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SLIC robust (SLICR) processing for fast, robust CT myocardial blood flow quantification

There are several computational methods for estimating myocardial blood flow (MBF) using CT myocardial perfusion imaging (CT-MPI). Previous work has shown that model-based deconvolution methods are more accurate and precise than model-independent methods such as singular value decomposition and max-upslope. However, iterative optimization is computationally expensive and models are sensitive to image noise, thus limiting the utility of low x-ray dose acquisitions. We propose a new processing method, SLICR, which segments the myocardium into super-voxels using a modified simple linear iterative clustering (SLIC) algorithm and quantifies MBF via a robust physiologic model (RPM). We compared SLICR against voxel-wise SVD and voxel-wise model-based deconvolution methods (RPM, single-compartment and Johnson-Wilson). We used image data from a digital CT-MPI phantom to evaluate robustness of processing methods to noise at reduced x-ray dose. We validate SLICR in a porcine model with and without partial occlusion of the LAD coronary artery with known pressure-wire fractional flow reserve. SLICR was ~50 times faster than voxel-wise RPM and other model-based methods while retaining sufficient resolution to show all clinically interesting features (e.g., a flow deficit in the endocardial wall). SLICR showed much better precision and accuracy than the other methods. For example, at simulated MBF=100 mL/min/100g and 100 mAs exposure (50% of nominal dose) in the digital simulator, MBF estimates were 101 ± 12 mL/min/100g, 160 ± 54 mL/min/100g, and 122 ± 99 mL/min/100g for SLICR, SVD, and Johnson-Wilson, respectively. SLICR even gave excellent results (103 ± 23 ml/min/100g) at 50 mAs, corresponding to 25% nominal dose.