title: Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis.
abstract: OBJECTIVE
  To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR).
  
  
  METHODS
  Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80.
  
  
  RESULTS
  Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification.
  
  
  CONCLUSIONS
  Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value.
  
  
  CONCLUSIONS
  • The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease • Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow • The incremental value of the transmural perfusion ratio is limited.
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands. a.coenen@erasmusmc.nl.|Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. a.coenen@erasmusmc.nl.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Coenen
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.|Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Lubbers
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Akira
authors.initials: A
authors.lastname: Kurata
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kono
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.|Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Admir
authors.initials: A
authors.lastname: Dedic
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.|Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Raluca G
authors.initials: RG
authors.lastname: Chelu
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Dijkshoorn
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.|NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK.
authors.forename: Alexia
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.|Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Robert-Jan M
authors.initials: RM
authors.lastname: van Geuns
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.|Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Coronary artery disease; Fractional flow reserve, myocardial; Perfusion; Tomography; X-ray computed