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Zhu MM, Zhu XM, Lin SS, Dong ST, Liu WY, zhang JY, Xu Y. The incremental value of CCTA-derived myocardial radiomics signature for ischemia diagnosis with reference to CT myocardial perfusion imaging. Br J Radiol 2023; 96:20220971. [PMID: 37191174 PMCID: PMC10392656 DOI: 10.1259/bjr.20220971] [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: 10/18/2022] [Revised: 02/17/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To explore the incremental value of myocardial radiomics signature derived from static coronary computed tomography angiography (CCTA) for identifying myocardial ischemia based on stress dynamic CT myocardial perfusion imaging (CT-MPI). METHODS Patients who underwent CT-MPI and CCTA were retrospectively enrolled from two independent institutions, one used as training and the other as testing. Based on CT-MPI, coronary artery supplying area with relative myocardial blood flow (rMBF) value <0.8 was considered ischemia. Conventional imaging features of target plaques which caused the most severe narrowing of the vessel included area stenosis, lesion length (LL), total plaque burden, calcification burden, non-calcification burden, high-risk plaque (HRP) score, and CT fractional flow reserve (CT-FFR). Myocardial radiomics features were extracted at three vascular supply areas from CCTA images. The optimized radiomics signature was added to the conventional CCTA features to build the combined model (radiomics + conventional). RESULTS There were 168 vessels from 56 patients enrolled in the training set, and the testing set consisted of 135 vessels from 45 patients. From either cohort, HRP score, LL, stenosis ≥50% and CT-FFR ≤0.80 were associated with ischemia. The optimal myocardial radiomics signature consisted of nine features. The detection of ischemia using the combined model was significantly improved compared with conventional model in both training and testing set (AUC 0.789 vs 0.608, p < 0.001; 0.726 vs 0.637, p = 0.045). CONCLUSIONS Myocardial radiomics signature extracted from static CCTA combining with conventional features could provide incremental value to diagnose specific ischemia. ADVANCES IN KNOWLEDGE Myocardial radiomics signature extracted from CCTA may capture myocardial characteristics and provide incremental value to detect specific ischemia when combined with conventional features.
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Affiliation(s)
- Meng-meng Zhu
- Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Xiao-mei Zhu
- Department of Radiology,, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shu-shen Lin
- CT collaboration, Siemens Healthineers Ltd, Shanghai, China
| | - Si-ting Dong
- Department of Radiology,, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wang-yan Liu
- Department of Radiology,, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-yin zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Xu
- Department of Radiology,, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Dai X, Lu Z, Yu Y, Yu L, Xu H, Zhang J. The use of lesion-specific calcium morphology to guide the appropriate use of dynamic CT myocardial perfusion imaging and CT fractional flow reserve. Quant Imaging Med Surg 2022; 12:1257-1269. [PMID: 35111621 DOI: 10.21037/qims-21-491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/18/2021] [Indexed: 12/28/2022]
Abstract
Background We aimed to optimize the diagnostic strategy for dynamic computed tomography myocardial perfusion imaging (CT-MPI) and CT fractional flow reserve (CT-FFR) in the evaluation of coronary artery disease (CAD). Methods Patients who had undergone coronary CT angiography (CCTA) + dynamic CT-MPI and invasive coronary angiography (ICA)/FFR within a 4-week period were retrospectively included. Lesion-specific characteristics were recorded, and multivariate logistic regression was performed to determine the predictors of mismatched CT findings with ICA results. An optimized diagnostic strategy was proposed based on the diagnostic performance of dynamic CT-MPI and CT-FFR compared with ICA/FFR. A net reclassification index (NRI) was calculated to determine the incremental discriminatory power of optimized CT-FFR + dynamic CT-MPI strategy compared to CT-FFR alone. Results The study included 180 patients with 229 diseased vessels. For CT-FFR, a calcified lesion with a calcium arc >180° was the only independent predictor for misdiagnosis of ischemic coronary stenosis (odds ratio =2.367; P=0.002). For noncalcified lesions and calcified lesions with a calcium arc ≤180°, the sensitivity and negative predictive value (NPV) of CT-FFR were similar to those of CT-MPI (all P values >0.05), whereas the specificity and positive predictive value (PPV) of CT-FFR were significantly lower (all P values <0.05). For calcified lesions with a calcium arc >180°, the specificity, NPV, and PPV of CT-FFR were inferior to those of CT-MPI (21.2% vs. 100%, 58.3% vs. 86.8%, and 62.9% vs. 100%, respectively; all P values <0.05). As guided by lesion-specific calcium morphology, an optimized CT-FFR + dynamic CT-MPI strategy (NRI =0.2; P=0.004) would have resulted in a 27.0% and 33.9% reduction of radiation dose and contrast medium consumption, respectively, and 25.3% of patients would have avoided unnecessary invasive tests. Conclusions The diagnostic performance of CT-FFR was significantly inferior in lesions with a calcium arc >180°. Lesion-specific calcium morphology is the preferred parameter to guide the appropriate use of CT-based functional assessment.
