title: Feasibility of dynamic CT-based adenosine stress myocardial perfusion imaging to detect and differentiate ischemic and infarcted myocardium in an large experimental porcine animal model.
abstract: The purpose of the study is feasibility of dynamic CT perfusion imaging to detect and differentiate ischemic and infarcted myocardium in a large porcine model. 12 Country pigs completed either implantation of a 75 % luminal coronary stenosis in the left anterior descending coronary artery simulating ischemia or balloon-occlusion inducing infarction. Dynamic CT-perfusion imaging (100 kV, 300 mAs), fluorescent microspheres, and histopathology were performed in all models. CT based myocardial blood flow (MBFCT), blood volume (MBVCT) and transit constant (Ktrans), as well as microsphere's based myocardial blood flow (MBFMic) were derived for each myocardial segment. According to histopathology or microsphere measurements, 20 myocardial segments were classified as infarcted and 23 were ischemic (12 and 14 %, respectively). Across all perfusion states, MBFCT strongly predicted MBFMic (β 0.88 ± 0.12, p < 0.0001). MBFCT, MBVCT, and Ktrans were significantly lower in ischemic/infarcted when compared to reference myocardium (all p < 0.01). Relative differences of all CT parameters between affected and non-affected myocardium were higher for infarcted when compared to ischemic segments under rest (48.4 vs. 22.6 % and 46.1 vs. 22.9 % for MBFCT, MBVCT, respectively). Under stress, MBFCT was significantly lower in infarcted than in ischemic myocardium (67.8 ± 26 vs. 88.2 ± 22 ml/100 ml/min, p = 0.002). In a large animal model, CT-derived parameters of myocardial perfusion may enable detection and differentiation of ischemic and infarcted myocardium.
authors.affiliation: Department of Clinical Radiology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany, fbamberg@post.harvard.edu.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Rabea
authors.initials: R
authors.lastname: Hinkel
authors.forename: Roy P
authors.initials: RP
authors.lastname: Marcus
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Baloch
authors.forename: Kristof
authors.initials: K
authors.lastname: Hildebrandt
authors.forename: Florian
authors.initials: F
authors.lastname: Schwarz
authors.forename: Holger
authors.initials: H
authors.lastname: Hetterich
authors.forename: Torleif A
authors.initials: TA
authors.lastname: Sandner
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.forename: Christian
authors.initials: C
authors.lastname: Kupatt
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Daniel
authors.initials: D
authors.lastname: Theisen
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
mesh_terms: D000241:Adenosine; D000818:Animals; D001783:Blood Flow Velocity; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D003937:Diagnosis, Differential; D004195:Disease Models, Animal; D005240:Feasibility Studies; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D013552:Swine; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000241:Adenosine