Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing: Detection of ischemia for intermediate coronary stenosis
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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DOI：
10.1016/j.ejrad.2016.02.027
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发表时间：
2016-05-01
影响因子：
3.3
通讯作者：
Honda, Hiroshi
中科院分区：
文献类型：
--
作者：
Nagao, Michinobu;Yamasaki, Yuzo;Honda, Hiroshi
目的：解剖学冠状动脉狭窄并不总是表明功能性狭窄，特别是对于中间冠状动脉病变。本研究的目的是提出一种使用全心脏动态 CT 血管造影 (heart-DCT) 来量化冠脉流量的新方法，并研究其检测中度冠状动脉狭窄引起的缺血的能力。 方法：参与者包括 36 名患有冠状动脉疾病的患者，他们使用管电压为 80 kV 的 320 探测器 CT 和心肌灌注闪烁扫描 (MPS) 进行心脏 DCT。在 15-25 个心动周期中，在舒张中期连续进行心脏 DCT，并在推注造影剂 (12-24m1) 后进行前瞻性 ECG 门控。通过运动相干图像处理 (MCIP) 将动态数据集计算为 90-100 个数据集。接下来，使用 MCIP 自动计算所有阶段直径 > 3 mm 的冠状动脉的时间密度曲线 (TDC)。在最大斜率法的基础上，将冠脉血流指数（CFI）定义为上止点（TDC）上冠状动脉衰减最大上斜率与升主动脉衰减上斜率的比值，用于量化冠脉流量。计算了轻度至中度狭窄的冠状动脉近端和远端部位的 CFI。 MPS 将冠状动脉区域分为非缺血性或缺血性。进行接受者操作特征 (ROC) 分析以确定 CFI 检测缺血的最佳截止值。结果：缺血的远端 CFI (0.26 +/- 0.08) 显着低于非缺血的远端 CFI (0.50 +/- 0.17，p < 0.0001)。缺血 (0.55 +/- 0.23) 和非缺血 (0.62 +/- 0.24) 之间近端 CFI 没有显着差异。 ROC 分析显示 0.39 是远端 CFI 检测缺血的最佳截止值，C 统计值为 0.91、100% 敏感性和 75% 特异性。结论：这种新颖的成像技术允许使用心脏 DCT 进行冠状动脉血流定量。远端 CFI 可以检测冠状动脉中间狭窄引起的心肌缺血。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Objectives: 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 (12-24m1). 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 nonischemia (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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.