Pulmonary CT perfusion robustly measures cardiac output in the context of multilevel pulmonary occlusion: a porcine study.
Cardiac output
Heart ventricles
Perfusion
Pulmonary artery
Tomography (x-ray computed)
Journal
European radiology experimental
ISSN: 2509-9280
Titre abrégé: Eur Radiol Exp
Pays: England
ID NLM: 101721752
Informations de publication
Date de publication:
22 Mar 2024
22 Mar 2024
Historique:
received:
22
06
2023
accepted:
09
01
2024
medline:
22
3
2024
pubmed:
22
3
2024
entrez:
22
3
2024
Statut:
epublish
Résumé
To validate pulmonary computed tomography (CT) perfusion in a porcine model by invasive monitoring of cardiac output (CO) using thermodilution method. Animals were studied at a single center, using a Swan-Ganz catheter for invasive CO monitoring as a reference. Fifteen pigs were included. Contrast-enhanced CT perfusion of the descending aorta and right and left pulmonary artery was performed. For variation purposes, a balloon catheter was inserted to block the contralateral pulmonary vascular bed; additionally, two increased CO settings were created by intravenous administration of catecholamines. Finally, stepwise capillary occlusion was performed by intrapulmonary arterial injection of 75-μm microspheres in four stages. A semiautomatic selection of AFs and a recirculation-aware tracer-kinetics model to extract the first-pass of AFs, estimating blood flow with the Stewart-Hamilton method, was implemented. Linear mixed models (LMM) were developed to calibrate blood flow calculations accounting with individual- and cohort-level effects. Nine of 15 pigs had complete datasets. Strong correlations were observed between calibrated pulmonary (0.73, 95% confidence interval [CI] 0.6-0.82) and aortic blood flow measurements (0.82, 95% CI, 0.73-0.88) and the reference as well as agreements (± 2.24 L/min and ± 1.86 L/min, respectively) comparable to the state of the art, on a relatively wide range of right ventricle-CO measurements. CT perfusion validly measures CO using LMMs at both individual and cohort levels, as demonstrated by referencing the invasive CO. Possible clinical applications of CT perfusion for measuring CO could be in acute pulmonary thromboembolism or to assess right ventricular function to show impairment or mismatch to the left ventricle. • CT perfusion measures flow in vessels. • CT perfusion measures cumulative cardiac output in the aorta and pulmonary vessels. • CT perfusion validly measures CO using LMMs at both individual and cohort levels, as demonstrated by using the invasive CO as a reference standard.
Sections du résumé
BACKGROUND
BACKGROUND
To validate pulmonary computed tomography (CT) perfusion in a porcine model by invasive monitoring of cardiac output (CO) using thermodilution method.
METHODS
METHODS
Animals were studied at a single center, using a Swan-Ganz catheter for invasive CO monitoring as a reference. Fifteen pigs were included. Contrast-enhanced CT perfusion of the descending aorta and right and left pulmonary artery was performed. For variation purposes, a balloon catheter was inserted to block the contralateral pulmonary vascular bed; additionally, two increased CO settings were created by intravenous administration of catecholamines. Finally, stepwise capillary occlusion was performed by intrapulmonary arterial injection of 75-μm microspheres in four stages. A semiautomatic selection of AFs and a recirculation-aware tracer-kinetics model to extract the first-pass of AFs, estimating blood flow with the Stewart-Hamilton method, was implemented. Linear mixed models (LMM) were developed to calibrate blood flow calculations accounting with individual- and cohort-level effects.
RESULTS
RESULTS
Nine of 15 pigs had complete datasets. Strong correlations were observed between calibrated pulmonary (0.73, 95% confidence interval [CI] 0.6-0.82) and aortic blood flow measurements (0.82, 95% CI, 0.73-0.88) and the reference as well as agreements (± 2.24 L/min and ± 1.86 L/min, respectively) comparable to the state of the art, on a relatively wide range of right ventricle-CO measurements.
CONCLUSIONS
CONCLUSIONS
CT perfusion validly measures CO using LMMs at both individual and cohort levels, as demonstrated by referencing the invasive CO.
RELEVANCE STATEMENT
CONCLUSIONS
Possible clinical applications of CT perfusion for measuring CO could be in acute pulmonary thromboembolism or to assess right ventricular function to show impairment or mismatch to the left ventricle.
KEY POINTS
CONCLUSIONS
• CT perfusion measures flow in vessels. • CT perfusion measures cumulative cardiac output in the aorta and pulmonary vessels. • CT perfusion validly measures CO using LMMs at both individual and cohort levels, as demonstrated by using the invasive CO as a reference standard.
Identifiants
pubmed: 38517595
doi: 10.1186/s41747-024-00431-7
pii: 10.1186/s41747-024-00431-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
51Subventions
Organisme : Deutsche Forschungsgesellschaft
ID : LE 817/40-1
Organisme : Deutsche Forschungsgesellschaft
ID : RE 4418/1-1
Organisme : Deutsche Forschungsgesellschaft
ID : PU 219/2-3
Informations de copyright
© 2024. The Author(s).
