Validation of myocardial perfusion quantification by dynamic CT in an ex-vivo porcine heart model

To test the accuracy of quantification of myocardial perfusion imaging (MPI) using computed tomography (CT) in ex-vivo porcine models. Five isolated porcine hearts were perfused according to Langendorff. Hearts were perfused using retrograde flow through the aorta and blood flow, blood pressure and heart rate were monitored throughout the experiment. An inflatable cuff was placed around the circumflex (Cx) artery to create stenosis grades which were monitored using a pressure wire, analysing perfusion at several fractional flow reserve values of 1.0, 0.7, 0.5, 0.3, and total occlusion. Second-generation dual-source CT was used to acquire dynamic MPI in shuttle mode with 350 mAs/rot at 100 kVp. CT MPI was performed using VPCT myocardium software, calculating myocardial blood flow (MBF, ml/100 ml/min) for segments perfused by Cx artery and non-Cx myocardial segments. Microspheres were successfully infused at three stenosis grades in three of the five hearts. Heart rate ranged from 75 to 134 beats per minute. Arterial blood flow ranged from 0.5 to 1.4 l min and blood pressure ranged from 54 to 107 mmHg. MBF was determined in 400 myocardial segments of which 115 were classified as ‘Cx-territory’. MBF was significantly different between non-Cx and Cx segments at stenosis grades with an FFR ≤0.70 (Mann–Whitney U test, p < 0.05). MBF showed a moderate correlation with microsphere MBF for the three individual hearts (Pearson correlation 0.62–0.76, p < 0.01). CT MPI can be used to determine regional differences in myocardial perfusion parameters, based on severity of coronary stenosis. Significant differences in MBF could be measured between non-ischemic and ischemic segments.