Accuracy of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model

Fabian Bamberg, Rabea Hinkel, Florian Schwarz, Torleif A. Sandner, Elisabeth Baloch, Roy Marcus, Alexander Becker, Christian Kupatt, Bernd J. Wintersperger, Thorsten R. Johnson, Daniel Theisen, Ernst Klotz, Maximilian F. Reiser, Konstantin Nikolaou

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

OBJECTIVE:: To determine the accuracy of computed tomography (CT) dynamic stress myocardial perfusion imaging to estimate myocardial blood flow (MBF) in a porcine animal model with variable degrees of induced coronary artery stenosis in comparison with microsphere-derived MBF. METHODS AND MATERIALS:: Seven domestic pigs (36 ± 4 kg) received stents (confirmed 3.0 mm diameter) in the left anterior descending coronary artery distal to first diagonal branch. A balloon catheter was placed within the stent and inflated to various degrees to obtain a defined luminal narrowing (50% and 75% diameter stenosis) as confirmed by intra-arterial flow wire measurement. All models underwent adenosine-mediated (140 μg/kg/min) dynamic stress and rest myocardial perfusion CT imaging using a dual-source CT scanner (shuttle-mode with 100 kV/300 mAs, 20 mL iopromide) with prospective acquisitions every second heartbeat for 30 seconds. CT-estimated MBF (MBFCT) was calculated using a model-based parametric deconvolution method and correlated to that of fluorescent microspheres (MBFmic) injected at each perfusion state. RESULTS:: All study procedures were performed without complications, and all animals completed the study protocol. Among 448 myocardial segments, 31 (7%) were considered nonevaluable because of motion artifacts. With stress, MBFCT increased significantly (1.10 ± 0.25 vs. 0.80 ± 0.28 mL/g/min, P < 0.001; at stress and rest, respectively) in all myocardial segments and correlated with MBFmic (r = 0.67, P < 0.001). MBFCT overestimated MBFmic, independently of adenosine-stress and degree of coronary stenosis (β = 2.3, 95% confidence interval: 1.81-2.79 mL/g/min, P < 0.001). Although there were no differences in MBFCT between 50% and 75% coronary stenosis at rest (0.01 ± 0.08 mL/g/min, P = 0.86), MBFCT was significantly lower at 75% than at 50% under stress conditions (0.53 ± 0.19 vs. 0.71 ± 0.24 mL/g/min, P = 0.002). CONCLUSIONS:: CT-derived MBF measurements at rest and stress with varying degrees of coronary stenosis show a valid difference but an underestimated correlation with microsphere-derived MBF in a porcine animal model.

Original languageEnglish
Pages (from-to)71-77
Number of pages7
JournalInvestigative Radiology
Volume47
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Keywords

  • Animal model
  • Cardiac CT perfusion
  • Dynamic acquisition
  • Ischemia

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