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Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it

Alexia Rossi1, Anoeshka Dharampal, Andrew Wragg

  • 1Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London E2 9JX, UK.

European Heart Journal. Cardiovascular Imaging
|August 13, 2013
PubMed

Insights

A new myocardial blood flow (MBF) index from computed tomography perfusion (CTP) imaging accurately identifies significant coronary artery disease. This quantitative MBF index outperforms visual CT coronary angiography (CTCA) and quantitative CT (QCT) in detecting functionally significant lesions, especially intermediate ones.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Medical Diagnostics

Background:

  • Coronary artery narrowing severity is a poor predictor of functional significance, particularly for intermediate lesions (30-70% diameter narrowing).
  • Accurate assessment of functional significance is crucial for managing stable chest pain patients and guiding revascularization decisions.

Purpose of the Study:

  • To compare the diagnostic performance of a quantitative hyperaemic myocardial blood flow (MBF) index derived from adenosine dynamic computed tomography perfusion (CTP) imaging.
  • To evaluate the MBF index against visual CT coronary angiography (CTCA) and semi-automatic quantitative CT (QCT) in detecting functionally significant coronary lesions.

Main Methods:

  • 80 patients with stable chest pain underwent CT coronary angiography (CTCA) and CTP before invasive coronary angiography (ICA).
  • A model-based parametric deconvolution method computed the MBF index (mL/100 mL/min).
  • Diagnostic performance was assessed by comparing the MBF index, visual CTCA, and QCT against invasive fractional flow reserve (FFR ≤0.75).

Main Results:

  • The MBF index demonstrated superior diagnostic performance with a larger area under the curve (0.95) compared to visual CTCA (0.85) and QCT (0.89) at the vessel-territory level (P<0.001).
  • An optimal MBF index cut-off of 78 mL/100 mL/min was identified for detecting functionally significant lesions.
  • In intermediate lesions, the MBF index significantly improved specificity (89%) compared to visual CTCA (69%) and QCT (77%).

Conclusions:

  • The quantitative MBF index derived from CTP imaging is a superior method for identifying functionally significant coronary lesions compared to visual CTCA and QCT.
  • The MBF index provides added diagnostic value beyond anatomical assessment by CTCA, particularly for intermediate coronary lesions.
  • This quantitative MBF index holds potential to improve patient management strategies for coronary artery disease.
Abstract

Keywords:
coronary artery diseasecoronary computed tomography angiographydynamic contrast-enhanced computed tomographymyocardial blood flowmyocardial perfusion

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