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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
08:13

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography

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Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based

Fabian Bamberg1, Alexander Becker, Florian Schwarz

  • 1Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. fbamberg@post.harvard.edu

Radiology
|August 18, 2011
PubMed

Insights

Dynamic CT-based myocardial perfusion imaging shows promise for detecting hemodynamically significant coronary artery stenosis. This technique may improve the accuracy of diagnosing coronary artery disease (CAD) by assessing myocardial blood flow (MBF).

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Medical Diagnostics

Background:

  • Coronary artery disease (CAD) diagnosis relies on identifying significant coronary artery stenosis.
  • Fractional flow reserve (FFR) is the gold standard for assessing the hemodynamic significance of coronary artery stenosis.
  • Computed tomography (CT) angiography can identify anatomical stenosis but may not always reflect hemodynamic significance.

Purpose of the Study:

  • To evaluate the feasibility of CT-based dynamic myocardial perfusion imaging for detecting hemodynamically significant coronary artery stenosis.
  • To compare CT-derived myocardial blood flow (MBF) with FFR measurements in patients with suspected or known CAD.

Main Methods:

  • Electrocardiographically triggered dynamic stress myocardial perfusion imaging was performed in patients with suspected CAD.
  • FFR was measured in coronary arteries with 50%-85% luminal narrowing.
  • CT-derived MBF was calculated using a model-based deconvolution method and correlated with FFR (≤0.75 indicating significance).

Main Results:

  • An MBF cut point of 75 mL/100 mL/min demonstrated the highest discriminatory power (C statistic, 0.707).
  • Initial CT angiography had low positive predictive value (PPV) for hemodynamically significant stenosis (49%).
  • Incorporating MBF improved PPV to 78% by reclassifying lesions, with MBF < 75 mL/100 mL/min strongly indicating hemodynamic significance (OR, 86.9).

Conclusions:

  • Dynamic CT-based stress myocardial perfusion imaging is feasible for detecting hemodynamically significant coronary artery stenosis.
  • This technique, by assessing MBF, can enhance the diagnostic accuracy of CT angiography in evaluating coronary artery lesions.
Abstract

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