Références
Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 29:2276–2315. https://doi.org/10.1093/eurheartj/ehn310
doi: 10.1093/eurheartj/ehn310
pubmed: 18757870
Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS (2020) Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart Assoc 9:e016784. https://doi.org/10.1161/JAHA.120.016784
doi: 10.1161/JAHA.120.016784
pubmed: 32809909
pmcid: 7660782
Konstantinides SV, Meyer G, Becattini C et al (2020) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 41:543–603. https://doi.org/10.1093/eurheartj/ehz40
doi: 10.1093/eurheartj/ehz40
pubmed: 31504429
Hariharan P, Dudzinski DM, Rosovsky R et al (2016) Relation among clot burden, right-sided heart strain and adverse events after acute pulmonary embolism. Am J Cardiol 118:1568–1573. https://doi.org/10.1016/j.amjcard.2016.08.025
doi: 10.1016/j.amjcard.2016.08.025
pubmed: 27742425
Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389. https://doi.org/10.1016/S0140-6736(98)07534-5
doi: 10.1016/S0140-6736(98)07534-5
pubmed: 10227218
Heit J (2005) Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost 3:1611–1617. https://doi.org/10.1111/j.1538-7836.2005.01415.x
doi: 10.1111/j.1538-7836.2005.01415.x
pubmed: 16102026
Dempsey SCH, Lee TY, Samani A, So A (2022) Effect of cardiac phase on cardiac output index derived from dynamic CT myocardial perfusion imaging. Tomography 8:1129–1140. https://doi.org/10.3390/tomography8020092
doi: 10.3390/tomography8020092
pubmed: 35448726
pmcid: 9024735
Srichai MB, Lim RP, Wong S, Lee VS (2009) Cardiovascular applications of phase-contrast MRI. AJR Am J Roentgenol 192:662–675. https://doi.org/10.2214/AJR.07.3744
doi: 10.2214/AJR.07.3744
pubmed: 19234262
Konstas AA, Goldmakher GV, Lee TY, Lev MH (2009) Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol 30:885–892. https://doi.org/10.3174/ajnr.A1492
doi: 10.3174/ajnr.A1492
pubmed: 19299489
pmcid: 7051660
Wildberger JE, Schoepf UJ, Mahnken AH et al (2005) Approaches to CT perfusion imaging in pulmonary embolism. Semin Roentgenol 40:64–73. https://doi.org/10.1053/j.ro.2004.09.006
doi: 10.1053/j.ro.2004.09.006
pubmed: 15732562
Mirsadraee S, Reid JH, Connell M et al (2016) Dynamic (4D) CT perfusion offers simultaneous functional and anatomical insights into pulmonary embolism resolution. Eur J Radiol 85:1883–1890. https://doi.org/10.1016/j.ejrad.2016.08.018
doi: 10.1016/j.ejrad.2016.08.018
pubmed: 27666631
Calamante F (2013) Arterial input function in perfusion MRI: a comprehensive review. Prog Nucl Magn Reson Spectrosc 74:1–32. https://doi.org/10.1016/j.pnmrs.2013.04.002
doi: 10.1016/j.pnmrs.2013.04.002
pubmed: 24083460
Zierler KL (1962) Theoretical basis of indicator-dilution methods for measuring flow and volume. Circ Res 10:393–407. https://doi.org/10.1161/01.RES.10.3.393
doi: 10.1161/01.RES.10.3.393
Mahnken AH, Klotz E, Hennemuth A et al (2003) Measurement of cardiac output from a test-bolus injection in multislice computed tomography. Eur Radiol 13:2498–2504. https://doi.org/10.1007/s00330-003-2054-x
doi: 10.1007/s00330-003-2054-x
pubmed: 12904885
Konno M, Hosokai Y, Usui A et al (2012) Cardiac output obtained from test bolus injections as a factor in contrast injection rate revision of following coronary CT angiography. Acta Radiol 53:1107–1111. https://doi.org/10.1258/ar.2012.1202
doi: 10.1258/ar.2012.1202
pubmed: 22993270
Ludman PF, Coats AJS, Poole-Wilson PA, Rees R (1993) Measurement accuracy of cardiac output in humans: indicator-dilution technique versus geometric analysis by ultrafast computed tomography. J Am Coll Cardiol 21:1482–1489. https://doi.org/10.1016/0735-1097(93)90328-X
doi: 10.1016/0735-1097(93)90328-X
pubmed: 8473660
Herfkens RJ, Axel L, Lipton MJ, Napel S, Berninger W, Redington R (1982) Measurement of cardiac output by computed transmission tomography. Invest Radiol 17:550–553. https://doi.org/10.1097/00004424-198211000-00005
doi: 10.1097/00004424-198211000-00005
pubmed: 7152858
Garrett JS, Lanzer P, Jaschke W et al (1985) Measurement of cardiac output by cine computed tomography. Am J Cardiol 56:657–661. https://doi.org/10.1016/0002-9149(85)91030-6
doi: 10.1016/0002-9149(85)91030-6
pubmed: 3901722
Pienn M, Kovacs G, Tscherner M et al (2013) Determination of cardiac output with dynamic contrast-enhanced computed tomography. Int J Cardiovasc Imaging 29:1871–1878. https://doi.org/10.1007/s10554-013-0279-6
doi: 10.1007/s10554-013-0279-6
pubmed: 23974909
Patil V, Johnson G (2011) An improved model for describing the contrast bolus in perfusion MRI. Med Phys 38:6380–6383. https://doi.org/10.1118/1.3658570
doi: 10.1118/1.3658570
pubmed: 22149821
pmcid: 3230640
Martin KT, Xin Y, Gaulton TG et al (2023) Electrical impedance tomography identifies evolution of regional perfusion in a porcine model of acute respiratory distress syndrome. Anesthesiology. https://doi.org/10.1097/ALN.0000000000004731
doi: 10.1097/ALN.0000000000004731
pubmed: 37566686