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Affiliation(s)
- Xu Dai
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yarong Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhu M, Gao Y, Wang J, Ge Y, Zhu Y, Zhu X, Xu Y. CCTA-derived strain analysis in detection of regional myocardial dysfunction in coronary artery disease patients with preserved left ventricular ejection fraction: A feasibility study. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:587-597. [PMID: 35275516 DOI: 10.3233/xst-211104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the feasibility of using coronary computed tomography angiography (CCTA)-derived strain to detect regional myocardial dysfunction in coronary artery disease (CAD) patients with normal left ventricular ejection fraction (LVEF). METHODS A total of 1,580 segments from 101 patients who underwent stressed CT myocardial perfusion imaging (CT-MPI) and CCTA were retrospectively enrolled in this study. The CT-derived global and segmental strain values were evaluated using the feature tracking technique. Segments with myocardial blood flow (MBF) < 125 ml/min/100 ml and 95 ml/min/100 ml were categorized as ischemic and infarcted, respectively. RESULTS Segmental radial strain (SRS) and segmental circumferential strain (SCS) in the abnormal segments (including all segments with MBF < 125 ml/min/100 ml) were significantly lower than those in the normal segments (14.81±8.65% vs 17.17±9.13%, p < 0.001; -10.21±5.79% vs -11.86±4.52%, p < 0.001, respectively). SRS and SCS values in infarcted segments were significantly impaired compared with the ischemic segments (12.43±8.03% vs. 15.32±8.71%, p = 0.038; -7.72±5.91% vs. -10.67±5.66%, p = 0.010, respectively). The AUCs for SRS and SCS in detecting infarcted segments were 0.622 and 0.698, respectively (p < 0.05). CONCLUSIONS It is feasible for using CCTA-derived strain parameters to detect regional myocardial dysfunction in CAD patients with preserved LVEF. Segmental radial and circumferential strain have the potential ability to distinguish myocardial ischemia from infarction, and normal from ischemic myocardium.
