Quantitative low-dose rest and stress CT myocardial perfusion imaging with a whole-heart coverage scanner improves functional assessment of coronary artery disease

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Abstract

Objective

We evaluated the diagnostic accuracy of myocardial blood flow (MBF) and perfusion reserve (MPR) measured from low-dose dynamic contrast-enhanced (DCE) imaging with a whole-heart coverage CT scanner for detecting functionally significant coronary artery disease (CAD).

Methods

Twenty one patients with suspected or known CAD had rest and dipyridamole stress MBF measurements with CT and SPECT myocardial perfusion imaging (MPI), and lumen narrowing assessment with coronary angiography (catheter and/or CT based) within 6 weeks. SPECT MBF measurements and coronary angiography were used together as reference to determine the functional significance of coronary artery stenosis. In each CT MPI study, DCE images of the whole heart were acquired with breath-hold using a low-dose acquisition protocol to generate MBF maps. Binomial logistic regression analysis was used to determine the diagnostic accuracy of CT-measured MBF and MPR (ratio of stress to rest MBF) for assessing functionally significant coronary stenosis.

Results

Mean stress MBF and MPR in ischemic segments were lower than those in non-ischemic segments (1.37 ± 0.34 vs. 2.14 ± 0.64 ml/min/g; 1.56 ± 0.41 vs. 2.53 ± 0.70; p < 0.05 for all). The receiver operating characteristic curve analysis revealed that MPR (AUC 0.916, 95%CI: 0.885–0.947) had a superior power than stress MBF (AUC 0.869, 95%CI: 0.830–0.909) for differentiating non-ischemic and ischemic myocardial segments (p = 0.045). On a per-vessel and per-segment analysis, concomitant use of MPR and stress MBF thresholds further improved the diagnostic accuracy compared to MPR or stress MBF alone for detecting obstructive coronary lesions (per-vessel: 93.4% vs. 83.6% and 88.5%, respectively; per-segment: 90.0% vs. 83.7% and 83.1%, respectively). The estimated effective dose of a rest and stress CT MPI study was 3.04 and 3.19 mSv respectively.

Conclusion

Quantitative rest and stress myocardial perfusion measurement with a large-coverage CT scanner improves the diagnostic accuracy for detecting functionally significant coronary stenosis.

Related collections

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The purpose of our study was to determine the effect of Adaptive Statistical Iterative Reconstruction (ASIR) on cardiac CT angiography (CTA) signal, noise, and image quality. We evaluated 62 consecutive patients at three sites who underwent clinically indicated cardiac CTA using an ASIR-capable 64-MDCT scanner and a low-dose cardiac CTA technique. Studies were reconstructed using filtered back projection (FBP), ASIR-FBP composites using 20-80% ASIR, and 100% ASIR. The signal and noise were measured in the aortic root and each of the four coronary arteries. Two blinded readers graded image quality on a 5-point Likert scale and determined the proportion of interpretable segments. All segments were included for analysis regardless of size. In comparison with FBP (0% ASIR), the use of 20%, 40%, 60%, 80%, and 100% ASIR resulted in reduced image noise between groups (-7%, -17%, -26%, -35%, and -43%, respectively; p < 0.001) without difference in signal (p = 0.60). There were significant differences between groups (0%, 20%, 40%, 60%, 80%, and 100% ASIR) in the Likert scores (1.5, 2.1, 3.7, 3.8, 2.0, and 1.1, respectively; p < 0.001) and proportion of interpretable segments (88.7%, 89.3%, 90.5%, 90.4%, 88.0%, and 87.3%, respectively; p < 0.001). Reconstruction using 40% and 60% ASIR had the highest Likert scores and largest proportion of interpretable segments. In comparison with FBP, each was associated with higher Likert scores and increased interpretable segments (p < 0.001 for all). ASIR resulted in noise reduction and significantly impacted image quality. When using a low tube current technique, cardiac CTA reconstruction using 40% or 60% ASIR significantly improved image quality and the proportion of interpretable segments compared with FBP reconstruction.

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Author and article information

Contributors

Aaron So

Journal

Journal ID (nlm-ta): Int J Cardiol Heart Vasc

Journal ID (iso-abbrev): Int J Cardiol Heart Vasc

Title: International Journal of Cardiology. Heart & Vasculature

Publisher: Elsevier

ISSN (Electronic): 2352-9067

Publication date PMC-release: 20 June 2019

Publication date Collection: September 2019

Publication date (Electronic): 20 June 2019

Volume: 24

Electronic Location Identifier: 100381

Affiliations

[a ]Radiology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan

[b ]Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan

[c ]Nuclear Medicine, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan

[d ]Cardiology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan

[e ]Imaging, Robarts Research Institute, London, Ontario, Canada

[f ]Imaging, Lawson Health Research Institute, London, Ontario, Canada

Author notes

[* ]Corresponding author at: Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada. aso@ 123456robarts.ca

[1]

I.L. Huang and M.T. Wu are co-first authors.

Article

Publisher ID: S2352-9067(19)30054-5 Publisher ID: 100381

DOI: 10.1016/j.ijcha.2019.100381

PMC ID: 6859740

SO-VID: dff43067-2146-4442-b5f6-336c1c490978

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 14 December 2018

Date revision received : 21 May 2019

Date accepted : 3 June 2019

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