Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing: Detection of ischemia for intermediate coronary stenosis

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• 作者：Michinobu Nagao^a ; ^{minagao@radiol.med.kyushu-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yuzo Yamasaki^b ; Takeshi Kamitani^b ; Satoshi Kawanami^a ; Koji Sagiyama^b ; Torahiko Yamanouchi^b ; Yamato Shimomiya^c ; Tetsuya Matoba^d ; Yasushi Mukai^d ; Keita Odashiro^e ; Shingo Baba^b ; Yasuhiro Maruoka^b ; Yoshiyuki Kitamura^b ; Akihiro Nishie^b ; Hiroshi Honda^b
• 关键词：AHA ; American Heart Association ; AUC ; area under the curve ; CAD ; coronary artery disease ; CCTA ; coronary computed tomography angiography ; CFI ; coronary flow index ; ECG ; electrocardiography ; FFR ; fractional flow reserve ; Heart-DCT ; dynamic CT angiography for the whole heart ; LAD ; left anterior descending artery ; LCX ; left circumflex artery ; MCIP ; motion coherence image processing ; MPR ; multiplanar reconstruction ; MPS ; myocardial perfusion scintigraphy ; RCA ; right coronary artery ; ROC ; receiver-op
• 刊名：European Journal of Radiology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：85
• 期：5
• 页码：996-1003
• 全文大小：2513 K

文摘

Anatomical coronary stenosis is not always indicative of functional stenosis, particularly for intermediate coronary lesions. The purpose of this study is to propose a new method for quantifying coronary flow using dynamic CT angiography for the whole heart (heart-DCT) and investigate its ability for detecting ischemia from intermediate coronary stenosis.

Methods

Participants comprised 36 patients with coronary artery disease who underwent heart-DCT using 320-detector CT with tube voltage of 80 kV and myocardial perfusion scintigraphy (MPS). Heart-DCT was continuously performed at mid-diastole throughout 15–25 cardiac cycles with prospective ECG-gating after bolus injection of contrast media (12–24 ml). Dynamic datasets were computed into 90–100 data sets by motion coherence image processing (MCIP). Next, time-density curves (TDCs) for coronary arteries with a diameter >3 mm were automatically calculated for all phases using MCIP. On the basis of the maximum slope method, coronary flow index (CFI) was defined as the ratio of the maximum upslope of coronary artery attenuation to the upslope of ascending aorta attenuation on the TDC, and was used to quantify coronary flow. CFIs for the proximal and distal sites of coronary arteries with mild-to-moderate stenosis were calculated. Coronary territories were categorized as non-ischemic or ischemic by MPS. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff for CFI to detect ischemia.

Results

Distal CFI was significantly lower for ischemia (0.26 ± 0.08) than for non-ischemia (0.50 ± 0.17, p < 0.0001). No significant difference in proximal CFI was seen between ischemia (0.55 ± 0.23) and non-ischemia (0.62 ± 0.24). ROC analysis revealed 0.39 as the optimal cutoff for distal CFI to detect ischemia, with C-statistics of 0.91, 100% sensitivity, and 75% specificity.

Conclusions

This novel imaging technique allows coronary flow quantification using heart-DCT. Distal CFI can detect myocardial ischemia derived from intermediate coronary stenosis.