European Radiology

, Volume 25, Issue 1, pp 49–57 | Cite as

Quantification of the myocardial area at risk using coronary CT angiography and Voronoi algorithm-based myocardial segmentation

  • Akira KurataEmail author
  • Atsushi Kono
  • Tsuyoshi Sakamoto
  • Teruhito Kido
  • Teruhito Mochizuki
  • Hiroshi Higashino
  • Mitsunori Abe
  • Adriaan Coenen
  • Raluca G. Saru-Chelu
  • Pim J. de Feyter
  • Gabriel P. Krestin
  • Koen Nieman



The purpose of this study was to estimate the myocardial area at risk (MAAR) using coronary computed tomography angiography (CTA) and Voronoi algorithm-based myocardial segmentation in comparison with single-photon emission computed tomography (SPECT).


Thirty-four patients with coronary artery disease underwent 128-slice coronary CTA, stress/rest thallium-201 SPECT, and coronary angiography (CAG). CTA-based MAAR was defined as the sum of all CAG stenosis (>50 %) related territories (the ratio of the left ventricular volume). Using automated quantification software (17-segment model, 5-point scale), SPECT-based MAAR was defined as the number of segments with a score above zero as compared to the total 17 segments by summed stress score (SSS), difference (SDS) score map, and comprehensive SPECT interpretation with either SSS or SDS best correlating CAG findings (SSS/SDS). Results were compared using Pearson's correlation coefficient.


Forty-nine stenoses were observed in 102 major coronary territories. Mean value of CTA-based MAAR was 28.3 ± 14.0 %. SSS-based, SDS-based, and SSS/SDS-based MAAR was 30.1 ± 6.1 %, 20.1 ± 15.8 %, and 26.8 ± 15.7 %, respectively. CTA-based MAAR was significantly related to SPECT-based MAAR (r = 0.531 for SSS; r = 0.494 for SDS; r = 0.814 for SSS/SDS; P < 0.05 in each).


CTA-based Voronoi algorithm myocardial segmentation reliably quantifies SPECT-based MAAR.

Key points

Voronoi algorithm allows for three-dimensional myocardial segmentation of coronary CT angiography

Stenosis-related CT myocardial territories correlate to SPECT based area at risk

CT angiography myocardial segmentation may assist in clinical decision-making


Area at risk Coronary artery disease CT angiography Computed tomography Myocardial ischemia 



Coronary artery bypass grafting


Coronary artery disease


CT angiography


Left ventricle (ventricular)


Multidetector-row computed tomography


Myocardial perfusion imaging


Myocardial area at risk


Percutaneous coronary intervention


Quantitative coronary analysis


Single-photon emission computed tomography





The scientific guarantor of this publication is Koen Nieman. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective observational multicenter study.


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Akira Kurata
    • 1
    Email author
  • Atsushi Kono
    • 1
  • Tsuyoshi Sakamoto
    • 3
  • Teruhito Kido
    • 4
  • Teruhito Mochizuki
    • 4
  • Hiroshi Higashino
    • 5
  • Mitsunori Abe
    • 6
  • Adriaan Coenen
    • 1
  • Raluca G. Saru-Chelu
    • 1
  • Pim J. de Feyter
    • 1
    • 2
  • Gabriel P. Krestin
    • 1
  • Koen Nieman
    • 1
    • 2
  1. 1.Department of RadiologyErasmus University Medical CenterRotterdamThe Netherlands
  2. 2.Department of CardiologyErasmus University Medical CenterRotterdamThe Netherlands
  3. 3.Development DivisionAZE incTokyoJapan
  4. 4.Department of RadiologyEhime University Graduate School of MedicineEhimeJapan
  5. 5.Department of RadiologyYotsuba Circulation ClinicEhimeJapan
  6. 6.Department of CardiologyYotsuba Circulation ClinicEhimeJapan

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