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Low-dose CT perfusion with combined use of CTP and CTP-derived coronary CT angiography at 70 kVp: validation with invasive fractional flow reserve

  • Cardiac
  • Published:
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Abstract

Objectives

To investigate the diagnostic performance of 70-kVp stress dynamic myocardial CT perfusion (CTP) as a low-dose, one-stop cardiac CT examination in clinical application.

Materials and methods

Consecutive symptomatic patients were prospectively recruited and scanned with stress dynamic myocardial CTP. The CTP phase with the best enhancement of the coronary arteries was selected and extracted as the CTP-derived single-phase coronary CT angiography (SP-CTA). The diagnostic performance of CTP and CTP+SP-CTA for functionally significant CAD was assessed. Invasive coronary angiography and fractional flow reserve were used as the reference standard for the myocardial ischemia evaluation.

Results

In total, 71 patients (43 men and 28 women; 63.6 ± 8.8 years old) underwent the stress dynamic myocardial CTP; 63 vessels (36.2%) from 42 of the patients (59.2%) were identified as causing ischemia. On a per-vessel basis, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy for CTP and CTP+SP-CTA were 77.8%, 93.7%, 87.5%, 88.1%, and 87.9% and 84.1%, 93.7%, 88.3%, 91.2%, and 90.2%, respectively. The area under the curve (AUC) of CTP+SP-CTA (AUC = 0.963; 95%CI, 0.938–0.989) was significantly superior to that of CTP (AUC = 0.922; 95%CI, 0.880–0.964) and that of SP-CTA (AUC = 0.833; 95%CI, 0.765–0.900) alone (all p < 0.01). The mean radiation dose of the CTP examination was 3.8 ± 1.4 mSv.

Conclusion

CTP-derived SP-CTA improved the diagnostic value of CTP. With a promising performance of myocardial ischemia detection and low radiation dose, the innovative low-dose, one-stop CTP examination is clinically feasible for patients who need to receive a myocardial perfusion assessment.

Key Points

• Myocardial CTP performed well in the evaluation of hemodynamically significant CAD.

• CTP-derived single-phase CCTA improved the diagnostic value of CTP.

• The combined use of low-dose CTP and CTP-derived CCTA at 70 kVp is clinically feasible for CAD patients who need to receive a myocardial perfusion assessment.

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Abbreviations

ATP:

Adenosine triphosphate

CAD:

Coronary artery disease

CCTA:

Coronary CT angiography

CM:

Contrast media

CT:

Computed tomography

CTP:

CT perfusion

DSCT:

Dual-source CT

ED:

Effective radiation dose

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

IQ:

Image quality

MBF:

Myocardial blood flow

SP-CTA:

Single-phase coronary CT angiography

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Acknowledgments

We thank Dr. Wei Han for kindly providing statistical advice for this manuscript and thank ASCI Cube ([ASCI]3) 2019 Program for the article discussion during the Program.

Funding

This study has received funding from the National Key Research and Development Program of China (Grant Nos. 2016YFC1300402, 2016YFC1300400, 2016), the Beijing Municipal Natural Science Interdisciplinary cooperation project Foundation (Grant No. Z171100001117136, 2017), and the National Natural Science Foundation of China (Grant No. 81873891, 2019).

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Author notes

  1. Zheng-Yu Jin and Yi-Ning Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Yan Yi, Cheng Xu, Zheng-Yu Jin & Yi-Ning Wang

  2. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Wei Wu & Zhu-Jun Shen

  3. Department of Radiology, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, South Korea

    Whal Lee

  4. Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan

    Chun-Ho Yun

  5. Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China

    Bin Lu

  6. The Institute of Diagnostic and Interventional Radiology, Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China

    Jia-Yin Zhang

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  1. Yan Yi
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Corresponding authors

Correspondence to Zheng-Yu Jin or Yi-Ning Wang.

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Guarantor

The scientific guarantor of this publication is Zheng-Yu Jin.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Wei Han kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Yi-Ning Wang is the first corresponding author and Zheng-Yu Jin is the second corresponding author of this work.

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Yi, Y., Xu, C., Wu, W. et al. Low-dose CT perfusion with combined use of CTP and CTP-derived coronary CT angiography at 70 kVp: validation with invasive fractional flow reserve. Eur Radiol 31, 1119–1129 (2021). https://doi.org/10.1007/s00330-020-07096-x

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  • DOI: https://doi.org/10.1007/s00330-020-07096-x

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