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JACC Cardiovasc Imaging. 2013 Dec;6(12):1229-38. doi: 10.1016/j.jcmg.2013.05.018. Epub 2013 Oct 23.

Myocardial CT perfusion imaging in a large animal model: comparison of dynamic versus single-phase acquisitions.

Author information

1
Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany.
2
Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany.
3
Department of Biostatistics, Ludwig-Maximilians-University, Munich, Germany.
4
Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
5
Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany.
6
Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany. Electronic address: fbamberg@med.lmu.de.

Abstract

OBJECTIVES:

This study sought to compare dynamic versus single-phase high-pitch computed tomography (CT) acquisitions for the assessment of myocardial perfusion in a porcine model with adjustable degrees of coronary stenosis.

BACKGROUND:

The incremental value of the 2 different approaches to CT-based myocardial perfusion imaging remains unclear.

METHODS:

Country pigs received stent implantation in the left anterior descending coronary artery, in which an adjustable narrowing (50% and 75% stenoses) was created using a balloon catheter. All animals underwent CT-based rest and adenosine-stress myocardial perfusion imaging using dynamic and single-phase high-pitch acquisitions at both degrees of stenosis. Fluorescent microspheres served as a reference standard for myocardial blood flow. Segmental CT-based myocardial blood flow (MBFCT) was derived from dynamic acquisitions. Segmental single-phase enhancement (SPE) was recorded from high-pitch, single-phase examinations. MBFCT and SPE were compared between post-stenotic and reference segments, and receiver-operating characteristic curve analysis was performed.

RESULTS:

Among 6 animals (28 ± 2 kg), there were significant differences of MBFCT and SPE between post-stenotic and reference segments for all acquisitions at 75% stenosis. By contrast, although for 50% stenosis at rest, MBFCT was lower in post-stenotic than in reference segments (0.65 ± 0.10 ml/g/min vs. 0.75 ± 0.16 ml/g/min, p < 0.05), there was no difference for SPE (128 ± 27 Hounsfield units vs. 137 ± 35 Hounsfield units, p = 0.17), which also did not significantly change under adenosine stress. In receiver-operating characteristic curve analyses, segmental MBFCT showed significantly better performance for ischemia prediction at 75% stenosis and stress (area under the curve: 0.99 vs. 0.89, p < 0.05) as well as for 50% stenosis, regardless of adenosine administration (area under the curve: 0.74 vs. 0.57 and 0.88 vs. 0.61, respectively, both p < 0.05).

CONCLUSIONS:

At higher degrees of coronary stenosis, both MBFCT and SPE permit an accurate prediction of segmental myocardial hypoperfusion. However, accuracy of MBFCT is higher than that of SPE at 50% stenosis and can be increased by adenosine stress at both degrees of stenosis.

KEYWORDS:

AUC; CT; CTA; FM; HU; Hounsfield units; MBF(CT); MBF(MIC); ROC; ROI; SPE; area under the curve; cardiac CT; computed tomography; computed tomography angiography; computed tomography–derived myocardial blood flow; fluorescent microsphere(s); infarct; ischemia; microsphere-derived myocardial blood flow; myocardial perfusion; receiver-operating characteristic; region of interest; single-phase enhancement

PMID:
24269264
DOI:
10.1016/j.jcmg.2013.05.018
[Indexed for MEDLINE]
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