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Affiliation(s)
- Mengmeng Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Yujie Gao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Jun Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, China
| | | | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, China
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Prevalence and disease features of myocardial ischemia with non-obstructive coronary arteries: Insights from a dynamic CT myocardial perfusion imaging study. Int J Cardiol 2021; 334:142-147. [PMID: 33932431 DOI: 10.1016/j.ijcard.2021.04.055] [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: 11/30/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ischemia with non-obstructive coronary arteries (INOCA) is not uncommon in clinical practice. However, the incidence and imaging characteristics of INOCA on dynamic CT myocardial perfusion imaging (CT-MPI) remains unclear. We aimed to investigate the prevalence and disease features of INOCA as evaluated by dynamic CT-MPI + coronary CT angiography (CCTA). METHODS Patients with suspected chronic coronary syndrome and intermediate-to-high pre-test probability of obstructive CAD (according to updated Diamond and Forrester Chest Pain Prediction Rule) were referred for dynamic CT-MPI + CCTA and retrospectively included. Various parameters, including myocardial blood flow (MBF) and high-risk plaque (HRP) features, were measured. INOCA was diagnosed if patients were revealed to have myocardial ischemia and absence of obstructive stenosis. RESULTS 314 patients were finally included. 20 patients (6.4%) were observed to have myocardial ischemia without obstructive stenosis. In addition, 138 patients (43.9%) had normal or near normal findings, 101 patients (32.2%) had obstructive stenosis without myocardial ischemia and 55 patients (17.5%) had obstructive stenosis with myocardial ischemia. Compared with patients with normal/near normal findings, patients with INOCA showed a higher prevalence of positive remodeling (40.0% vs. 17.4%, p = 0.04). In patients with obstructive stenosis, the mean age, calcium score and incidence of spotty calcification, positive remodeling as well as HRPs were significantly higher than those in patients with INOCA (p < 0.05 for all). CONCLUSIONS The overall prevalence of INOCA was low in patients with suspected chronic coronary syndrome. HRPs were less frequently presented in patients with INOCA, compared with patients having obstructive coronary stenosis.
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Tomizawa N, Chou S, Fujino Y, Matsuoka S, Yamamoto K, Inoh S, Nojo T, Kumamaru KK, Fujimoto S, Nakamura S. Impact of Abnormal Remote Stress Myocardial Blood Flow by Dynamic CT Perfusion on Clinical Outcomes. Sci Rep 2020; 10:10244. [PMID: 32581277 PMCID: PMC7314791 DOI: 10.1038/s41598-020-66992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/01/2020] [Indexed: 12/05/2022] Open
Abstract
The objective of this study was to investigate the incremental prognostic value for adverse events of myocardial blood flow (MBF) derived from stress computed tomography perfusion (CTP) at remote myocardium over cardiac risk factors and ischemia. We prospectively analyzed 242 patients who underwent dynamic CTP and CT angiography. Adverse events were defined as a composite of all-cause mortality, non-fatal myocardial infarction, unstable angina, heart failure requiring hospitalization, peripheral artery disease, and stroke. MBF value was calculated in each myocardial segment and ischemia was defined as mild decrease in MBF in two consecutive segments or moderate decrease in a single segment accompanied with a coronary stenosis ≥50%. The mean MBF of the non-ischemic segments was defined as remote MBF. We divided the patients into two groups by median MBF value of 1.15 ml/min/g. During a median follow-up of 18 months, 18 patients had adverse events. Annual event rate showed a significant difference between patients with low (≤1.15 ml/min/g) and high (>1.15 ml/min/g) MBF (6.1% vs 1.8%, p = 0.02). Univariate analysis showed that low MBF was a significant predictor of events (hazard ratio (HR): 3.4; 95% confidence interval (CI): 1.2 to 12.0; p = 0.02). This relationship maintained significant after adjusted for the presence of ischemia and cardiac risk factors (HR: 3.0; 95%CI: 1.1 to 11.1; p = 0.04). In conclusion, MBF value ≤1.15 ml/min/g derived from dynamic CTP in remote myocardium is significantly related with poor outcome and this relationship was independent of myocardial ischemia and cardiac risk factors.
