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Published on: February 16, 2016
Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories
Marco Giordano1,2, Dirk H J Poot1,2, Adriaan Coenen3
1Department of Imaging Physics, TU Delft, 2628CJ, Delft, The Netherlands.
Insights
A new method quantifying hypoperfused volume (HPV) from CT angiography accurately identifies significant coronary artery stenosis. This approach offers improved objectivity and reproducibility compared to manual analysis of myocardial blood flow (MBF).
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Dynamic CT perfusion (CTP) assesses coronary stenosis significance via myocardial blood flow (MBF).
- Current CTP MBF analysis faces limitations due to subjective interpretation and variability.
- A novel method is needed to objectively quantify perfusion deficits in coronary artery disease.
Purpose of the Study:
- Introduce and evaluate a novel method to quantify hypoperfused volume (HPV) in myocardial territories.
- Overcome limitations of current dynamic CTP MBF analysis for assessing coronary stenosis.
- Improve diagnostic performance and reproducibility in identifying hemodynamically significant stenoses.
Main Methods:
- Evaluated HPV diagnostic performance in 22 patients (57 vessels) using CT angiography (CTA) and CTP.
- Used invasive fractional flow reserve (FFR) as the reference standard for stenosis significance.
- Compared HPV performance to manually annotated mean MBF (MA-MBF) using leave-one-case out cross-validation and assessed inter-observer reproducibility.
Main Results:
- HPV achieved 72% accuracy, 72% sensitivity, and 72% specificity, comparable to MA-MBF (70% accuracy, 50% sensitivity, 79% specificity).
- HPV demonstrated superior inter-observer reproducibility with Spearman correlation (ρ = 0.94) and kappa statistic (κ = 0.86) versus MA-MBF (ρ = 0.72, κ = 0.82).
- Parameter settings did not significantly influence HPV's diagnostic performance.
Conclusions:
- The proposed hypoperfused volume (HPV) method accurately classifies hemodynamically significant coronary stenoses.
- HPV offers accuracy comparable to expert-annotated mean MBF while significantly improving inter-observer reproducibility.
- HPV provides a more objective criterion for associating stenotic coronaries with supplied myocardial territories.
Purpose:
Myocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods.
Methods:
The diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed.
Results:
Leave-one-case out cross-validation showed that HPV has an accuracy of 72% (58-83%) with sensitivity of 72% (47-90%) and specificity of 72% (58-83%). The accuracy of MA-MBF was 70% (57-82%) with a sensitivity of 50% (26-74%) and a specificity of 79% (64-91%). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant.
Conclusions:
The proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.
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