Michinobu Nagao1, Yuzo Yamasaki2, Takeshi Kamitani2, Satoshi Kawanami3, Koji Sagiyama2, Torahiko Yamanouchi2, Yamato Shimomiya4, Tetsuya Matoba5, Yasushi Mukai5, Keita Odashiro6, Shingo Baba2, Yasuhiro Maruoka2, Yoshiyuki Kitamura2, Akihiro Nishie2, Hiroshi Honda2. 1. Departments of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Japan. Electronic address: minagao@radiol.med.kyushu-u.ac.jp. 2. Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan. 3. Departments of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Japan. 4. Departments of Medical Technology, Graduate School of Medical Sciences, Kyushu University, Japan. 5. Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Japan. 6. Departments of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Japan.
Abstract
OBJECTIVES: Anatomical coronary stenosis is not always indicative of functional stenosis, particularly for intermediate coronary lesions. The purpose of this study is to propose a new method for quantifying coronary flow using dynamic CT angiography for the whole heart (heart-DCT) and investigate its ability for detecting ischemia from intermediate coronary stenosis. METHODS: Participants comprised 36 patients with coronary artery disease who underwent heart-DCT using 320-detector CT with tube voltage of 80kV and myocardial perfusion scintigraphy (MPS). Heart-DCT was continuously performed at mid-diastole throughout 15-25 cardiac cycles with prospective ECG-gating after bolus injection of contrast media (12-24ml). Dynamic datasets were computed into 90-100 data sets by motion coherence image processing (MCIP). Next, time-density curves (TDCs) for coronary arteries with a diameter >3mm were automatically calculated for all phases using MCIP. On the basis of the maximum slope method, coronary flow index (CFI) was defined as the ratio of the maximum upslope of coronary artery attenuation to the upslope of ascending aorta attenuation on the TDC, and was used to quantify coronary flow. CFIs for the proximal and distal sites of coronary arteries with mild-to-moderate stenosis were calculated. Coronary territories were categorized as non-ischemic or ischemic by MPS. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff for CFI to detect ischemia. RESULTS: Distal CFI was significantly lower for ischemia (0.26±0.08) than for non-ischemia (0.50±0.17, p<0.0001). No significant difference in proximal CFI was seen between ischemia (0.55±0.23) and non-ischemia (0.62±0.24). ROC analysis revealed 0.39 as the optimal cutoff for distal CFI to detect ischemia, with C-statistics of 0.91, 100% sensitivity, and 75% specificity. CONCLUSIONS: This novel imaging technique allows coronary flow quantification using heart-DCT. Distal CFI can detect myocardial ischemia derived from intermediate coronary stenosis.
OBJECTIVES: Anatomical coronary stenosis is not always indicative of functional stenosis, particularly for intermediate coronary lesions. The purpose of this study is to propose a new method for quantifying coronary flow using dynamic CT angiography for the whole heart (heart-DCT) and investigate its ability for detecting ischemia from intermediate coronary stenosis. METHODS:Participants comprised 36 patients with coronary artery disease who underwent heart-DCT using 320-detector CT with tube voltage of 80kV and myocardial perfusion scintigraphy (MPS). Heart-DCT was continuously performed at mid-diastole throughout 15-25 cardiac cycles with prospective ECG-gating after bolus injection of contrast media (12-24ml). Dynamic datasets were computed into 90-100 data sets by motion coherence image processing (MCIP). Next, time-density curves (TDCs) for coronary arteries with a diameter >3mm were automatically calculated for all phases using MCIP. On the basis of the maximum slope method, coronary flow index (CFI) was defined as the ratio of the maximum upslope of coronary artery attenuation to the upslope of ascending aorta attenuation on the TDC, and was used to quantify coronary flow. CFIs for the proximal and distal sites of coronary arteries with mild-to-moderate stenosis were calculated. Coronary territories were categorized as non-ischemic or ischemic by MPS. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff for CFI to detect ischemia. RESULTS: Distal CFI was significantly lower for ischemia (0.26±0.08) than for non-ischemia (0.50±0.17, p<0.0001). No significant difference in proximal CFI was seen between ischemia (0.55±0.23) and non-ischemia (0.62±0.24). ROC analysis revealed 0.39 as the optimal cutoff for distal CFI to detect ischemia, with C-statistics of 0.91, 100% sensitivity, and 75% specificity. CONCLUSIONS: This novel imaging technique allows coronary flow quantification using heart-DCT. Distal CFI can detect myocardial ischemia derived from intermediate coronary stenosis.