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Proceedings Paper

Comparison of quantitative myocardial perfusion imaging CT to fluorescent microsphere-based flow from high-resolution cryo-images
Author(s): Brendan L. Eck; Rachid Fahmi; Jacob Levi; Anas Fares; Hao Wu; Yuemeng Li; Mani Vembar; Amar Dhanantwari; Hiram G. Bezerra; David L. Wilson
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Paper Abstract

Myocardial perfusion imaging using CT (MPI-CT) has the potential to provide quantitative measures of myocardial blood flow (MBF) which can aid the diagnosis of coronary artery disease. We evaluated the quantitative accuracy of MPI-CT in a porcine model of balloon-induced LAD coronary artery ischemia guided by fractional flow reserve (FFR). We quantified MBF at baseline (FFR=1.0) and under moderate ischemia (FFR=0.7) using MPI-CT and compared to fluorescent microsphere-based MBF from high-resolution cryo-images. Dynamic, contrast-enhanced CT images were obtained using a spectral detector CT (Philips Healthcare). Projection-based mono-energetic images were reconstructed and processed to obtain MBF. Three MBF quantification approaches were evaluated: singular value decomposition (SVD) with fixed Tikhonov regularization (ThSVD), SVD with regularization determined by the L-Curve criterion (LSVD), and Johnson-Wilson parameter estimation (JW). The three approaches over-estimated MBF compared to cryo-images. JW produced the most accurate MBF, with average error 33.3±19.2mL/min/100g, whereas LSVD and ThSVD had greater over-estimation, 59.5±28.3mL/min/100g and 78.3±25.6 mL/min/100g, respectively. Relative blood flow as assessed by a flow ratio of LAD-to-remote myocardium was strongly correlated between JW and cryo-imaging, with R2=0.97, compared to R2=0.88 and 0.78 for LSVD and ThSVD, respectively. We assessed tissue impulse response functions (IRFs) from each approach for sources of error. While JW was constrained to physiologic solutions, both LSVD and ThSVD produced IRFs with non-physiologic properties due to noise. The L-curve provided noise-adaptive regularization but did not eliminate non-physiologic IRF properties or optimize for MBF accuracy. These findings suggest that model-based MPI-CT approaches may be more appropriate for quantitative MBF estimation and that cryo-imaging can support the development of MPI-CT by providing spatial distributions of MBF.

Paper Details

Date Published: 29 March 2016
PDF: 9 pages
Proc. SPIE 9788, Medical Imaging 2016: Biomedical Applications in Molecular, Structural, and Functional Imaging, 97882F (29 March 2016); doi: 10.1117/12.2217027
Show Author Affiliations
Brendan L. Eck, Case Western Reserve Univ. (United States)
Rachid Fahmi, Case Western Reserve Univ. (United States)
Jacob Levi, Case Western Reserve Univ. (United States)
Anas Fares, Harrington Heart & Vascular Institute, Univ. Hospitals Case Medical Ctr. (United States)
Hao Wu, Case Western Reserve Univ. (United States)
Yuemeng Li, Case Western Reserve Univ. (United States)
Mani Vembar, Philips Healthcare (United States)
Amar Dhanantwari, Philips Healthcare (United States)
Hiram G. Bezerra, Harrington Heart & Vascular Institute, Univ. Hospitals Case Medical Ctr. (United States)
David L. Wilson, Case Western Reserve Univ. (United States)


Published in SPIE Proceedings Vol. 9788:
Medical Imaging 2016: Biomedical Applications in Molecular, Structural, and Functional Imaging
Barjor Gimi; Andrzej Krol, Editor(s)

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