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

• Published in: European radiology Vol. 27; no. 6; pp. 2309 - 2316
• Main Authors: Coenen, Adriaan, Lubbers, Marisa M., Kurata, Akira, Kono, Atsushi, Dedic, Admir, Chelu, Raluca G., Dijkshoorn, Marcel L., Rossi, Alexia, van Geuns, Robert-Jan M., Nieman, Koen
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2017; Springer Nature B.V
• Subjects: Adenosine; Aged; Cardiac; Cardiology; Cardiovascular disease; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Coronary vessels; Diagnostic Radiology; Female; Hemodynamics - physiology; Humans; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Myocardial Perfusion Imaging - methods; Neuroradiology; Patients; Prospective Studies; Radiology; Severity of Illness Index; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; Vein & artery diseases; Netherlands; Tomography; Perfusion; Coronary artery disease; X-ray computed; Fractional flow reserve, myocardial
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4567-0

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