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

Michinobu Nagao, Yuzo Yamasaki, Takeshi Kamitani, Satoshi Kawanami, Koji Sagiyama, Torahiko Yamanouchi, Yamato Shimomiya, Tetsuya Matoba, Yasushi Mukai, Keita Odashiro, Shingo Baba, Yasuhiro Maruoka, Yoshiyuki Kitamura, Akihiro Nishie, Hiroshi Honda

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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 (12-24 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.

Original languageEnglish
Pages (from-to)996-1003
Number of pages8
JournalEuropean Journal of Radiology
Volume85
Issue number5
DOIs
Publication statusPublished - May 1 2016

Fingerprint

Coronary Stenosis
Angiography
Ischemia
Coronary Vessels
Myocardial Perfusion Imaging
Perfusion Imaging
ROC Curve
Pathologic Constriction
Diastole
Contrast Media
Myocardial Ischemia
Aorta
Coronary Artery Disease
Electrocardiography
Sensitivity and Specificity
Injections
Datasets

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing : Detection of ischemia for intermediate coronary stenosis. / Nagao, Michinobu; Yamasaki, Yuzo; Kamitani, Takeshi; Kawanami, Satoshi; Sagiyama, Koji; Yamanouchi, Torahiko; Shimomiya, Yamato; Matoba, Tetsuya; Mukai, Yasushi; Odashiro, Keita; Baba, Shingo; Maruoka, Yasuhiro; Kitamura, Yoshiyuki; Nishie, Akihiro; Honda, Hiroshi.

In: European Journal of Radiology, Vol. 85, No. 5, 01.05.2016, p. 996-1003.

Research output: Contribution to journalArticle

@article{8fdbb2c200e84da69f0a73ac348e5ed8,
title = "Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing: Detection of ischemia for intermediate coronary stenosis",
abstract = "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 (12-24 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.",
author = "Michinobu Nagao and Yuzo Yamasaki and Takeshi Kamitani and Satoshi Kawanami and Koji Sagiyama and Torahiko Yamanouchi and Yamato Shimomiya and Tetsuya Matoba and Yasushi Mukai and Keita Odashiro and Shingo Baba and Yasuhiro Maruoka and Yoshiyuki Kitamura and Akihiro Nishie and Hiroshi Honda",
year = "2016",
month = "5",
day = "1",
doi = "10.1016/j.ejrad.2016.02.027",
language = "English",
volume = "85",
pages = "996--1003",
journal = "European Journal of Radiology",
issn = "0720-048X",
publisher = "Elsevier Ireland Ltd",
number = "5",

}

TY - JOUR

T1 - Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing

T2 - Detection of ischemia for intermediate coronary stenosis

AU - Nagao, Michinobu

AU - Yamasaki, Yuzo

AU - Kamitani, Takeshi

AU - Kawanami, Satoshi

AU - Sagiyama, Koji

AU - Yamanouchi, Torahiko

AU - Shimomiya, Yamato

AU - Matoba, Tetsuya

AU - Mukai, Yasushi

AU - Odashiro, Keita

AU - Baba, Shingo

AU - Maruoka, Yasuhiro

AU - Kitamura, Yoshiyuki

AU - Nishie, Akihiro

AU - Honda, Hiroshi

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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 (12-24 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.

AB - 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 (12-24 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.

UR - http://www.scopus.com/inward/record.url?scp=84960399805&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960399805&partnerID=8YFLogxK

U2 - 10.1016/j.ejrad.2016.02.027

DO - 10.1016/j.ejrad.2016.02.027

M3 - Article

C2 - 27130062

AN - SCOPUS:84960399805

VL - 85

SP - 996

EP - 1003

JO - European Journal of Radiology

JF - European Journal of Radiology

SN - 0720-048X

IS - 5

ER -