Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing: Detection of ischemia for intermediate coronary stenosis. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Nagao, Michinobu; Yamasaki, Yuzo; Kamitani, Takeshi; Kawanami, Satoshi; Sagiyama, Koji; Yamanouchi, Torahiko; Shimomiya, Yamato; Matoba, Tetsuya; Mukai, Yasushi; Odashiro, Keita; Baba, Shingo; Maruoka, Yasuhiro; Kitamura, Yoshiyuki; Nishie, Akihiro; Honda, Hiroshi
• Is Part Of: European journal of radiology. Volume 85:Issue 5(2016)
• Page Start: 996
• Page End: 1003
• Publication Date: 2016-05
• Subjects: AHA American Heart Association -- AUC area under the curve -- CAD coronary artery disease -- CCTA coronary computed tomography angiography -- CFI coronary flow index -- ECG electrocardiography -- FFR fractional flow reserve -- Heart-DCT dynamic CT angiography for the whole heart -- LAD left anterior descending artery -- LCX left circumflex artery -- MCIP motion coherence image processing -- MPR multiplanar reconstruction -- MPS myocardial perfusion scintigraphy -- RCA right coronary artery -- ROC receiver-operating-characteristic -- SPECT single-photon emission computed tomography -- TDC time-density curve -- VOI volume of interest -- WR washout rate; Coronary computed tomography angiography -- Coronary artery disease -- Motion coherence analysis -- Myocardial perfusion scintigraphy; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2016.02.027
• Languages: English
• ISSNs: 0720-048X

Abstract

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 80 kV 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 (12–24 ml). 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 >3 mm 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.