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Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image
Michinobu Nagao1, Yuzo Yamasaki2, Takeshi Kamitani2
1Departments of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Japan.
Insights
This study introduces a new method using dynamic CT angiography (heart-DCT) to quantify coronary flow and detect ischemia from intermediate coronary stenosis. Distal coronary flow index (CFI) effectively identifies myocardial ischemia, offering improved diagnostic capabilities.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Anatomical stenosis on coronary CT angiography does not always correlate with functional significance, especially for intermediate lesions.
- Accurate assessment of coronary flow is crucial for diagnosing ischemia caused by intermediate coronary stenosis.
Purpose of the Study:
- To introduce a novel method for quantifying whole-heart coronary flow using dynamic CT angiography (heart-DCT).
- To evaluate the efficacy of this heart-DCT method in detecting myocardial ischemia associated with intermediate coronary stenosis.
Main Methods:
- 36 patients with coronary artery disease underwent heart-DCT and myocardial perfusion scintigraphy (MPS).
- Coronary flow was quantified using the coronary flow index (CFI) derived from time-density curves calculated via motion coherence image processing.
- Distal and proximal CFIs were assessed and correlated with MPS-defined ischemic territories.
Main Results:
- Distal CFI was significantly lower in ischemic territories (0.26±0.08) compared to non-ischemic territories (0.50±0.17, p<0.0001).
- Proximal CFI showed no significant difference between ischemic and non-ischemic territories.
- Receiver-operating-characteristic analysis identified an optimal distal CFI cutoff of 0.39 for ischemia detection, with high sensitivity (100%) and specificity (75%).
Conclusions:
- Dynamic CT angiography (heart-DCT) provides a novel method for quantitative coronary flow assessment.
- Distal coronary flow index (CFI) derived from heart-DCT is a reliable indicator for detecting myocardial ischemia caused by 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.
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