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Updated: May 10, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardium: dynamic versus single-shot CT perfusion imaging
Armin M Huber1, Vivian Leber, Bettina M Gramer
1Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar der Technischen, Universität München, Ismaninger Str. 22, 81675 Munich, Germany; Clinic for Cardiology and Internal Intensive Care Medicine, Klinikum Bogenhausen, Munich, Germany.
Insights
Dynamic CT perfusion imaging accurately detects coronary artery stenosis. Semiquantitative (upslope, peak enhancement) and quantitative (myocardial blood flow) parameters show high diagnostic accuracy for coronary artery stenosis.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Coronary artery stenosis detection is crucial for cardiovascular health.
- Traditional methods like coronary angiography have limitations.
- Dynamic CT perfusion imaging offers a non-invasive alternative for assessing myocardial blood flow.
Purpose of the Study:
- To evaluate the diagnostic accuracy of dynamic CT perfusion imaging for detecting hemodynamically significant coronary artery stenosis.
- To compare the accuracy of CT perfusion parameters with coronary angiography and fractional flow reserve (FFR).
Main Methods:
- Thirty-two patients underwent dynamic CT perfusion imaging under adenosine stress.
- Key parameters analyzed: time to peak, area under the curve, upslope, peak enhancement, and myocardial blood flow (MBF).
- Results were compared to coronary angiography and FFR using ROC analysis.
Main Results:
- Upslope (AUC 0.87), peak enhancement (AUC 0.83), and MBF (AUC 0.86) demonstrated high diagnostic accuracy.
- MBF achieved 100% specificity in detecting stenosis.
- Threshold values for optimal detection were established for each parameter.
Conclusions:
- Dynamic CT perfusion imaging, particularly upslope, peak enhancement, and quantitative MBF, is highly accurate for diagnosing coronary artery stenosis.
- These CT perfusion parameters offer a reliable, non-invasive method for assessing coronary artery disease severity.
Purpose:
To determine the diagnostic accuracy of dynamic computed tomographic (CT) perfusion imaging of the myocardium for the detection of hemodynamically relevant coronary artery stenosis compared with the accuracy of coronary angiography and fractional flow reserve (FFR) measurement.
Materials And Methods:
This study was approved by the institutional review board and the Federal Radiation Safety Council (Bundesamt für Strahlenschutz). All patients provided written informed consent. Thirty-two consecutive patients in adenosine stress conditions underwent dynamic CT perfusion imaging (14 consecutive data sets) performed by using a 256-section scanner with an 8-cm detector and without table movement. Time to peak, area under the curve, upslope, and peak enhancement were determined after calculation of time-attenuation curves. In addition, myocardial blood flow (MBF) was determined quantitatively. Results were compared with those of coronary angiography and FFR measurement by using a receiver operating characteristic (ROC) analysis. In addition, threshold values based on the Youden index and sensitivity and specificity were calculated.
Results:
Area under the ROC curve, sensitivity, and specificity, respectively, were 0.67, 41.4% (95% confidence interval [CI]: 23.5%, 61.1%), and 86.6% (95% CI: 76.0%, 93.7%) for time to peak; 0.74, 58.6% (95% CI: 38.9%, 76.5%), and 83.6% (95% CI: 72.5%, 91.5%) for area under the curve; 0.87, 82.8% (95% CI: 64.2%, 94.1%), and 88.1% (95% CI: 77.8%, 94.7%) for upslope; 0.83, 82.8% (95% CI: 64.2%, 94.1%), and 89.6% (95% CI: 79.6%, 95.7%) for peak enhancement; and 0.86, 75.9% (95% CI: 56.5%, 89.7%), and 100% (95% CI: 94.6%, 100%) for MBF. The thresholds determined by using the Youden index were 148.5 HU · sec for area under the curve, 12 seconds for time to peak, 2.5 HU/sec for upslope, 34 HU for peak enhancement, and 1.64 mL/g/min for MBF.
Conclusion:
The semiquantitative parameters upslope and peak enhancement and the quantitative parameter MBF showed similar high diagnostic accuracy.
Supplemental Material:
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121441/-/DC1.
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