scholarly journals Quantification of myocardial ischemia and subtended myocardial mass at adenosine stress cardiac computed tomography. A feasibility study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Van Driest ◽  
R J Van Der Geest ◽  
A Broersen ◽  
J Dijkstra ◽  
M El Mahdiui ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Perfusion Defect ◽  
Visual Analysis ◽  
Left Ventricular ◽  
Coronary Artery Lesion ◽  
Adenosine Stress ◽  
Coronary Artery Lesions ◽  
Myocardial Mass

Abstract Introduction Combination of computed tomography angiography (CTA) and adenosine stress CT myocardial perfusion (CTP) allows for coronary artery lesion assessment as well as myocardial ischemia. Nowadays, ischemia on CTP is assessed semi-quantitatively by visual analysis. The aim of this study was to fully quantify myocardial ischemia and the subtended myocardial mass on CTP. Methods We included 33 patients referred for a combined CTA and adenosine stress CTP with good or excellent imaging quality on CTP. Firstly, the coronary artery tree was automatically extracted from CTA and the relevant coronary artery lesions (≥50%) were manually defined (Fig. 1A). Secondly, epi- and endocardial contours along with CTP deficits were manually defined in short-axis images (Fig. 1D, 1E). Thirdly, a Voronoi-based algorithm was used to quantify the subtended myocardial mass (Fig. 1B). Fourthly, the perfusion defect and subtended myocardial mass were spatially registered to the CTA and measured in grams (Fig. 1F, 1C). Finally, this can be used to quantitatively correlate the perfusion defect to the subtended myocardial mass. Results Voronoi-based segmentation was successful in all cases. We assessed a total of 64 relevant coronary artery lesions. Average values for left ventricular mass, total subtended mass and perfusion defect mass were 118, 69 and 7 grams respectively. In 19/33 patients (58%) the total perfusion defect mass could be distributed over the relevant coronary artery lesion(s). Conclusions Quantification of myocardial ischemia and subtended myocardial mass using a Voronoi-based segmentation algorithm seem feasible at adenosine stress CTP and allows for quantitative correlation of coronary artery lesions to corresponding areas of myocardial hypoperfusion. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Quantification of myocardial ischemia and subtended myocardial mass at adenosine stress cardiac computed tomography: a feasibility study

2021 ◽  
Author(s):  
F. Y. van Driest ◽  
R. J. van der Geest ◽  
A. Broersen ◽  
J. Dijkstra ◽  
M. el Mahdiui ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Perfusion Defect ◽  
Visual Analysis ◽  
Left Ventricular ◽  
Coronary Artery Lesion ◽  
Adenosine Stress ◽  
Coronary Artery Lesions ◽  
Myocardial Mass

AbstractCombination of coronary computed tomography angiography (CCTA) and adenosine stress CT myocardial perfusion (CTP) allows for coronary artery lesion assessment as well as myocardial ischemia. However, myocardial ischemia on CTP is nowadays assessed semi-quantitatively by visual analysis. The aim of this study was to fully quantify myocardial ischemia and the subtended myocardial mass on CTP. We included 33 patients referred for a combined CCTA and adenosine stress CTP protocol, with good or excellent imaging quality on CTP. The coronary artery tree was automatically extracted from the CCTA and the relevant coronary artery lesions with a significant stenosis (≥ 50%) were manually defined using dedicated software. Secondly, epicardial and endocardial contours along with CT perfusion deficits were semi-automatically defined in short-axis reformatted images using MASS software. A Voronoi-based segmentation algorithm was used to quantify the subtended myocardial mass, distal from each relevant coronary artery lesion. Perfusion defect and subtended myocardial mass were spatially registered to the CTA. Finally, the subtended myocardial mass per lesion, total subtended myocardial mass and perfusion defect mass (per lesion) were measured. Voronoi-based segmentation was successful in all cases. We assessed a total of 64 relevant coronary artery lesions. Average values for left ventricular mass, total subtended mass and perfusion defect mass were 118, 69 and 7 g respectively. In 19/33 patients (58%) the total perfusion defect mass could be distributed over the relevant coronary artery lesion(s). Quantification of myocardial ischemia and subtended myocardial mass seem feasible at adenosine stress CTP and allows to quantitatively correlate coronary artery lesions to corresponding areas of myocardial hypoperfusion at CCTA and adenosine stress CTP.

