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Improved visualization of the coronary arteries using motion correction during vasodilator stress CT myocardial
Bhavna Balaney1, Mani Vembar2, Michael Grass3
1Departments of Medicine and Radiology, University of Chicago Medical Center, Chicago, IL, United States.
Insights
A new motion correction algorithm improves visualization of coronary arteries during stress CT perfusion imaging. This advancement allows for a potential single-scan assessment of coronary anatomy and myocardial perfusion, reducing patient radiation and contrast dose.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- Stress computed tomography perfusion (sCTP) complements coronary CT angiography (CCTA) for assessing coronary artery disease.
- Current sCTP requires a separate scan, increasing contrast dose and radiation due to motion artifacts at higher heart rates.
- A novel motion correction algorithm was developed to improve sCTP visualization.
Purpose of the Study:
- To evaluate the effectiveness of a novel motion correction algorithm (MCR) in improving coronary artery visualization on sCTP images.
- To determine if MCR allows for a combined CCTA + sCTP evaluation in a single scan.
- To assess the impact of MCR on image quality metrics like signal-to-noise and contrast-to-noise ratios.
Main Methods:
- 28 patients underwent CCTA and sCTP imaging.
- Stress images were reconstructed using standard filtered back-projection (FBP) and motion-compensated back-projection (MCR).
- A blinded reader graded motion artifact severity and measured SNR and CNR for both reconstruction methods.
Main Results:
- MCR significantly improved visualization scores for all coronary segments compared to FBP.
- 16% of segments non-diagnostic on FBP were improved to diagnostic quality with MCR.
- Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were not degraded by the motion correction algorithm.
Conclusions:
- The MCR algorithm enhances coronary anatomy visualization in sCTP without compromising image quality.
- This technique is a significant advancement towards single-scan CCTA and sCTP assessments.
- Implementing MCR can lead to reduced study time, radiation exposure, and contrast agent administration.
Background:
Vasodilator stress computed tomography perfusion (sCTP) imaging is complementary to coronary CT angiography (CCTA), used to determine the hemodynamic significance of coronary artery disease. However, it requires a separate image acquisition due to motion artifacts caused by higher heart rates during stress, resulting in increased iodine contrast dose and radiation. We sought to determine whether a novel motion correction algorithm applied to stress images would improve the visualization of the coronary arteries to potentially allow CCTA + sCTP evaluation in a single scan.
Methods:
28 patients referred for clinically indicated CCTA (iCT, Philips) underwent sCTP imaging (retrospective-gating with dose modulation; 100 kVp and 250 mA; 5.2 ± 4.3 mSv) after regadenoson (0.4 mg, Astellas). Stress images were reconstructed using standard filtered back-projection (FBP) and also processed to generate interaction-free coronary motion-compensated back-projection reconstructions (MCR). Each coronary artery from standard FBP and MCR images was viewed side-by-side by a reader blinded to the reconstruction technique, who graded severity of motion artifact by segment (scale 0-5, with 3 as the threshold for diagnostic quality) and to measure signal-to-noise and contrast-to-noise ratios (SNR, CNR).
Results:
Visualization scores were higher with MCR for all coronary segments, including 14/86 (16%) segments deemed as non-diagnostic on FBP images. SNR (7 ± 2) and CNR (15 ± 8) were unchanged by motion-correction (7 ± 3, p = 0.88 and 15 ± 5, p = 0.94, respectively).
Conclusions:
MCR improves the visualization of coronary anatomy on sCTP images without degrading image characteristics. This algorithm is an important step towards the combined assessment of coronary anatomy and myocardial perfusion in a single scan, which will reduce study time, radiation exposure and contrast dose.
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