Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320-MDCT: the CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study

Abstract

Objective: Coronary MDCT angiography has been shown to be an accurate noninvasive tool for the diagnosis of obstructive coronary artery disease (CAD). Its sensitivity and negative predictive value for diagnosing percentage of stenosis are unsurpassed compared with those of other noninvasive testing methods. However, in its current form, it provides no information regarding the physiologic impact of CAD and is a poor predictor of myocardial ischemia. CORE320 is a multicenter multinational diagnostic study with the primary objective to evaluate the diagnostic accuracy of 320-MDCT for detecting coronary artery luminal stenosis and corresponding myocardial perfusion deficits in patients with suspected CAD compared with the reference standard of conventional coronary angiography and SPECT myocardial perfusion imaging.

Conclusion: We aim to describe the CT acquisition, reconstruction, and analysis methods of the CORE320 study.

Fig. 1

Overall enrollment strategy of CORE320 Multicenter study. All patients enrolled with clinical indication for invasive coronary angiography will undergo either clinical or research SPECT study at validated site, MDCT angiography and perfusion study, and invasive coronary angiography within 60 days of each other.

Fig. 2

Coronary artery segmentation model used for CORE-64 study with 19 segments: five in right coronary artery, six in left anterior descending coronary artery (including left main), seven in left circumflex coronary artery, and one in intermediate branch. Entire coronary artery tree is included in model. All segments ≥ 1.0 mm will be included in data analysis. C1 = proximal left circumflex coronary artery, C2 = midleft circumflex coronary artery, C3 = first obtuse marginal, C4 = second obtuse marginal, C5 = third obtuse marginal, C6 = grouped distal left circumflex coronary artery (first left posterolateral, second left posterolateral, and third left posterolateral; segments 19.1, 23, 24, 25, and 26 of Coronary Artery Surgery Study model [28]), C7 = left posterior descending, C8 = intermediate branch, L1 = left main (LM), L2 = proximal left anterior descending, L3 = midleft anterior descending, L4 = distal left anterior descending, L5 = first diagonal branch, L6 = second diagonal branch, R1 = proximal right coronary artery, R2 = midright coronary artery, R3 = distal right coronary artery, R4 = right posterior descending, R5 = grouped right posterolateral (first right posterolateral, second right posterolateral, and third right posterolateral; segments 5, 6, 7, 8 of Coronary Artery Surgery Study model). Adapted with permission from [25].

Fig. 3

Thirteen-segment myocardial model. Red denotes left anterior descending artery territory, blue denotes left circumflex territory, and yellow denotes right coronary artery territory.

Fig. 4

Adenosine stress CT myocardial perfusion analysis using combination of visual and quantitative data to assess myocardium for perfusion abnormalities. A, B, and C, Multiplanar reconstructions show vertical long-axis (A), short-axis (B), and horizontal long-axis (C) views. D, Thirteen-segment polar plot displays color-coded map of transmural perfusion ratio (i.e., subendocardial attenuation divided by subepicardial attenuation). Perfusion deficit is confirmed both visually and quantitatively to be present in anterior and anteroseptal walls corresponding to obstructive atherosclerosis in left anterior descending artery and first obtuse marginal artery.