Related Experiment Video
Updated: Jan 10, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative cardiac CT perfusion: physiologically-inspired model and identifying microvascular disease from
Hao Wu1, Yingnan Song1, Ammar Hoori1
1Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.
Insights
Cardiac CT perfusion software distinguishes obstructive coronary artery disease from microvascular dysfunction. This advanced analysis of myocardial blood flow (MBF) aids in diagnosing ischemia, particularly in diabetic patients.
Area of Science:
- Cardiovascular imaging and diagnostics
- Medical software and algorithms
- Physiology and pathophysiology of the heart
Background:
- Distinguishing between obstructive coronary artery disease (CAD) and microvascular disease (MVD) is crucial for accurate diagnosis and treatment of cardiac ischemia.
- Previously validated advanced cardiac CT perfusion (CCTP) methods were employed to interpret results.
- The study aimed to differentiate flow-limiting stenosis (obstructive lesions with low myocardial blood flow) from MVD (non-obstructive lesions with low myocardial blood flow).
Purpose of the Study:
- To evaluate an advanced, physiologically inspired cardiac CT perfusion (CCTP) software for distinguishing ischemia caused by obstructive coronary artery disease versus microvascular disease (MVD).
- To assess the capability of automated CCTP analysis in differentiating the causes of myocardial ischemia.
- To investigate the prevalence of MVD in patients with suspected CAD, including subgroups like diabetics.
Main Methods:
- Retrospective evaluation of 104 patients with suspected CAD, including 18 with diabetes, who underwent CCTA + CCTP.
- Utilized an automated pipeline for CCTP analysis, incorporating corrections and robust estimation of whole heart and territorial myocardial blood flow (MBF).
- Coronary artery stenosis severity was scored using CAD-RADS, with CAD-RADS ≥ 3 indicating obstructive stenosis.
Main Results:
- A threshold MBF of 200 mL/min/100g was established for normal perfusion.
- In patients with obstructive disease (CAD-RADS ≥ 3), 76% showed ischemia in the corresponding territory.
- MBF significantly differed between territories with and without obstructive stenosis (165 vs. 274 mL/min/100g, p < 0.05), with a negative correlation between MBF and CAD-RADS (ρ = -0.53, p < 0.05).
- Microvascular disease was identified in 56% of diabetic patients compared to 6% of non-diabetics.
Conclusions:
- Coronary CT angiography (CCTA) combined with an automated quantitative CCTP approach effectively distinguishes ischemia due to obstructive lesions from MVD.
- The automated CCTP analysis provides valuable quantitative assessment of myocardial blood flow.
- This technology aids in the etiological diagnosis of cardiac ischemia, highlighting a higher prevalence of MVD in diabetic patients.
Objective:
Use our advanced, physiologically inspired cardiac CT perfusion (CCTP) software to distinguish ischemia due to obstructive disease vs. microvascular disease (MVD).
Background:
Previously validated advanced CCTP methods were used. We interpreted results to identify flow-limiting stenosis [i.e., obstructive-lesion & low myocardial blood flow (MBF)] vs. microvascular disease (i.e., no-obstructive-lesion & low-MBF).
Methods:
We retrospectively evaluated 104 patients with suspected CAD, including 18 with diabetes, who underwent CCTA + CCTP. Whole heart and territorial MBF was assessed using our automated pipeline for CCTP analysis that included beam hardening correction; temporal scan registration; automated segmentation; fast, accurate, robust MBF estimation; and visualization. Stenosis severity was scored using the CCTA coronary-artery-disease-reporting-and-data-system (CAD-RADS), with obstructive stenosis deemed as CAD-RADS ≥ 3.
Results:
We established a threshold MBF (MBF = 200-mL/min-100 g) for normal perfusion. In patients with CAD-RADS ≥ 3 (obstructive disease), 28/37(76%) patients showed ischemia in the corresponding territory. On a per-vessel basis (n = 256), MBF showed a significant difference between territories with and without obstructive stenosis (165 ± 61 mL/min-100 g vs. 274 ± 62 mL/min-100 g, p < 0.05). A significant negative rank correlation (ρ = -0.53, p < 0.05) between territory MBF and CAD-RADS was seen. Two patients with obstructive disease had normal perfusion, suggesting collaterals and/or hemodynamically insignificant stenosis. Among diabetics, 10 of 18 (56%) demonstrated diffuse ischemia consistent with MVD. Among non-diabetics, only 6% had MVD. Sex-specific prevalence of MVD was 21%/24% (M/F).
Conclusion:
CCTA in conjunction with a new automated quantitative CCTP approach can determine the distinction of ischemia due to obstructive lesions vs. MVD.
