Quantification of vessel-specific coronary perfusion territories using minimum-cost path assignment and computed tomography angiography: Validation in a swine model

Abstract

BackgroundAs combined morphological and physiological assessment of coronary artery disease (CAD) is necessary to reliably resolve CAD severity, the objective of this study was to validate an automated minimum-cost path assignment (MCP) technique which enables accurate, vessel-specific assignment of the left (LCA) and right (RCA) coronary perfusion territories using computed tomography (CT) angiography data for both left and right ventricles. MethodsSix swine were used to validate the MCP technique. In each swine, a dynamic acquisition comprised of twenty consecutive volume scans was acquired with a 320-slice CT scanner following peripheral injection of contrast material. From this acquisition the MCP technique was used to automatically assign LCA and RCA perfusion territories for the left and right ventricles, independently. Each animal underwent another dynamic CT acquisition following direct injection of contrast material into the LCA or RCA. Using this acquisition, reference standard LCA and RCA perfusion territories were isolated from the myocardial blush. The accuracy of the MCP technique was evaluated by quantitatively comparing the MCP-derived LCA and RCA perfusion territories to these reference standard territories. ResultsAll MCP perfusion territory masses (MassMCP) and all reference standard perfusion territory masses (MassRS) in the left ventricle were related by MassMCP = 0.99MassRS+0.35 g (r = 1.00). MassMCP and MassRS in the right ventricle were related by MassMCP = 0.94MassRS+0.39 g (r = 0.96). ConclusionThe MCP technique was validated in a swine animal model and has the potential to be used for accurate, vessel-specific assignment of LCA and RCA perfusion territories in both the left and right ventricular myocardium using CT angiography data.