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Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories. / Giordano, Marco; Poot, Dirk; Coenen, Adriaan; van Walsum, Theo; Tezza, Michela; Nieman, Koen; Niessen, Wiro.

In: Medical Physics, Vol. 44, No. 4, 22.03.2017, p. 1347-1358.

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Giordano, Marco ; Poot, Dirk ; Coenen, Adriaan ; van Walsum, Theo ; Tezza, Michela ; Nieman, Koen ; Niessen, Wiro. / Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories. In: Medical Physics. 2017 ; Vol. 44, No. 4. pp. 1347-1358.

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@article{115c62e06d6d4deebf0ce838e6d0c252,
title = "Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories",
abstract = "PurposeMyocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods.MethodsThe diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed.ResultsLeave-one-case out cross-validation showed that HPV has an accuracy of 72{\%} (58–83{\%}) with sensitivity of 72{\%} (47–90{\%}) and specificity of 72{\%} (58–83{\%}). The accuracy of MA-MBF was 70{\%} (57–82{\%}) with a sensitivity of 50{\%} (26–74{\%}) and a specificity of 79{\%} (64–91{\%}). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant.ConclusionsThe proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.",
keywords = "coronary CTA, coronary stenosis, dynamic CT perfusion, fractional flow reserve, Myocardial blood flow",
author = "Marco Giordano and Dirk Poot and Adriaan Coenen and {van Walsum}, Theo and Michela Tezza and Koen Nieman and Wiro Niessen",
year = "2017",
month = "3",
day = "22",
doi = "10.1002/mp.12126",
language = "English",
volume = "44",
pages = "1347--1358",
journal = "Medical Physics",
issn = "0094-2405",
publisher = "AAPM - American Association of Physicists in Medicine",
number = "4",

}

RIS

TY - JOUR

T1 - Classification of hemodynamically significant stenoses from dynamic CT perfusion and CTA myocardial territories

AU - Giordano, Marco

AU - Poot, Dirk

AU - Coenen, Adriaan

AU - van Walsum, Theo

AU - Tezza, Michela

AU - Nieman, Koen

AU - Niessen, Wiro

PY - 2017/3/22

Y1 - 2017/3/22

N2 - PurposeMyocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods.MethodsThe diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed.ResultsLeave-one-case out cross-validation showed that HPV has an accuracy of 72% (58–83%) with sensitivity of 72% (47–90%) and specificity of 72% (58–83%). The accuracy of MA-MBF was 70% (57–82%) with a sensitivity of 50% (26–74%) and a specificity of 79% (64–91%). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant.ConclusionsThe proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.

AB - PurposeMyocardial blood flow (MBF) obtained by dynamic CT perfusion (CTP) has been recently introduced to assess hemodynamic significance of coronary stenosis in coronary artery disease. The diagnostic performance of dynamic CTP MBF is limited due to subjective interpretation of MBF maps and MBF variations caused by physiological, methodological, and technical issues. In this paper, we introduce a novel method to quantify the hypoperfused volume (HPV) in myocardial territories derived from CT angiography (CTA) to overcome the limitations of current dynamic CTP MBF analysis methods.MethodsThe diagnostic performance of HPV in classifying significant stenoses was evaluated on 22 patients (57 vessels) that underwent CTA, CTP and invasive fractional flow reserve (FFR). FFR was used as the standard of reference to determine stenosis significance. The diagnostic performance was compared to that of the mean MBF computed in regions manually annotated by an expert (MA-MBF). HPV was derived by thresholding the MBF in myocardial territories constructed from CTA by locating the closest artery. Diagnostic performance was evaluated using leave-one-case out cross-validation. Inter-observer reproducibility was assessed by performing annotations of coronary seeds (HPV) and manual regions (MA-MBF) with two users. In addition, the influence of different parameter settings on the diagnostic performance of HPV was assessed.ResultsLeave-one-case out cross-validation showed that HPV has an accuracy of 72% (58–83%) with sensitivity of 72% (47–90%) and specificity of 72% (58–83%). The accuracy of MA-MBF was 70% (57–82%) with a sensitivity of 50% (26–74%) and a specificity of 79% (64–91%). The Spearman correlation and the kappa statistic was (ρ = 0.94, κ = 0.86) for HPV and (ρ = 0.72, κ = 0.82) for MA-MBF. The influence of parameter settings on HPV based diagnostic performance was not significant.ConclusionsThe proposed HPV accurately classifies hemodynamically significant stenoses with a level of accuracy comparable to the mean MBF in regions annotated by an expert. HPV improves inter-observer reproducibility as compared to MA-MBF by providing a more objective criterion to associate the stenotic coronary with the supplied myocardial territory.

KW - coronary CTA

KW - coronary stenosis

KW - dynamic CT perfusion

KW - fractional flow reserve

KW - Myocardial blood flow

UR - http://resolver.tudelft.nl/uuid:115c62e0-6d6d-4dee-bf0c-e838e6d0c252

U2 - 10.1002/mp.12126

DO - 10.1002/mp.12126

M3 - Article

VL - 44

SP - 1347

EP - 1358

JO - Medical Physics

T2 - Medical Physics

JF - Medical Physics

SN - 0094-2405

IS - 4

ER -

ID: 20215335