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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Relationship between microvascular status and diagnostic performance of stress dynamic CT perfusion imaging
Naoki Nagasawa1,2, Satoshi Nakamura3, Hideki Ota4
1Department of Radiology, Mie University Hospital, Tsu, Japan.
Insights
Microvascular status impacts stress dynamic CT perfusion imaging (CTP) diagnostic performance for coronary stenosis. Relative myocardial blood flow (MBF) shows more consistent accuracy than absolute MBF across different microvascular statuses.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Myocardial Perfusion Assessment
Background:
- Assessing hemodynamically significant stenosis is crucial for cardiovascular disease management.
- Stress dynamic CT perfusion imaging (CTP) is a non-invasive tool for evaluating myocardial blood flow (MBF).
- The influence of non-ischemic myocardium microvascular status on CTP diagnostic performance requires further investigation.
Purpose of the Study:
- To investigate the relationship between microvascular status in the non-ischemic myocardium and the diagnostic performance of stress dynamic CTP.
- To evaluate how different levels of remote MBF affect the accuracy of CTP in detecting significant coronary stenosis.
Main Methods:
- 157 patients underwent coronary computed tomography angiography (CTA), CTP, and invasive coronary angiography (ICA) with fractional flow reserve (FFR).
- Hemodynamically significant stenosis was defined by FFR and ICA.
- Myocardial blood flow (MBF) was quantified, with relative MBF normalized to remote MBF.
Main Results:
- Receiver operating characteristic curve analysis showed improved diagnostic performance with higher remote MBF for both absolute and relative MBF.
- Relative MBF demonstrated higher areas under the curve (0.83) compared to absolute MBF (0.80) in patients with high remote MBF.
- For high remote MBF, relative MBF achieved 69% sensitivity, 88% specificity, and 85% accuracy in detecting significant stenosis.
Conclusions:
- Microvascular status in the non-ischemic myocardium significantly influences dynamic CTP's diagnostic performance.
- Relative MBF appears more reliable than absolute MBF for ischemia detection across varying microvascular statuses.
- Personalized evaluation of myocardial perfusion in CTP is necessary due to the impact of remote MBF on diagnostic accuracy.
Objectives:
This study aimed to investigate the relationship between microvascular status in the non-ischemic myocardium and the diagnostic performance of stress dynamic CT perfusion imaging (CTP) in detecting hemodynamically significant stenosis.
Materials And Methods:
This study included 157 patients who underwent coronary computed tomography angiography (CTA), CTP, and invasive coronary angiography (ICA), including fractional flow reserve (FFR). Hemodynamically significant stenosis was defined by FFR and ICA. A relative myocardial blood flow (MBF) for each myocardial segment was normalized to the highest MBF (remote MBF) among 16 segments.
Results:
The receiver operating characteristic curve analysis for detecting hemodynamically significant stenosis at the vessel level indicated that patients with lower, intermediate, and higher remote MBF had areas under the curve (AUC) of 0.66, 0.70, and 0.80, respectively, for absolute MBF and AUCs of 0.63, 0.70, and 0.83, respectively, for relative MBF. The optimal cut-off values for absolute MBF were proportional to the levels of remote MBFs, while the ones for relative MBF were more consistent across lower to higher remote MBFs. For the patients with high remote MBF, the relative MBF demonstrated a sensitivity of 69%, specificity of 88%, and accuracy of 85% in detecting hemodynamically significant stenosis.
Conclusion:
The microvascular status in the non-ischemic myocardium influenced the diagnostic performance of dynamic CTP and threshold values of absolute MBFs, suggesting the potential preference for relative MBF over absolute MBF in clinical settings. Dynamic CTP's quantification of MBF offers the benefit of indicating reliability in ischemia detection relative to microvascular status.
Key Points:
Question The relationship between microvascular status and diagnostic performance of dynamic CTP imaging has not been fully investigated. Findings The diagnostic performance of dynamic CTP and threshold values of absolute MBF were impacted by microvascular status. Clinical relevance The differences in diagnostic accuracy of dynamic CTP related to varying remote MBF values necessitate a personalized evaluation of myocardial perfusion in dynamic CTP images.
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