Myocardial blood flow analysis of stress dynamic myocardial CT perfusion for hemodynamically significant coronary artery disease diagnosis: The clinical value of relative parameter optimization

Abstract Background The methods for calculating the optimal myocardial blood flow (MBF) relative parameters in stress dynamic myocardial CT perfusion (CTP) in detection of hemodynamically significant coronary artery disease (CAD) are non-uniform and lack of standard. Methods A total of 86 patients who were prospectively recruited underwent ATP-stress dynamic myocardial CTP. The relative MBF perfusion parameters were calculated as Ratio1, Ratio2 and Ratio3 according to the three types of reference MBF values, respectively: 1) average segmental MBF value, 2) 75th percentile of the average segmental MBF value, and 3) highest segmental MBF value. All the data were derived from both the endocardial and transmural layers of the myocardium. Invasive coronary angiography and fractional flow reserve (ICA/FFR) were used as the reference standards for myocardial ischemia evaluation. Results 151 vessels of 60 patients (43 men and 17 women; 61.38 ± 8.01 years) were enrolled in the analysis. The performance of endocardial layer was superior to that of the transmural layer (all P  Conclusions The relative MBF parameter of the endocardial myocardium using the highest segmental MBF value as a reference provided optimal diagnostic accuracy for the detection of hemodynamically significant CAD.