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Updated: Oct 6, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Incremental value of volumetric quantification for myocardial perfusion imaging by computed tomography
Anna Oleksiak1, Cezary Kępka2, Koen Nieman3
1Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warszawa, Poland. aoleksiak@ikard.pl.
Insights
Volumetric computed tomography perfusion (VOL CTP) accurately quantifies myocardial ischemia, outperforming standard CTP and CT-FFR in predicting revascularization needs for coronary artery disease. This method provides crucial prognostic information for treatment decisions.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Interventional Cardiology
Background:
- Myocardial ischemia extent is key for coronary artery disease treatment decisions.
- Computed tomography perfusion (CTP) offers volumetric data, but its clinical value is under investigation.
Purpose of the Study:
- To compare a novel volumetric CTP (VOL CTP) method against other CT imaging techniques for predicting revascularization.
Main Methods:
- Prospective study of 53 patients with 50-90% coronary stenosis.
- Dynamic CTP and CT-derived fractional flow reserve (CT-FFR) were performed.
- Myocardial ischemia percentage was calculated using VOL CTP; a 10% cut-off defined significant ischemia.
Main Results:
- VOL CTP (≥10% ischemia) showed superior prediction of revascularization (AUC 0.973) compared to CT-FFR (0.793), standard CTP (0.865), and CTA (0.668).
- 18 patients had ≥10% ischemia by VOL CTP; 16 patients underwent revascularization.
- VOL CTP demonstrated statistically significant superiority over other methods (P <0.001).
Conclusions:
- Volumetric CTP quantification is feasible for assessing myocardial ischemia.
- VOL CTP provides actionable information beyond standard CTP and CT-FFR for patients with significant coronary stenosis.
Abstract:
ackground: The extent of myocardial ischemia is the crucial prognostic factor for interventional treatment decision making for coronary artery disease. The ability of computed tomography per-fusion (CTP) to provide the missing volumetric information and its clinical value remains unknown.
Aims:
The study aimed to compare a novel ischemic volume quantification method based on dynamic computed tomography perfusion (VOL CTP) with other CT-based imaging modalities for revascularization prediction.
Methods:
In this prospective study, 53 (25 females, 63.5 [8.5] years old) consecutive symptomatic patients with 50%-90% coronary artery stenosis (n ≥1) on coronary computed tomography angiography underwent computed-tomography-derived fractional flow reserve (CT-FFR) analysis and dynamic CTP. We calculated the percentage of myocardial ischemia on the CTP-derived images. A 10% cut-off was used to define functionally significant ischemia. The outcomes include coronary revas-cularization during the follow-up of 2.5 (interquartile range, 1.4-2.8) years. Physicians were blinded to the results of CTP and CT-FFR.
Results:
Of the 53 patients in the study (68 arteries with 50%-90% stenosis), 16 underwent revascularization (12 elective, 4 event-driven). In the CTP quantitative analysis, 26 patients had ischemia. Overall, 18 patients had ischemia ≥10% on volumetric ischemia quantification based on dynamic computed tomography perfusion (VOL CTP), and 28 patients had CT-FFR <0.8. VOL CTP, standard CTP, CT-FFR, and computed tomography coronary angiography (CTA) ≥70% performed well for the prediction of total revascularization. Area under the curve was 0.973 vs. 0.865, vs. 0.793, vs. 0.668, respectively. The VOL CTP with ≥10% cut-off was superior to the CT-FFR, standard CTP, and CTA ≥70% (P <0.001; P = 0.002 and P <0.001 respectively).
Conclusions:
VOL CTP quantification is feasible and adds important, actionable information to that provided by standard CTP or CT-FFR in patients with 50%-90% coronary artery stenosis.
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