TY - JOUR
T1 - Estimating coronary blood flow using CT transluminal attenuation flow encoding
T2 - Formulation, preclinical validation, and clinical feasibility
AU - Lardo, Albert C.
AU - Rahsepar, Amir Ali
AU - Seo, Jung Hee
AU - Eslami, Parastou
AU - Korley, Frederick
AU - Kishi, Satoru
AU - Abd, Thura
AU - Mittal, Rajat
AU - George, Richard T.
N1 - Funding Information:
Support: This work was funded in part by the Coulter Foundation (A.C.L., R.T.G.) and the Maryland Innovation Initiative (A.C.L.).
Funding Information:
Conflict of interest: Under a licensing agreement between HeartMetrics, Inc. and the Johns Hopkins University, A.C.L. and R.M. are entitled to royalties on an invention that is related to work described in this article. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. A.C.L. and R.M. are founders and equity holders in HeartMetrics, Inc. R.T.G. and A.C.L. receive research support from Astellas Pharma and Toshiba. R.T.G. is a consultant for ICON Medical Imaging.
Publisher Copyright:
© 2015 Society of Cardiovascular Computed Tomography.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background: We present the formulation and testing of a new CT angiography (CTA)-based method for noninvasive measurement of absolute coronary blood flow (CBF) termed transluminal attenuation flow encoding (TAFE). CTA provides assessment of coronary plaque but does not allow for detection of vessel specific ischemia. A simple and direct method to calculate absolute CBF from a standard CTA could isolate the functional consequence of disease and aid therapy decisions. Methods: We present the theoretical framework and initial testing of TAFE. Nine canine models of ischemic heart disease were prepared and underwent CT imaging and microsphere measurements of myocardial blood flow. Additionally, 39 acute chest pain patients with normal coronary arteries underwent coronary CTA. We applied TAFE to calculate absolute CBF in the coronary arteries using 4 vessel input parameters including transluminal attenuation gradient, cross-sectional area, length, and the contrast bolus duration derived from the arterial input function. Results: In animal studies, TAFE-derived CBF in the left anterior descending, left circumflex, and right coronary artery was 20.8 ± 10.4 mL/min, 27.0 ± 13.4 mL/min, and 6.0 ± 3.7 mL/min, respectively. TAFE-derived CBF divided by myocardial mass strongly correlated with microsphere myocardial blood flow (R2 = 0.90, P < .001). In human studies, TAFE-derived CBF in the left anterior descending, left circumflex, and right coronary artery was 26.4 ± 10.7 mL/min, 20.1 ± 13.0 mL/min, and 43.2 ± 40.9 mL/min, respectively. CBF per unit mass was 0.93 ± 0.48 mL/g/min in patients. Interobserver variability was minimal with excellent correlation (R = 0.96, P < .0001) and agreement (mean difference, 4.2 mL/min). Conclusion: TAFE allows for quantification of absolute CBF from a standard CTA acquisition and may provide functional significance of coronary disease without complex computational methods.
AB - Background: We present the formulation and testing of a new CT angiography (CTA)-based method for noninvasive measurement of absolute coronary blood flow (CBF) termed transluminal attenuation flow encoding (TAFE). CTA provides assessment of coronary plaque but does not allow for detection of vessel specific ischemia. A simple and direct method to calculate absolute CBF from a standard CTA could isolate the functional consequence of disease and aid therapy decisions. Methods: We present the theoretical framework and initial testing of TAFE. Nine canine models of ischemic heart disease were prepared and underwent CT imaging and microsphere measurements of myocardial blood flow. Additionally, 39 acute chest pain patients with normal coronary arteries underwent coronary CTA. We applied TAFE to calculate absolute CBF in the coronary arteries using 4 vessel input parameters including transluminal attenuation gradient, cross-sectional area, length, and the contrast bolus duration derived from the arterial input function. Results: In animal studies, TAFE-derived CBF in the left anterior descending, left circumflex, and right coronary artery was 20.8 ± 10.4 mL/min, 27.0 ± 13.4 mL/min, and 6.0 ± 3.7 mL/min, respectively. TAFE-derived CBF divided by myocardial mass strongly correlated with microsphere myocardial blood flow (R2 = 0.90, P < .001). In human studies, TAFE-derived CBF in the left anterior descending, left circumflex, and right coronary artery was 26.4 ± 10.7 mL/min, 20.1 ± 13.0 mL/min, and 43.2 ± 40.9 mL/min, respectively. CBF per unit mass was 0.93 ± 0.48 mL/g/min in patients. Interobserver variability was minimal with excellent correlation (R = 0.96, P < .0001) and agreement (mean difference, 4.2 mL/min). Conclusion: TAFE allows for quantification of absolute CBF from a standard CTA acquisition and may provide functional significance of coronary disease without complex computational methods.
KW - Computed tomography
KW - Coronary atherosclerosis
KW - Coronary blood flow
KW - Fractional flow reserve
KW - Myocardial ischemia
KW - Transluminal attenuation gradients
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U2 - 10.1016/j.jcct.2015.03.018
DO - 10.1016/j.jcct.2015.03.018
M3 - Article
C2 - 26460186
AN - SCOPUS:84949322104
VL - 9
SP - 559-566.e1
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
SN - 1934-5925
IS - 6
ER -