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Non-invasive assessment of functionally relevant coronary artery stenoses with quantitative CT perfusion: preliminary clinical experiences

  • Cardiac
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Abstract

Objectives

We developed a quantitative Dynamic Contrast-Enhanced CT (DCE-CT) technique for measuring Myocardial Perfusion Reserve (MPR) and Volume Reserve (MVR) and studied their relationship with coronary stenosis.

Methods

Twenty-six patients with Coronary Artery Disease (CAD) were recruited. Degree of stenosis in each coronary artery was classified from catheter-based angiograms as Non-Stenosed (NS, angiographically normal or mildly irregular), Moderately Stenosed (MS, 50–80% reduction in luminal diameter), Severely Stenosed (SS, >80%) and SS with Collaterals (SSC). DCE-CT at rest and after dipyridamole infusion was performed using 64-slice CT. Mid-diastolic heart images were corrected for beam hardening and analyzed using proprietary software to calculate Myocardial Blood Flow (MBF, in mL∙min-1∙100 g-1) and Blood Volume (MBV, in mL∙100 g-1) parametric maps. MPR and MVR in each coronary territory were calculated by dividing MBF and MBV after pharmacological stress by their respective baseline values.

Results

MPR and MVR in MS and SS territories were significantly lower than those of NS territories (p < 0.05 for all). Logistic regression analysis identified MPR∙MVR as the best predictor of ≥50% coronary lesion than MPR or MVR alone.

Conclusions

DCE-CT imaging with quantitative CT perfusion analysis could be useful for detecting coronary stenoses that are functionally significant.

Key Points

• A new quantitative CT technique for measuring myocardial function has been developed

• This new technique provides data about myocardial perfusion and volume reserve

• It demonstrates the important relationship between myocardial reserve and coronary stenosis.

• This single test can identify which coronary stenoses are functionally significant

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Acknowledgements

The authors thank Anna MacDonald, Karen Betteridge and Lynn Bender for their help on the patient studies. This work was supported in part by the Canadian Institutes of Health Research (Ottawa, ON, Canada), Canadian Foundation of Innovation (Ottawa, ON, Canada), Ontario Research Fund (Toronto, ON, Canada), Ontario Innovation Trust (Toronto, ON, Canada), and GE Healthcare (Waukesha, WI, USA). T.-Y. Lee is a grant recipient of and consultant to GE Healthcare on the CT Perfusion software. J. Hsieh and J.-Y. Li are employees of GE Healthcare.

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Authors and Affiliations

  1. Imaging Program, Lawson Health Research Institute, London, Ontario, Canada

    Aaron So, Gerald Wisenberg & Ting-Yim Lee

  2. Imaging Research Laboratories, Robarts Research Institute, 100 Perth Drive, London, Ontario, N6A 5K8, Canada

    Aaron So & Ting-Yim Lee

  3. Medical Biophysics, University of Western Ontario, London, Ontario, Canada

    Aaron So, Gerald Wisenberg & Ting-Yim Lee

  4. Medical Imaging, University of Western Ontario, London, Ontario, Canada

    Gerald Wisenberg, Ali Islam, Justin Amann, Walter Romano & Ting-Yim Lee

  5. Cardiology, London Health Sciences Centre, London, Ontario, Canada

    Gerald Wisenberg, James Brown, Dennis Humen & George Jablonsky

  6. Radiology, St. Joseph’s Health Care, London, Ontario, Canada

    Ali Islam, Justin Amann & Walter Romano

  7. CT Engineering, GE Healthcare, Waukesha, Wisconsin, USA

    Jian-Ying Li & Jiang Hsieh

Authors
  1. Aaron So
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  2. Gerald Wisenberg
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  3. Ali Islam
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  9. Jian-Ying Li
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  10. Jiang Hsieh
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Correspondence to Aaron So.

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So, A., Wisenberg, G., Islam, A. et al. Non-invasive assessment of functionally relevant coronary artery stenoses with quantitative CT perfusion: preliminary clinical experiences. Eur Radiol 22, 39–50 (2012). https://doi.org/10.1007/s00330-011-2260-x

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  • DOI: https://doi.org/10.1007/s00330-011-2260-x

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