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Yu L, Tao X, Dai X, Liu T, Zhang J. Dynamic CT Myocardial Perfusion Imaging in Patients without Obstructive Coronary Artery Disease: Quantification of Myocardial Blood Flow according to Varied Heart Rate Increments after Stress. Korean J Radiol 2020; 22:97-105. [PMID: 32783416 PMCID: PMC7772379 DOI: 10.3348/kjr.2020.0249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The present study aimed to investigate the association between myocardial blood flow (MBF) quantified by dynamic CT myocardial perfusion imaging (CT-MPI) and the increments in heart rate (HR) after stress in patients without obstructive coronary artery disease. MATERIALS AND METHODS We retrospectively included 204 subjects who underwent both dynamic CT-MPI and coronary CT angiography (CCTA). Patients with more than minimal coronary stenosis (diameter ≥ 25%), history of myocardial infarction/revascularization, cardiomyopathy, and microvascular dysfunction were excluded. Global MBF at stress was measured using hybrid deconvolution and maximum slope model. Furthermore, the HR increments after stress were recorded. RESULTS The median radiation dose of dynamic CT-MPI plus CCTA was 5.5 (4.5-6.8) mSv. The median global MBF of all subjects was 156.4 (139.8-180.4) mL/100 mL/min. In subjects with HR increment between 10 to 19 beats per minute (bpm), the global MBF was significantly lower than that of subjects with increment between 20 to 29 bpm (153.3 mL/100 mL/min vs. 171.3 mL/100 mL/min, p = 0.027). This difference became insignificant when the HR increment further increased to ≥ 30 bpm. CONCLUSION The global MBF value was associated with the extent of increase in HR after stress. Significantly higher global MBF was seen in subjects with HR increment of ≥ 20 bpm.
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Affiliation(s)
- Lihua Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Dai
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ting Liu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Yu M, Shen C, Dai X, Lu Z, Wang Y, Lu B, Zhang J. Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography–Guided Strategy. Circ Cardiovasc Imaging 2020; 13:e009775. [PMID: 31910669 DOI: 10.1161/circimaging.119.009775] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Dynamic computed tomography (CT) myocardial perfusion imaging (MPI) provides quantitative myocardial blood flow for the precise assessment of myocardial ischemia. However, compared with coronary CT angiography (CCTA), whether this functional imaging modality can reduce invasive coronary angiography without revascularization remains unknown. We aimed to determine the clinical outcomes of a dynamic CT-MPI+CCTA-guided versus CCTA-guided strategy in patients with suspected coronary artery disease.
Methods:
Consecutive patients with intermediate pretest probability of coronary artery disease were prospectively enrolled and randomized to dynamic CT-MPI+CCTA-guided or CCTA-guided workup. The primary end point was the rate of invasive coronary angiography without revascularization within 3 months. The secondary end point was a composite of major adverse cardiac event at the 3-month, 6-month, and 1-year follow-up.
Results:
A total of 240 patients (mean age, 69.01±11.2 years; 173 men) were included. The total radiation dose and contrast media usage within 90 days were higher in the CT-MPI+CCTA group than in the CCTA group (10.3 versus 7.1 mSv,
P
=0.031; 134.5±40.6 versus 108.1±48.2 mL,
P
<0.0001). Compared with the CCTA-guided group, the CT-MPI+CCTA-guided group had significantly lower rates of invasive coronary angiography within 90 days (48.3% [58/120] versus 30.8% [37/120],
P
=0.006) and invasive coronary angiography without revascularization (50.0% [29/58] versus 10.8% [4/37],
P
<0.0001). There were no significant differences regarding the frequency of major adverse cardiac event between the 2 groups at the 3-month, 6-month, and 1-year follow-up.
Conclusions:
In patients with intermediate pretest probability of coronary artery disease, CT-MPI+CCTA-guided patient management may be preferred over the CCTA-guided strategy as an approach to reduce unnecessary invasive procedures.
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Affiliation(s)
- Mengmeng Yu
- Institute of Diagnostic and Interventional Radiology (M.Y., X.D., J.Z.), Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Chengxing Shen
- Department of Cardiology (C.S., Z.L.), Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xu Dai
- Institute of Diagnostic and Interventional Radiology (M.Y., X.D., J.Z.), Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhigang Lu
- Department of Cardiology (C.S., Z.L.), Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital (Y.W.), Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases (B.L.), Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology (M.Y., X.D., J.Z.), Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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