title: Hemodynamic significance of coronary stenosis by vessel attenuation measurement on CT compared with adenosine perfusion MRI.
abstract: OBJECTIVE
  We assessed the association between corrected contrast opacification (CCO) based on coronary computed tomography angiography (cCTA) and inducible ischemia by adenosine perfusion magnetic resonance imaging (APMR).
  
  
  METHODS
  Sixty cardiac asymptomatic patients with extra-cardiac arterial disease (mean age 64.4 ± 7.7 years; 78% male) underwent cCTA and APMR. Luminal CT attenuation values (Hounsfield Units) were measured in coronary arteries from proximal to distal, with additional measurements across sites with >50% lumen stenosis. CCO was calculated by dividing coronary CT attenuation by descending aorta CT attenuation. A reversible perfusion defect on APMR was considered as myocardial ischemia.
  
  
  RESULTS
  In total, 169 coronary stenoses were found. Seven patients had 8 perfusion defects on APMR, with 11 stenoses in corresponding vessels. CCO decrease across stenoses with hemodynamic significance was 0.144 ± 0.112 compared to 0.047 ± 0.104 across stenoses without hemodynamic significance (P=0.003). CCO decrease in lesions with and without anatomical stenosis was similar (0.054 ± 0.116 versus 0.052 ± 0.101; P=0.89). Using 0.20 as preliminary CCO decrease cut-off, hemodynamic significance would be excluded in 82.9% of anatomical stenoses.
  
  
  CONCLUSIONS
  CCO decrease across coronary stenosis is associated with myocardial ischemia on APMR. CCO based on common cCTA data is a novel method to assess hemodynamic significance of anatomical stenosis.
authors.affiliation: From the Department of Radiology, Center for Medical Imaging-North East Netherlands, Department of Cardiology, and Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Martijn A M
authors.initials: MAM
authors.lastname: den Dekker
authors.affiliation: From the Department of Radiology, Center for Medical Imaging-North East Netherlands, Department of Cardiology, and Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Pelgrim
authors.affiliation: From the Department of Radiology, Center for Medical Imaging-North East Netherlands, Department of Cardiology, and Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gabija
authors.initials: G
authors.lastname: Pundziute
authors.affiliation: From the Department of Radiology, Center for Medical Imaging-North East Netherlands, Department of Cardiology, and Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Edwin R
authors.initials: ER
authors.lastname: van den Heuvel
authors.affiliation: From the Department of Radiology, Center for Medical Imaging-North East Netherlands, Department of Cardiology, and Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.affiliation: From the Department of Radiology, Center for Medical Imaging-North East Netherlands, Department of Cardiology, and Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.vliegenthart@umcg.nl.
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol; D000241:Adenosine
keywords: Computed Tomography; Contrast opacification; Coronary artery disease; Magnetic resonance imaging