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European Radiology
Published in: European Radiology 6/2017

Open Access 01-06-2017 | Cardiac

Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

Authors: Adriaan Coenen, Marisa M. Lubbers, Akira Kurata, Atsushi Kono, Admir Dedic, Raluca G. Chelu, Marcel L. Dijkshoorn, Alexia Rossi, Robert-Jan M. van Geuns, Koen Nieman

Published in: European Radiology | Issue 6/2017

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Abstract

Objectives

To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR).

Methods

Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80.

Results

Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification.

Conclusions

Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value.

Key Points

• The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease
• Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow
• The incremental value of the transmural perfusion ratio is limited
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Metadata
Title
Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis
Authors
Adriaan Coenen
Marisa M. Lubbers
Akira Kurata
Atsushi Kono
Admir Dedic
Raluca G. Chelu
Marcel L. Dijkshoorn
Alexia Rossi
Robert-Jan M. van Geuns
Koen Nieman
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4567-0

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