MCP-based tessellation using inherently co-registered CCTA and CT-MPI enables accurate vessel-specific myocardium-at-risk assessment and offers a promising platform for anatomical-functional integration in coronary disease.
Coronary angiograms reconstructed directly from dynamic CT-MPI data provided inherent co-registration between coronary arteries and myocardial perfusion maps, allowing validation of coronary-based myocardial territory assignment.
Vessel-specific myocardial territories assigned by a minimum cost path (MCP) approach showed moderate spatial overlap with CT-MPI-derived hypoperfusion.
The surface area of MCP-assigned territories correlated strongly with the surface area of CT-MPI-derived hypoperfused territories.
Agreement between MCP-assigned territories and CT-MPI hypoperfusion was highest in the left anterior descending (LAD) territory.
The authors conclude that MCP-based tessellation with inherently co-registered CCTA and CT-MPI enables accurate vessel-specific myocardium-at-risk assessment.
When a heart artery is narrowed, doctors want to know how much heart muscle depends on it and could be starved of blood. CT scans of the heart arteries (CCTA) show the vessels, but estimating which part of the muscle each vessel feeds relies on computer algorithms. Checking these algorithms has been hard because the artery images and the blood-flow images usually do not line up perfectly. In this study, researchers built the artery images directly from a dynamic CT scan that also measures blood flow to the heart muscle, so both image types matched automatically. They used a computer method (minimum cost path) to assign heart muscle territories to each artery and compared them with areas of low blood flow in 22 patients (27 areas of reduced flow). The predicted territories overlapped moderately with the low-flow areas (Dice 0.72), and their sizes were strongly correlated (r = 0.81). Agreement was best for the territory of the left anterior descending artery. This research suggests that artery-based territory mapping can reasonably approximate which heart muscle is at risk and could help link the appearance of arteries with their effect on blood flow. The study was small and included only patients with well-defined areas of reduced blood flow, so further testing would be needed before wide use.
Seresti A, Castillo E, Menon K, Marsden A, Nguyen P, Malik S, et al.. (2026). Vessel Dependent Myocardium at Risk on Coronary CT Angiography Validated Against Dynamic CT Myocardial Perfusion Imaging.. Journal of cardiovascular translational research. https://doi.org/10.1007/s12265-026-10861-w