Quantitative Analysis of First-Pass Contrast-Enhanced Myocardial Perfusion Multidetector CT Using a Patlak Plot Method and Extraction Fraction Correction During Adenosine Stress

Takashi Ichihara,Albert C Lardo,Richard T George,Joao A C Lima,Caterina Silva

doi:10.1109/tns.2010.2084104

Abstract

The purpose of this study was to develop a quantitative method for myocardial blood flow (MBF) measurement that can be used to derive accurate myocardial perfusion measurements from dynamic multidetector computed tomography (MDCT) images by using a compartment model for calculating the first-order transfer constant ( K 1 ) with correction for the capillary transit extraction fraction ( E ). Six canine models of left anterior descending (LAD) artery stenosis were prepared and underwent first-pass contrast-enhanced MDCT perfusion imaging during adenosine infusion (0.14-0.21 mg/kg/min). K 1 , which is the first-order transfer constant from left ventricular (LV) blood to myocardium, was measured using the Patlak plot method applied to time-attenuation curve data of the LV blood pool and myocardium. The results were compared against microsphere MBF measurements, and the extraction fraction of contrast agent was calculated. K 1 is related to the regional MBF as K 1 = EF , E =(1- exp (- PS / F )), where PS is the permeability-surface area product and F is myocardial flow. Based on the above relationship, a look-up table from K 1 to MBF can be generated and Patlak plot-derived K 1 values can be converted to the calculated MBF. The calculated MBF and microsphere MBF showed a strong linear association. The extraction fraction in dogs as a function of flow ( F ) was E =(1- exp (-(0.2532 F +0.7871)/ F )) . Regional MBF can be measured accurately using the Patlak plot method based on a compartment model and look-up table with extraction fraction correction from K 1 to MBF.

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