 vs. 35.5 ± 11.2, p = 0.396). Effective radiation dose was lower with 3rd-DSCT (3.97 ± 0.92 mSv with a conversion factor of 0.017 mSv/mGy·cm) compared to 2nd-DSCT (5.49 ± 1.36 mSv, p < 0.001). Incomplete coverage was more frequent with 2nd-DSCT than with 3rd-DSCT (1.9% [1/53] vs. 56% [30/54], p < 0.001). In propensity score-matched cohorts, MBF was comparable between 3rd-DSCT and 2nd-DSCT in non-ischemic (146.2 ± 26.5 vs. 157.5 ± 34.9 mL/min/100 g, p = 0.137) as well as ischemic myocardium (92.7 ± 21.1 vs. 90.9 ± 29.7 mL/min/100 g, p = 0.876). CONCLUSION The radiation increase inherent to the widened z-axis coverage in 3rd-DSCT can be balanced by using a tube voltage of 70 kV without compromising image quality or MBF quantification. In dynamic CTP, a z-axis coverage of 10.5 cm is sufficient to achieve complete coverage of the LV myocardium in most patients.
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Affiliation(s)
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Mie, Japan.
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Yoshitaka Goto
- Department of Radiology, Mie University Hospital, Mie, Japan
| | | | - Naoki Nagasawa
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Mie, Japan
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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.
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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
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Kuwahara N, Tanabe Y, Kido T, Kurata A, Uetani T, Ochi H, Kawaguchi N, Kido T, Ikeda S, Yamaguchi O, Asano M, Mochizuki T. Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease. Cardiovasc Interv Ther 2019; 35:327-335. [PMID: 31630340 PMCID: PMC7497437 DOI: 10.1007/s12928-019-00627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate the feasibility of the stenosis-related quantitative perfusion ratio (QPR) for detecting hemodynamically significant coronary artery disease (CAD). Twenty-seven patients were retrospectively enrolled. All patients underwent dynamic myocardial computed tomography perfusion (CTP) and coronary computed tomography angiography (CTA) before invasive coronary angiography (ICA) measuring the fractional flow reserve (FFR). Coronary lesions with FFR ≤ 0.8 were defined as hemodynamically significant CAD. The myocardial blood flow (MBF) was calculated using dynamic CTP data, and CT-QPR was calculated as the CT-MBF relative to the reference CT-MBF. The stenosis-related CT-MBF and QPR were calculated using Voronoi diagram-based myocardial segmentation from coronary CTA data. The relationships between FFR and stenosis-related CT-MBF or QPR and the diagnostic performance of the stenosis-related CT-MBF and QPR were evaluated. Of 81 vessels, FFR was measured in 39 vessels, and 20 vessels (51%) in 15 patients were diagnosed as hemodynamically significant CAD. The stenosis-related CT-QPR showed better correlation (r = 0.70, p < 0.05) than CT-MBF (r = 0.56, p < 0.05). Sensitivity and specificity for detecting hemodynamically significant CAD were 95% and 58% for CT-MBF, and 95% and 90% for CT-QPR, respectively. The area under the receiver operating characteristic curve for the CT-QPR was significantly higher than that for the CT-MBF (0.94 vs. 0.79; p < 0.05). The stenosis-related CT-QPR derived from dynamic myocardial CTP and coronary CTA showed a better correlation with FFR and a higher diagnostic performance for detecting hemodynamically significant CAD than the stenosis-related CT-MBF.
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Affiliation(s)
- Natsumi Kuwahara
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- 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
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hitomi Ochi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Migiwa Asano
- Department of Legal Medicine, 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
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Comparison of the different imaging time points in delayed phase cardiac CT for myocardial scar assessment and extracellular volume fraction estimation in patients with old myocardial infarction. Int J Cardiovasc Imaging 2018; 35:917-926. [DOI: 10.1007/s10554-018-1513-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/11/2018] [Indexed: 01/02/2023]
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11
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Kitagawa K, Goto Y, Nakamura S, Takafuji M, Hamdy A, Ishida M, Sakuma H. Dynamic CT Perfusion Imaging: State of the Art. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kakuya Kitagawa
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yoshitaka Goto
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Satoshi Nakamura
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Masafumi Takafuji
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Ahmed Hamdy
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
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