Abstract 4177: Quantitative Evaluation of Regional Myocardial Blood Flow Using Multi-detector Row Computed Tomography in Pre- and Post- Coronary Artery Bypass Grafting Patients; Assessment with Regional Left Ventricular Function

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroshi Imagawa ◽  
Fumiaki Shikata ◽  
Teruhito Kido ◽  
Akira Kurata ◽  
Hiroshi Higashino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Coronary Artery ◽  
Myocardial Blood Flow ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Adenosine Stress ◽  
Bypass Grafting ◽  
Regional Left Ventricular Function ◽  
Cabg Patients

Introduction: The advent of high resolution multidetector computed tomography (MDCT) created the potential to quantify myocardial blood flow (MBF) reduction. The effect in regional MBF produced by coronary artery bypass grafting has not been quantitatively evaluated. The purpose of this study was to test the hypothesis that adenosine stress/rest MDCT can detect ischemia by measuring MBF differences in pre- versus post-CABG patients. Methods: Ninety regional areas in 10 patients (median age 71; 65–79, 7 males), scheduled for CABG at our institution, were studied. Each patient underwent adenosine stress 64-slice MDCT perfusion imaging in both pre- and postoperative period. Myocardial blood flow was calculated with Patlak plots analysis. Regional left ventricular function (LVF) was assessed by Echocardiography. Results: Preoperative mean MBF in ischemic and non-ischemic areas was 0.76±0.49 (ml/g/min) and 2.15±0.66, respectively (p<0.05). Postoperative MBF increased to 1.40±0.77 (ml/g/min) in ischemic areas (p<0.05), though the non-ischemic area showed no differences. The degree of ischemia on MDCT was correlated to change in regional LVF. Postoperative assessment revealed the improved regional LVF that was correlated with the increase in regional MBF. Conclusions: The regional MBF can be quantitatively assessed by adenosine stress 64-slice MDCT perfusion imaging. This technique provides quantitative information about regional MBF in pre- and post- CABG patients, which may predict the regional LVF recovery after CABG.

Abstract 152: Tri-Dimentional Fusion Image of Multidetector 64-Slice-Computed Tomography and Single-Photon Emission Computed Tomography enables us to Evaluate Complicated Hemodynamics in Patients with Coronary Artery Lesions after Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Masanori Abe ◽  
Makoto Watanabe ◽  
Ryuji Fukazawa ◽  
Shunichi Ogawa
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Myocardial Ischemia ◽  
Fusion Imaging ◽  
Emission Computed Tomography ◽  
Coronary Artery Lesions ◽  
Collateral Arteries ◽  
Fusion Images

Introduction: An important complication of Kawasaki disease (KD) is myocardial ischemia and acute myocardial infarction which occurs by thrombosis in coronary aneurysms and severe stenosis. The most characteristic features of coronary artery lesions (CALs) are dilation or aneurysm in acute stage and stenosis after convalescence stage. As these lesions exist singly or multiply in one coronary branch or multiple branches, coronary hemodynamics can be complicated. Ordinal methods have less potential for detection of these diseased states. Recently, Fusion imaging from coronary CT angiography (CTA) /SPECT has been thought good method for evaluation of location and severity of myocardial damages in adults. Therefore, we evaluate CALs, ischemia, and infarction after KD by Fusion imaging. Patients and Method: Seventeen patients (16 males and 1 female, age10 to 34 y) were subject. Eight patients had coronary artery bypass grafting (CABG). These tests were performed 8 to 30 years after onset of KD. CTA are performed by 64-slice-CT (LightSpeed VCT:GE Healthcare) ,and SPECT (Infinia:GE) by Tc-tetrofosmin was performed at rest and at stress after infusing adenosine. CTA and SPECT images were fused by the software (CardIQ Fusion:GE). Results and findings: In all cases, we had enough good images to detect the location of CALs and the area of ischemia. 1) Fusion images showed that no patient had significant stenotic findings at the anastomosis of bypass-graft at least several years after CABG. 2) Coronary native small branches arose from giant aneurysm were occluded by thrombosis and sub-aneurysmal lesions were infracted which were not detected by ordinal method. 3) Minimum sized myocardial ischemic lesions along to the normal visual epicardial coronary artery were detected and were suspected the existence of abnormal micro-coronary circulation caused by fibrous plaque or micro-thrombosis. 4) Collateral arteries at the stenotic and/or occluded lesions with or without ischemia were clearly detected by Fusion method. conclusion: Fusion images can visualize morphologically and functionally complicated CALs, myocardial ischemia ,and myocardial infarction after KD. Also, we can realize that peripheral coronary vessels are damaged with myocardial ischemia.

