Myocardial CT Perfusion Imaging in a Large Animal Model: Comparison of Dynamic Versus Single-Phase Acquisitions

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• 作者：Florian Schwarz ; Rabea Hinkel ; Elisabeth Baloch ; Roy P. Marcus ; Kristof Hildebr ; t ; Torleif A. S ; ner ; Christian Kupatt ; Verena Hoffmann ; Bernd J. Wintersperger ; Maximilian F. Reiser ; Daniel Theisen ; Konstantin Nikolaou ; Fabian Bamberg
• 关键词：cardiac CT ; infarct ; ischemia ; myocardial perfusion
• 刊名：JACC: Cardiovascular Imaging
• 出版年：December, 2013
• 年：2013
• 卷：6
• 期：12
• 页码：1229-1238
• 全文大小：723 K

文摘

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Objectives

This study sought to compare dynamic versus single-phase high-pitch computed tomography (CT) acquisitions for the assessment of myocardial perfusion in a porcine model with adjustable degrees of coronary stenosis.

Background

The incremental value of the 2 different approaches to CT-based myocardial perfusion imaging remains unclear.

Methods

Country pigs received stent implantation in the left anterior descending coronary artery, in which an adjustable narrowing (50% and 75% stenoses) was created using a balloon catheter. All animals underwent CT-based rest and adenosine-stress myocardial perfusion imaging using dynamic and single-phase high-pitch acquisitions at both degrees of stenosis. Fluorescent microspheres served as a reference standard for myocardial blood flow. Segmental CT-based myocardial blood flow (MBF_CT) was derived from dynamic acquisitions. Segmental single-phase enhancement (SPE) was recorded from high-pitch, single-phase examinations. MBF_CT and SPE were compared between post-stenotic and reference segments, and receiver-operating characteristic curve analysis was performed.

Results

Among 6 animals (28 卤 2 kg), there were significant differences of MBF_CT and SPE between post-stenotic and reference segments for all acquisitions at 75% stenosis. By contrast, although for 50% stenosis at rest, MBF_CT was lower in post-stenotic than in reference segments (0.65 卤 0.10 ml/g/min vs. 0.75 卤 0.16 ml/g/min, p < 0.05), there was no difference for SPE (128 卤 27 Hounsfield units vs. 137 卤 35聽Hounsfield units, p聽= 0.17), which also did not significantly change under adenosine stress. In receiver-operating characteristic curve analyses, segmental MBF_CT showed significantly better performance for ischemia prediction at 75% stenosis and stress (area under the curve: 0.99 vs. 0.89, p < 0.05) as well as for 50% stenosis, regardless of adenosine administration (area under the curve: 0.74 vs. 0.57 and 0.88 vs. 0.61, respectively, both p < 0.05).

Conclusions

At higher degrees of coronary stenosis, both MBF_CT and SPE permit an accurate prediction of segmental myocardial hypoperfusion. However, accuracy of MBF_CT is higher than that of SPE at 50% stenosis and can be increased by adenosine stress at both degrees of stenosis.