Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories

Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories

Giordano, M. (TU Delft ImPhys/Quantitative Imaging; Erasmus Universiteit Rotterdam)
Poot, D.H.J. (TU Delft ImPhys/Quantitative Imaging; Erasmus Universiteit Rotterdam)
Coenen, Adriaan (Erasmus Universiteit Rotterdam)
van Walsum, Theo (Erasmus Universiteit Rotterdam)
Tezza, Michela (University of Verona)
Nieman, Koen (Erasmus Universiteit Rotterdam)
Niessen, W.J. (TU Delft ImPhys/Quantitative Imaging; Erasmus Universiteit Rotterdam)

2017-03-22

Purpose
Myocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods.


Methods
The diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed.


Results
Leave-one-case out cross-validation showed that HPV has an accuracy of 72% (58–83%) with sensitivity of 72% (47–90%) and specificity of 72% (58–83%). The accuracy of MA-MBF was 70% (57–82%) with a sensitivity of 50% (26–74%) and a specificity of 79% (64–91%). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant.


Conclusions
The proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.

coronary CTA
coronary stenosis
dynamic CT perfusion
fractional flow reserve
Myocardial blood flow

http://resolver.tudelft.nl/uuid:115c62e0-6d6d-4dee-bf0c-e838e6d0c252

https://doi.org/10.1002/mp.12126

2018-03-22

0094-2405

Medical Physics, 44 (4), 1347-1358

Institutional Repository

journal article

© 2017 M. Giordano, D.H.J. Poot, Adriaan Coenen, Theo van Walsum, Michela Tezza, Koen Nieman, W.J. Niessen