P2716Correlation between computed tomography derived ischemia index and conventional fractional flow reserve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Yamaji ◽  
A Katsuki ◽  
H Haque ◽  
N Uetake ◽  
A Miyazaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Ischemia ◽  
Left Ventricular Volume ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Ct Coronary Angiography ◽  
Artery Disease

Abstract Background Computed tomography (CT) derived ischemia index is a novel tool to determine the significance of coronary artery disease, however, its ability to identify myocardial ischemia has not been examined. Methods From Jan. 2013 to Dec. 2015, 14,000 patients underwent ECG-gated CT coronary angiography for suspected coronary artery disease. From Jan. 2013 to Jan. 2016, 483 patients (589 vessels) underwent conventional FFR to assess myocardial ischemia. Among those, FFR was assessed in 148 patients (167 vessels) within 30 days after CT coronary angiography. We further excluded 24 patients with prior stenting or bypass grafting, 3 patients with multiple MDCT or FFR, and 6 patients with insufficient datasets. Finally, we included 117 patients (127 vessels) to assess the correlation between CT derived ischemia index and conventional FFR. CT derived ischemia index was calculated as follows: left ventricular volume distally to the coronary artery lumen (cm3)/coronary artery lumen area (mm2). Left ventricular volume was automatically determined using Advantage Workstation and divided according to the nearest coronary artery tree. Center of coronary arteries were manually traced and contours of coronary artery lumen were automatically depicted. CT derived ischemia index was calculated at approximately every 0.625mm point of coronary artery. Moving median of consecutive 5 points (approximately 3.125mm) were used to remove outliers. Maximum value of CT derived ischemia index per coronary artery segment was calculated to determine the significance of coronary artery disease. Results Mean age was 71.3±10.5 years and 63.8% of patients were male. Coronary angiography was performed to assess conventional FFR at the median of 13 days (IQR 7 to 18 days) after CT. Majority of the target vessel was left anterior descending artery (71.7%), followed by right coronary artery (14.2%), left circumflex artery (13.4%) and left main coronary artery (0.8%). According to the quantitative coronary angiography, minimum lumen diameter was 1.47±0.32mm with percent diameter stenosis of 48.3±10.4%. Median FFR value was 0.83 (IQR 0.76 to 0.88) and positive test for myocardial ischemia (FFR <0.80) was observed in 42 vessels (33.1%). Maximum CT derived ischemia index per segment ranged from 1.825 to 57.296 (median 8.333, IQR 4.911 to 14.484). There was a negative correlation between CT derived ischemia index and FFR (r=−0.319, 95% confidence interval −0.467 to −0.153, P<0.001). Receiver operating characteristic analysis indicated CT derived ischemia index of 9.962 has 76.2% sensitivity and 70.6% specificity for the presence of FFR<0.80 (AUC 0.73, 95% CI 0.64 to 0.82). Conclusions A novel tool of CT derived ischemia index has a significant negative correlation with conventional FFR in lesions with mild to moderate stenosis. Larger multicenter prospective studies are needed to fully determine the impact of CT derived ischemia index.

