Relative Myocardial Blood Flow by Dynamic Computed Tomographic Perfusion Imaging Predicts Hemodynamic Significance of Coronary Stenosis Better Than Absolute Blood Flow

Kono, Atsushi K.; Coenen, Adriaan; Lubbers, Marisa; Kurata, Akira; Rossi, Alexia; Dharampal, Anoeshka S.; Dijkshoorn, Marcel L.; Geuns, Robert‐Jan van; Krestin, Gabriël P.; Nieman, Koen

doi:10.1097/rli.0000000000000087

Cited by 63 publications

(46 citation statements)

References 29 publications

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“…The results of our study confirm the hypothesis that incorporating assessment of the remote myocardium to calculate the MBF ratio may mitigate technical and interindividual differences in reference MBF values and thus improve diagnostic performance for the detection of myocardial ischemia [14]. Several prior studies have shown the ability of stress dynamic CT MPI to detect myocardial perfusion deficits in patients with hemodynamically relevant CAD but also reported a distinct variability in optimal MBF cutoff values, ranging from 57 to 90 mL/100 mL/min [3,5,7,8,12,13].…”

Section: Discussionsupporting

confidence: 85%

“…Kono et al [14] reported a higher sensitivity (97.8% vs 88.9%) but decreased specificity (69.6 vs 47.8%) for MBF ratio and absolute MBF, respectively, compared with our results (sensitivity, 90.7% and 82.4%; specificity, 93.1% and 80.5%). Although they used a nearly identical calculated optimal absolute MBF threshold of 103.1 mL/100 mL/min, they computed an optimal MBF ratio cutoff of 0.85 compared with less than or equal to 103 mL/100 mL/min and less than or equal to 0.71 in our study, respectively.…”

Section: Myocardial Blood Flow Measured By Myocardial Perfusion Imagingcontrasting

confidence: 73%

“…Thus, the development of a universal optimal MBF threshold for evaluating CT MPI datasets remains challenging. Kono et al [14] recently compared in a small group of patients MBF ratio derived from CT MPI with invasive fractional flow reserve (FFR) measurements and found that MBF ratio showed a superior correlation with invasive FFR compared with absolute MBF, improving the identification of patients with hemodynamically significant CAD. Note-Data are percentages.…”

Section: Discussionmentioning

confidence: 97%

“…This may be caused not only by technical or methodologic reasons but also by systematic interindividual differences in MBF. As recently reported, a relative measure of focal MBF in comparison with healthy remote myocardium (MBF ratio) may be more accurate for the identification of hemodynamically significant coronary artery stenosis [14].…”

Section: Wichmann Et Almentioning

confidence: 96%

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Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease

Wichmann

Meinel

Schoepf

et al. 2015

American Journal of Roentgenology

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Section: Discussionsupporting

confidence: 85%

Section: Myocardial Blood Flow Measured By Myocardial Perfusion Imagingcontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 97%

Section: Wichmann Et Almentioning

confidence: 96%

See 2 more Smart Citations

Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease

Wichmann

Meinel

Schoepf

et al. 2015

American Journal of Roentgenology

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“…Superior diagnostic performance of the CT-derived relative MBF value has been demonstrated for the detection of significant coronary artery stenosis when compared with absolute MBF values. 37, 38 Kono et al demonstrated that the AUC of the relative MBF value was significantly greater than that of the absolute MBF value (0.87 and 0.75, respectively). Their AUCs were comparable with our current results.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Goto

Kitagawa

Uno

et al. 2017

Circ J

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limited response to vasodilator stress, resulting in globally reduced hyperemic MBF. 15 Because the endocardial layer is most susceptible to ischemia, 16,17 the ratio of endocardial MBF and epicardial MBF might be a more useful indicator of flow-limiting CAD.The purpose of this study was to investigate whether the transmural ratio of absolute MBF can improve the accuracy of CTP when compared with absolute MBF for the detection of flow-limiting CAD, as defined by fractional flow reserve (FFR). We also explored the prevalence of myocardial scar in candidates for CTP and its effect on the diagnostic performance of CTP. Methods Study PopulationIn the comprehensive cardiac CT registry at Mie University C oronary computed tomography angiography (CCTA) allows noninvasive assessment of the morphology of coronary artery stenosis and is highly useful for ruling out the presence of obstructive coronary artery disease (CAD). 1,2 However, because obstructive stenosis identified by CCTA is a poor predictor of the presence of myocardial ischemia, a functional test is generally recommended to investigate the hemodynamic significance of the stenotic lesion. 3 Stress dynamic CT perfusion (CTP) with absolute quantification of myocardial blood flow (MBF) is a new noninvasive technique for the assessment of myocardial ischemia. 4,5 Previous CTP studies used absolute MBF thresholds in mL/100 g/min to discriminate flow-limiting CAD, 6-10 but the absolute MBF can vary because of factors other than the degree of coronary artery stenosis. Yoshitaka Goto, MD; Kakuya Kitagawa, MD; Mio Uno, MD; Shiro Nakamori, MD; Tatsuro Ito, MD; Naoki Nagasawa, PhD; Kaoru Dohi, MD; Hajime Sakuma, MD Background: Previous dynamic stress computed tomography perfusion (CTP) studies used absolute myocardial blood flow (MBF in mL/100 g/min) as a threshold to discriminate flow-limiting coronary artery disease (CAD), but absolute MBF can be vary because of multiple factors. The aim of this study was to compare the diagnostic performance of absolute MBF and the transmural perfusion ratio (TPR) for the detection of flow-limiting CAD, and to clarify the influence of CT delayed enhancement (CTDE) on the diagnostic performance of CTP.

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Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories

et al. 2017

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Purpose: Myocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused 20 by physiological, methodological and technical issues. In this paper we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) in order to overcome the limitations of current dynamic CTP MBF analysis methods. Methods:The diagnostic performance of HPV in classifying significant stenoses was 25 evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by 30 locating the closest artery. Diagnostic performance was evaluated using leave-onecase out cross validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. Additionally, the influence of different parameter settings on the diagnostic performance of HPV was assessed. 35Results: Leave-one-case out cross validation showed that HPV has an accuracy of 72%(58%-83%) with sensitivity of 72%(47%-90%) and specificity of 72%(58%-83%).The accuracy of MA-MBF was 70%(57%-82%) with a sensitivity of 50%(26%-74%) and a specificity of 79%(64%-91%). The Spearman correlation and the kappa statistic was (ρ=0.94, κ=0.86) for HPV and (ρ=0.72, κ=0.82) for MA-MBF. The influence of 40 parameter settings on HPV based diagnostic performance was not significant. Conclusions:The proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the 45 supplied myocardial territory.

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Relative Myocardial Blood Flow by Dynamic Computed Tomographic Perfusion Imaging Predicts Hemodynamic Significance of Coronary Stenosis Better Than Absolute Blood Flow

Abstract: The MBFratio seems to better identify hemodynamically significant coronary artery disease than does the absolute MBF determined by dynamic CT perfusion imaging. This may be caused by microvascular status or related to the methodology.

Cited by 63 publications

References 29 publications

Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease

Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories

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