Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study

Ostovaneh, Mohammad Reza; Vavere, Andrea L.; Mehra, Vishal C.; Kofoed, Klaus F.; Matheson, Matthew B.; Arbab‐Zadeh, Armin; Fujisawa, Yasuko; Schuijf, Joanne D.; Rochitte, Carlos Eduardo; Scholte, Arthur J.; Kitagawa, Kakuya; Dewey, Marc; Cox, Christopher; DiCarli, Marcelo F.; George, Richard Т. De; Lima, João A.C.

doi:10.1016/j.jcct.2018.03.010

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Therefore, myocardial perfusion can, in principle, be measured quantitatively (absolute MBF) 142 ( Fig. 7a) and/or semiquantitatively (static imaging) 143,144 . Furthermore, microvascular disease in addition to collateral circulation specifically in patients with occluded vessels can also be evaluated 145,146 .…”

Section: Key Points For Echocardiographymentioning

confidence: 99%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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International guidelines advocate noninvasive testing for patients with suspected ischaemia before proceeding with revascularization decision-making 1-4. Noninvasive clinical cardiac imaging continues to undergo rapid evolution, focusing on quantitative perfusion technologies for the assessment of myocardial ischaemia and coronary flow. At present, imaging of myocardial ischaemia stands at a crossroads. During a European meeting on quantitative cardiac imaging, a bench-to-bedside-to-bench perspective was used to summarize the current status and future potential of myocardial ischaemia imaging from the viewpoint of basic scientists and clinical researchers. This approach created discussions, which led to this Consensus Statement on the main advantages and disadvantages of each imaging modality, a clinical consensus on the appropriateness for specific indications and a summary of the latest developments, which together provide a framework for future quantitative imaging of myocardial ischaemia. Pathophysiology considerations The coronary circulation comprises the epicardial conductance vessels (diameter 1-6 mm) feeding an extensive network of small vessels (diameter <300-400 μm) that penetrates the cardiac muscle tissue and is the site of regulation of myocardial blood flow (MBF; Fig. 1a,b). High-resolution 3D fluorescence cryomicrotome imaging 5 has also revealed the existence of abundant small

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Section: Key Points For Echocardiographymentioning

confidence: 99%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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“…These techniques are based on different pathophysiological assumptions: in s-CTP, a vasodilator stress is used to quantify the MBF; if the myocardium is normally perfused, the contrast agent is regularly transported inside it; if ischemia is present, less contrast agent reaches the affected region and its wash-in or wash-out is delayed. It is possible to measure MBF quantitatively or semi-quantitatively [ 67 , 68 ]. Otherwise, FFR CT uses mathematical models to calculate the FFR providing detailed information on the degree of coronary artery obstruction and the effect such obstructions may have on myocardial perfusion.…”

Section: The Role Of Multimodality Imaging In Identifying Patients Wo...mentioning

confidence: 99%

The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes

Tassetti,

Sfriso,

Torlone

et al. 2024

JCM

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Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.

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“…Pure anatomical evaluation of stenosis severity by CTA does not inform about the hemodynamic significance of a given coronary stenosis [3,4]. The additional use of physiologic information to detect hemodynamically significant CAD, see Figure 1, has an incremental prognostic value over CTA alone and allows improved risk stratification of patients with CTA-detected stenosis [5][6][7], as shown, for example, in the CORE320 study [8]. Second line non-invasive functional assessment of a detected coronary artery stenosis is therefore an attractive addition to CTA, but relies mostly on referral to other imaging modalities: non-invasively by cardiac magnetic resonance (MR) perfusion [9,10], positron-emission tomography (PET) [11] or CT perfusion (CTP) [12].…”

Section: Manteltext Introductionmentioning

confidence: 99%

“…Preliminary analysis: Image quality assessment by temporal averaging. Cardiac volumes were averaged for different sample window widths of(1,2,3,4,6,8) time points centered on the reference volume most suitable for visual assessment of perfusion defects. Objective image quality (noise, signal-to-noise ratio, contrast-to-nose ratio) was assessed in the left ventricle, the healthy and the ischemic myocardium, respectively.…”

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Noise reduction and motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP): preliminary clinical evaluation of the ASTRA4D algorithm

et al. 2019

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Objectives. To propose and evaluate a four-dimensional (4D) algorithm for joint motion elimination and spatiotemporal noise reduction in low-dose dynamic myocardial computed tomography perfusion (CTP).Methods. Thirty patients with suspected or confirmed coronary artery disease were prospectively included und underwent dynamic contrast-enhanced 320-row CTP. The presented deformable image registration method ASTRA4D identifies a low-dimensional linear model of contrast propagation (by principal component analysis, PCA) of the ex-ante temporally smoothed time-intensity curves (by local polynomial regression). Quantitative (standard deviation, signal-to-noise ratio (SNR), temporal variation, volumetric deformation) and qualitative (motion, contrast, contour sharpness; 1, poor; 5, excellent) measures of CTP quality were assessed for the original and motion-compensated volumes (without and with temporal filtering, PCA/ASTRA4D). Following visual myocardial perfusion deficit detection by two readers, diagnostic accuracy was evaluated using 1.5T magnetic resonance (MR) myocardial perfusion imaging as the reference standard in 15 patients.Results. Registration using ASTRA4D was successful in all 30 patients and resulted in comparison with the benchmark PCA in significantly (p<0.001) reduced noise over time (-83%, 178.5 vs 29.9) and spatially (-34%, 21.4 vs 14.1) as well as improved SNR (+47%, 3.6 vs 5.3) and subjective image quality (motion, contrast, contour sharpness: +1.0, +1.0, +0.5). ASTRA4D resulted in significantly improved per-segment sensitivity of 91% (58/64) and similar specificity of 96% (429/446) compared with PCA (52%, 33/64; 98%, 435/446; p=0.011) and the original sequence (45%, 29/64; 98%, 438/446; p=0.003) in the visual detection of perfusion deficits. Conclusions.The proposed functional approach to temporal denoising and morphologic alignment was shown to improve quality metrics and sensitivity of 4D CTP in the detection of myocardial ischemia. 4 Abstrakt (Deutsch) Zielsetzung. Die Entwicklung und Bewertung einer Methode zur simultanen Rauschreduktion und Bewegungskorrektur für niedrig dosierte dynamische CT Myokardperfusion. Methoden. Dreißig prospektiv eingeschlossene Patienten mit vermuteter oder bestätigter koronarer Herzkrankheit wurden einer dynamischen CT Myokardperfusionsuntersuchung unterzogen. Die präsentierte Registrierungsmethode ASTRA4D ermittelt ein niedrigdimensionales Modell des Kontrastmittelflusses (mittels einer Hauptkomponentenanalyse, PCA) der vorab zeitlich geglätteten Intensitätskurven (mittels lokaler polynomialer Regression). Quantitative (Standardabweichung, Signal-Rausch-Verhältnis (SNR), zeitliche Schwankung, räumliche Verformung) und qualitative (Bewegung, Kontrast, Kantenschärfe; 1, schlecht; 5, ausgezeichnet) Kennzahlen der unbearbeiteten und bewegungskorrigierten Perfusionsdatensätze (ohne und mit zeitlicher Glättung PCA/ASTRA4D) wurden ermittelt. Nach visueller Beurteilung von myokardialen Perfusionsdefiziten durch zwei Radiologen wurde die diagnostische Genauigkeit im Ver...

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Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study

Cited by 6 publications

References 16 publications

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes

Noise reduction and motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP): preliminary clinical evaluation of the ASTRA4D algorithm

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