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Quantification of volumetric coronary blood flow with dual-energy digital subtraction angiography
1Department of Radiological Sciences, Medical Sciences I, University of California, Irvine, 92717, USA.
Insights
Dual-energy digital subtraction angiography (DE DSA) provides accurate volumetric coronary blood flow (BF) measurements. This technique allows for reliable assessment of arterial stenosis during routine coronary arteriography without significant BF changes.
Area of Science:
- Cardiovascular Imaging
- Physiology
- Medical Devices
Background:
- Visual interpretation of coronary arteriograms presents challenges.
- Physiological methods for assessing coronary artery stenosis are under investigation.
- Volumetric coronary blood flow (BF) aids in analyzing arterial obstruction significance.
Purpose of the Study:
- To evaluate the accuracy of motion-immune dual-energy digital subtraction angiography (DE DSA) for measuring coronary blood flow (BF).
- To determine if BF measurements can be obtained before significant changes occur due to contrast injection.
- To assess the feasibility of BF measurement during routine coronary arteriography.
Main Methods:
- Utilized a transmit-time ultrasound flow probe on the left anterior descending coronary artery (LAD) in anesthetized pigs.
- Employed a vascular occluder for flow adjustments.
- Performed contrast injections during image acquisition using a motion-immune DE DSA system.
- Generated time-density curves from tissue-suppressed, energy-subtracted images for BF calculation.
Main Results:
- DE DSA measurements of BF correlated extremely well with ultrasound flow measurements (r=.96).
- The correlation equation was DE DSA = 0.90 ultrasound + 3.10 mL/min.
- Contrast injection increased BF by an average of only 15% during image acquisition.
Conclusions:
- Motion-immune DE DSA enables accurate volumetric coronary blood flow (BF) measurements.
- BF measurements can be completed before significant contrast-induced changes occur.
- This method is suitable for integration into routine coronary arteriography procedures.
Background:
As a solution to the well-documented problems associated with visual interpretation of coronary arteriograms, more physiological methods of assessing coronary artery stenosis are being investigated. Volumetric coronary blood flow (BF) can be a valuable aid in the analysis of functional significance of arterial obstruction.
Methods And Results:
The left anterior descending coronary artery (LAD) of 15 anesthetized pigs (40 to 50 kg) was dissected free from the epicardium in its proximal portion, and a transmit-time ultrasound flow probe of the appropriate size was applied. A vascular occluder was positioned distal to the flow probe for flow adjustments. Contrast injections (2 to 4 mL/s for 3 seconds) were made into the left main coronary artery during image acquisition with a motion-immune dual-energy digital subtraction angiography (DE DSA) system. Tissue-suppressed energy-subtracted images were used to generate time-density curves. BF measurements were made in the LAD vascular bed with use of the time-density curve, with consideration that blood was momentarily replaced with contrast during the injection. In 19 comparisons, the mean BF, measured with the use of DE DSA, correlated extremely well with the mean ultrasound flow (DE DSA=0.90 ultrasound+3.10 mL/min, r=.96). Also, contrast injection increased the BF by an average of only 15% during the image-acquisition time interval.
Conclusions:
Accurate BF measurements can be made with motion-immune DE DSA. The BF measurements can be completed before the onset of significant changes in BF due to contrast injection. Furthermore, it is possible to make the BF measurements during routine coronary arteriography.