Korean J Radiol.  2013 Feb;14(1):21-29. 10.3348/kjr.2013.14.1.21.

Time Efficiency and Diagnostic Accuracy of New Automated Myocardial Perfusion Analysis Software in 320-Row CT Cardiac Imaging

• Rief M
• Stenzel F
• Kranz A
• Schlattmann P
• Dewey M

• KMID: 1430040
• DOI: http://doi.org/10.3348/kjr.2013.14.1.21

Abstract

OBJECTIVE
We aimed to evaluate the time efficiency and diagnostic accuracy of automated myocardial computed tomography perfusion (CTP) image analysis software.
MATERIALS AND METHODS
320-row CTP was performed in 30 patients, and analyses were conducted independently by three different blinded readers by the use of two recent software releases (version 4.6 and novel version 4.71GR001, Toshiba, Tokyo, Japan). Analysis times were compared, and automated epi- and endocardial contour detection was subjectively rated in five categories (excellent, good, fair, poor and very poor). As semi-quantitative perfusion parameters, myocardial attenuation and transmural perfusion ratio (TPR) were calculated for each myocardial segment and agreement was tested by using the intraclass correlation coefficient (ICC). Conventional coronary angiography served as reference standard.
RESULTS
The analysis time was significantly reduced with the novel automated software version as compared with the former release (Reader 1: 43:08 +/- 11:39 min vs. 09:47 +/- 04:51 min, Reader 2: 42:07 +/- 06:44 min vs. 09:42 +/- 02:50 min and Reader 3: 21:38 +/- 3:44 min vs. 07:34 +/- 02:12 min; p < 0.001 for all). Epi- and endocardial contour detection for the novel software was rated to be significantly better (p < 0.001) than with the former software. ICCs demonstrated strong agreement (> or = 0.75) for myocardial attenuation in 93% and for TPR in 82%. Diagnostic accuracy for the two software versions was not significantly different (p = 0.169) as compared with conventional coronary angiography.
CONCLUSION
The novel automated CTP analysis software offers enhanced time efficiency with an improvement by a factor of about four, while maintaining diagnostic accuracy.

Keyword

Computed tomography; Myocardial perfusion imaging; Software; Coronary disease; Automated analysis

MeSH Terms

Aged
Analysis of Variance
Body Mass Index
Coronary Angiography
Coronary Artery Disease/*radiography
*Efficiency, Organizational
Female
Humans
Male
Middle Aged
Myocardial Perfusion Imaging/*methods
Pattern Recognition, Automated/*methods
Prospective Studies
Radiographic Image Interpretation, Computer-Assisted/*methods
*Software
Statistics, Nonparametric
Time Factors
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Overall reading time. For novel software, overall reading time was significantly reduced (white boxplots) compared to former version (grey boxplots, p = <0.001 for all readers). Median (horizontal bar within boxplot) analysis time of Reader 1 and Reader 2 was equivalent, however Reader 3 with more experience had significantly less reading time in both novel and former software version compared to Readers 1 and 2. Black dots represent 5th/95th percentile.

• 

  Fig. 2 Myocardial contour detection. Effects of improved automated contour detection by novel software version are shown in column 2 where precise epicardial (red) and endocardial (green) delineation is present. Only few endocardial regions need manual correction (arrowheads) and especially epicardium had to be manually corrected only in septal area of apical third of heart (bottom row, image in middle with arrows). In contrast, detection was poor (column 1) in former software version and required extensive, almost circumferential contour corrections (arrows and arrowheads) in total of 18 slices. Results after manual correction are represented in column 3 showing congruent delineation of epi- and endocardial borders with exclusion of papillary muscles and trabecular structures. All images (wl 100/ww 200) are taken from rest CTP, slice thickness is 8 mm.

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