Abstract 11726: Novel Non-Invasive Method to Estimate Myocardial Mass at Risk Calculated From Cardiac Computed Tomography Data: Validation Study Using Angiographic Myocardial Jeopardy Scores in Patients With Single Vessel Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Seiko IDE ◽  
Satoru Sumitsuji ◽  
Kensuke Yokoi ◽  
Masatoki Yoshida ◽  
Isamu Mizote ◽  
...  
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Heart Disease ◽  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Myocardial Mass ◽  
Non Invasive ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Background: The myocardial mass at risk (MMAR), representing volume of myocardium distal to culprit lesion, is one of important factors for predicting adverse cardiac event in ischemic heart disease. However, current non-invasive cardiac imaging fails to quantify MMAR in patients with stable coronary artery disease. We have developed a new software calculating MMAR of any designated coronary artery by reconstructing the 3-dimensional-volume-data of cardiac computed tomography (CCT). The novel index, ratio of MMAR to whole left ventricular volume (%LV-MMAR), calculated with this software would be appealing to obtain MMAR objectively. This study aims to compare the %LV-MMAR with Bypass Angioplasty Revascularization Investigation (BARI) and modified Albert Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) scores, both of which are invasive angiographic methods widely used to estimate MMAR, in patients with single-vessel disease. Methods: Between April 2008 and March 2014, patients suspected of effort angina pectoris without history of previous myocardial infarction were assessed with CCT and invasive coronary angiography. Of those, 48 patients who were revealed single-vessel disease (left anterior descending artery (LAD): n=22, left circumflex artery (LCX): n=11 and right coronary artery (RCA): n=15) were included in this study. %LV-MMAR was calculated on the software. BARI and modified APPROACH score were calculated and compared with %LV-MMAR. Results: Mean %LV-MMAR was 27.6 [18.2-37.1] %. BARI and APPROACH scores showed a significant correlation (r=0.92, p<0.0001). Also, a significant correlation was observed between %LV-MMAR versus BARI and %LV-MMAR versus APPROACH (r=0.95, p<0.0001 and r=0.9, p<0.0001, respectively). %LV-MMAR showed significant correlation with BARI and APPROACH scores in all vessels; LAD (r=0.95, p<0.0001 and r=0.91, p<0.0001, respectively), LCX (r=0.91, p=0.0001 and r=0.83, p=0.0002, respectively) and RCA (r=0.92, p<0.0001 and r=0.85, p<0.0001, respectively). Conclusions: This study revealed %LV-MMAR, calculated from CCT data on novel software, to be a promising index for estimating perfusion territory noninvasively in good agreement with BARI and modified APPROACH score.

Abstract 2941: Combined Assessment of Coronary Artery Stenosis and Myocardial Ischemia by Rest-Dipyridamole Stress Multidetector Computed Tomography

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Patricia M Carrascosa ◽  
Carlos Capuñay ◽  
Jorge Carrascosa ◽  
Alejandro Deviggiano ◽  
Alejandro Goldsmit ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Contrast Enhancement ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Artery Disease ◽  
Mdct Coronary Angiography ◽  
Dipyridamole Stress

Introduction: MDCT coronary angiography has been evolving as a noninvasive method for the assessment of coronary artery disease (CAD). More recently, It has been demonstrated that MDCT identifies reduced contrast enhancement in ischemic and/or scarred myocardial segments. Objective: to determine the ability of rest-stress multidetector computed tomography (RS-MDCT) to detect myocardial ischemia and to assess the relationship between MDCT myocardial perfusion abnormalities and coronary artery stenosis. Methods: Forty seven patients underwent stress/rest 99mTc sestamibi SPECT and RS-MDCT, using a 16-row detector scanner (Philips Brilliance-16). Myocardial segments were classified by SPECT as normal, ischemic or scarred. SPECT results were then compared with MDCT regional myocardial contrast enhancement. The results of MDCT coronary angiography were also analyzed in 20 patients who underwent invasive catheterization. Results: The presence of a reduction in contrast enhancement at rest by MDCT identified scar by SPECT with 96% sensitivity and 98% specificity. A stress-induced reduction in contrast enhancement by MDCT identified ischemia by SPECT with 77% sensitivity and 99% specificity. The segment-based sensitivity and specificity for the detection of significant stenosis by MDCT were 92% and 98%, respectively. Conclusion: Our results showed that a rest-dipyridamole stress MDCT protocol can identify the presence of myocardial ischemia as well as the severity of coronary artery stenosis in patients with suspected coronary artery disease.

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