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Dynamic CT myocardial perfusion imaging

Philips CT Clinical Science Philips Healthcare • USA

Detection of ischemia in a porcine model with FFR verification

Fahmi R, Eck B.L., Vembar M, Bezerra H.G., Wilson D.L.

* This article was originally published in Medical Imaging 2014: Biomedical Applications in Molecular, Structural, and Functional Imaging.
Dynamic cardiac CT perfusion (CTP) is a high resolution, non-invasive technique for assessing myocardial blood flow (MBF), which in concert with coronary CT angiography enable CT to provide a unique, comprehensive, fast analysis of both coronary anatomy and functional flow. We assessed perfusion in a porcine model with and without coronary occlusion. To induce occlusion, each animal underwent left anterior descending (LAD) stent implantation and angioplasty balloon insertion. Normal flow condition was obtained with balloon completely deflated. Partial occlusion was induced by balloon inflation against the stent with FFR used to assess the extent of occlusion. Prospective ECG-triggered partial scan images were acquired at end systole (45% R-R) using a multi-detector CT (MDCT) scanner. Images were reconstructed using FBP and a hybrid iterative reconstruction (iDoseā“, Philips Healthcare). Processing included: beam hardening (BH) correction, registration of image volumes using 3D cubic B-spline normalized mutual-information and spatio-temporal bilateral altering to reduce partial scan artifacts and noise variation. Absolute blood flow was calculated with a deconvolution-based approach using singular value decomposition (SVD). Arterial input function was estimated from the left ventricle (LV) cavity. Regions of interest (ROIs) were identified in healthy and ischemic myocardium and compared in normal and occluded conditions. Under-perfusion was detected in the correct LAD territory and flow reduction agreed well with FFR measurements. Flow was reduced, on average, in LAD territories by 54%.

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Nov 6, 2014

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3D, artifacts, Cardiac, coronary angiography, coronary arteries, Dynamic, ECG-gated dynamic imaging, FBP reconstruction, high resolution, iDose4, LAD, left ventricle, myocardial perfusion, occlusion, Perfusion, prospective, stent, Vascular

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