Florian Schwarz1, Rabea Hinkel2, Elisabeth Baloch1, Roy P Marcus1, Kristof Hildebrandt1, Torleif A Sandner1, Christian Kupatt2, Verena Hoffmann3, Bernd J Wintersperger4, Maximilian F Reiser5, Daniel Theisen5, Konstantin Nikolaou5, Fabian Bamberg6. 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.
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.
Authors: A M Bucher; C N De Cecco; U J Schoepf; R Wang; F G Meinel; S R Binukrishnan; J V Spearman; T J Vogl; B Ruzsics Journal: Br J Radiol Date: 2014-08-19 Impact factor: 3.039
Authors: Bernhard Bischoff; Simon Deseive; Martin Rampp; Andrei Todica; Marc Wermke; Stefan Martinoff; Steffen Massberg; Maximilian F Reiser; Hans-Christoph Becker; Jörg Hausleiter Journal: Int J Cardiovasc Imaging Date: 2016-11-15 Impact factor: 2.357
Authors: Filippo Cademartiri; Sara Seitun; Alberto Clemente; Ludovico La Grutta; Patrizia Toia; Giuseppe Runza; Massimo Midiri; Erica Maffei Journal: Cardiovasc Diagn Ther Date: 2017-04