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Functional Assessment of Coronary Artery Disease Using Whole-Heart Dynamic Computed Tomographic Perfusion
Logan Hubbard1, Benjamin Ziemer1, Jerry Lipinski1
1From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine.
Insights
A new dynamic CT perfusion technique using first-pass analysis (FPA) accurately assesses coronary artery disease with significantly lower radiation doses compared to existing methods. This advance offers improved anatomical and functional evaluation for patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Physics
Background:
- Coronary artery disease (CAD) evaluation using computed tomographic (CT) angiography shows poor correlation with myocardial ischemia.
- Current dynamic CT perfusion techniques for ischemia assessment have limitations in accuracy and high radiation doses.
- A need exists for accurate, low-dose dynamic CT perfusion techniques for improved CAD assessment.
Purpose of the Study:
- To validate a novel first-pass analysis (FPA) based dynamic CT perfusion technique.
- To compare the accuracy and radiation dose of the new FPA technique against an existing maximum slope model (MSM) technique.
- To assess the potential of FPA for improved anatomical and functional evaluation of CAD.
Main Methods:
- Acquisition of 20 contrast-enhanced CT volume scans in a swine model to generate CT angiography and perfusion images.
- Induction of coronary artery stenosis and measurement of fractional flow reserve (FFR) using a pressure wire.
- Application of the new FPA technique (2 volume scans) and the existing MSM technique (20 volume scans) for perfusion measurements.
Main Results:
- The FPA technique demonstrated a strong correlation with FFR (R 2=0.85), comparable to the MSM technique (R 2=0.80).
- Effective radiation doses were significantly lower for FPA (2.64 mSv) compared to MSM (26.4 mSv).
- The FPA technique achieved accurate perfusion measurements with substantially fewer scans and reduced radiation exposure.
Conclusions:
- The novel FPA-based dynamic CT perfusion technique was successfully validated in a swine model.
- The FPA technique shows potential for accurate, low-dose assessment of coronary artery disease.
- This technique may improve both anatomical and functional evaluation of CAD, reducing patient radiation exposure.
Background:
Computed tomographic (CT) angiography is an important tool for the evaluation of coronary artery disease but often correlates poorly with myocardial ischemia. Current dynamic CT perfusion techniques can assess ischemia but have limited accuracy and deliver high radiation dose. Therefore, an accurate, low-dose, dynamic CT perfusion technique is needed.
Methods And Results:
A total of 20 contrast-enhanced CT volume scans were acquired in 5 swine (40±10 kg) to generate CT angiography and perfusion images. Varying degrees of stenosis were induced using a balloon catheter in the proximal left anterior descending coronary artery, and a pressure wire was used for reference fractional flow reserve (FFR) measurement. Perfusion measurements were made with only 2 volume scans using a new first-pass analysis (FPA) technique and with 20 volume scans using an existing maximum slope model (MSM) technique. Perfusion (P) and FFR measurements were related by PFPA=1.01 FFR-0.03 (R2=0.85) and PMSM=1.03 FFR-0.03 (R2=0.80) for FPA and MSM techniques, respectively. Additionally, the effective radiation doses were calculated to be 2.64 and 26.4 mSv for FPA and MSM techniques, respectively.
Conclusions:
A new FPA-based dynamic CT perfusion technique was validated in a swine animal model. The results indicate that the FPA technique can potentially be used for improved anatomical and functional assessment of coronary artery disease at a relatively low radiation dose.
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