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Functional assessment of coronary artery flow using adenosine stress dual-energy CT: a preliminary study

By Michinobu Nagao, Teruhito Kido, Kouki Watanabe, Hideyuki Saeki, Hideki Okayama, Akira Kurata, Kohei Hosokawa, Hiroshi Higashino and Teruhito Mochizuki

Abstract

We attempted to assess coronary artery flow using adenosine-stress and dual-energy mode with dual-source CT (DE-CT). Data of 18 patients with suspected coronary arteries disease who had undergone cardiac DE-CT were retrospectively analyzed. The patients were divided into two groups: 10 patients who performed adenosine stress CT, and 8 patients who performed rest CT as controls. We reconstructed an iodine map and composite images at 120 kV (120 kV images) using raw data with scan parameters of 100 and 140 kV. We measured mean attenuation in the coronary artery proximal to the distal portion on both the iodine map and 120 kV images. Coronary enhancement ratio (CER) was calculated by dividing mean attenuation in the coronary artery by attenuation in the aortic root, and was used as an estimate of coronary enhancement. Coronary stenosis was identified as a reduction in diameter of >50% on CT angiogram, and myocardial ischemia was diagnosed by adenosine-stress myocardial perfusion scintigraphy. The iodine map showed that CER was significantly lower for ischemic territories (0.76 ± 0.06) or stenosed coronary arteries (0.77 ± 0.06) than for non-ischemic territories (0.95 ± 0.21, P = 0.02) or non-stenosed coronary arteries (1.07 ± 0.33, P < 0.001). The 120 kV images showed no difference in CER between these two groups. Use of CER on the iodine map separated ischemic territories from non-ischemic territories with a sensitivity of 86% and a specificity of 75%. Our quantification is the first non-invasive analytical technique for assessment of coronary artery flow using cardiac CT. CER on the iodine map is a candidate method for demonstration of alteration in coronary artery flow under adenosine stress, which is related to the physiological significance of coronary artery disease

Topics: Original Paper
Publisher: Springer Netherlands
OAI identifier: oai:pubmedcentral.nih.gov:3092061
Provided by: PubMed Central

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Citations

  1. A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience.
  2. (2003). ACC/AHA/ ASNC guidelines for the clinical use of cardiac radionuclide imaging.
  3. (2006). ACC/AHA/SCAI
  4. (2009). Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.
  5. (2007). Assessment of intermediate severity coronary lesions in the catheterization laboratory.
  6. Aviles FF et al (2005) Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European society of cardiology.
  7. (2000). Coronary physiology revisited: practical insights from the cardiac catheterization laboratory.
  8. (2004). CT perfusion image of the lung: value in detection of pulmonary embolism in a porcine model.
  9. (1998). Current concepts of coronary flow reserve for clinical decision making during cardiac catheterization.
  10. (2005). Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.
  11. (1984). Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis?
  12. (1990). Effect of adenosine on human coronary arterial circulation.
  13. (2006). First performance evaluation of a dual-source CT (DSCT) system.
  14. (2004). Fractional flow reserve: critical review of an important physiologic adjunct to angiography.
  15. (2010). Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging 3:179–186
  16. (2007). Material differentiation by dual energy CT: initial experience.
  17. (1996). Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses.
  18. (2005). Multislice computed tomography perfusion imaging for visualization of acute pulmonary embolism: animal experience.
  19. (2005). Myocardial perfusionimagingusingadenosinetriphosphatestressmultislice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy.
  20. Pelt N et al (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina.
  21. (2006). Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology.
  22. (2009). Pulmonary embolism detection with dual-energy CT: experimental study of dual-source CT in rabbits.
  23. (2008). Quantification of myocardial perfusion by contrast-enhanced 64-slice MDCT: characterization of ischemic myocardium.
  24. (1991). Quantitative thallium-201 single-photon emission computed tomography during maximal pharmacologic coronary vasodilatation with adenosine for assessing coronary artery disease.
  25. (2007). Reliable high-speed coronary computed tomography in symptomatic patients.
  26. (1977). Selective iodine imaging using K-edge energies in computerized x-ray tomography.
  27. (2008). Spatial heterogeneity of myocardial perfusion predicts local potassium channel expression and action potential duration. Cardiovasc Res 77:489–496 480 Int J Cardiovasc Imaging
  28. (2002). Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging
  29. Tsiflikas I et al (2008) Dualsource CT: effects of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy.
  30. Zwerner PL et al (2008) Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience.