Development of a theory for generating regional cardiac perfusion images during coronary angiography in the coronary angiography lab

• Published in: The International Journal of Cardiovascular Imaging Vol. 30; no. 1; pp. 9 - 19
• Main Authors: Sakaguchi, Takuya, Ichihara, Takashi, Trost, Jeffrey C., Yousuf, Omair, Lima, Joao A. C., Yao, Jingwu, George, Richard T.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.01.2014; Springer Nature B.V
• Subjects: Animals; Cardiac Imaging; Cardiac-Gated Imaging Techniques; Cardiology; Contrast Media; Coronary Angiography; Coronary Circulation; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Disease Models, Animal; Electrocardiography; Fluoroscopy; Imaging; Iopamidol; Linear Models; Medicine; Medicine & Public Health; Models, Cardiovascular; Myocardial Perfusion Imaging - methods; Original Paper; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Radiology; Swine; Time Factors; Myocardium; Coronary angiography; Compartment model; Perfusion; Kety model
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-013-0304-9

The purpose of this study was to develop a novel theory and method for generating regional myocardial perfusion images using fluoroscopy in the coronary angiography lab. We modified the Kety model to introduce the Patlak plot method for two-dimensional fluoroperfusion (FP) imaging. For evaluation, seven porcine models of myocardial ischemia with stenosis in the left coronary artery were prepared. Rest and stress FP imaging were performed using cardiovascular X-ray imaging equipment during the injection of iopamidol via the left main coronary artery. Images were acquired and retrospectively ECG gated at 80 % of the R–R interval. FP myocardial blood flow (MBF) was obtained using the Patlak plot method applied to time-intensity curve data of the proximal artery and myocardium. The results were compared to microsphere MBF measurements. Time-intensity curves were also used to generate color-coded FP maps. There was a moderate linear correlation between the calculated FP MBF and the microsphere MBF (y = 0.9758x + 0.5368, R 2  = 0.61). The color-coded FP maps were moderately correlated with the regional distribution of flow. This novel method of first-pass contrast-enhanced two-dimensional fluoroscopic imaging can quantify MBF and provide color coded FP maps representing regional myocardial perfusion.