Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Wang, Rui; Renker, Matthias; Schoepf, U. Joseph; Wichmann, Julian L.; Fuller, Stephen R.; Rier, Jeremy D.; Bayer, Richard R.; Steinberg, Daniel H.; De Cecco, Carlo N.; Baumann, Stefan
• Is Part Of: European journal of radiology. Volume 84:Issue 8(2015)
• Page Start: 1509
• Page End: 1515
• Publication Date: 2015-08
• Subjects: CAD coronary artery disease -- CCTA coronary CT angiography -- CCO corrected coronary attenuation -- ICA invasive catheter angiography -- LL lesion length -- MLD minimal luminal diameter -- FFR fractional flow reserve -- ROC receiver-operating characteristics -- TAG transluminal attenuation gradient; Coronary artery disease -- Coronary angiography -- Coronary computed tomography angiography -- Fractional flow reserve; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2015.05.010
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Evaluation of the diagnostic performance of CCTA predictors for coronary stenosis. TAG was unable to detect hemodynamically significant coronary lesions. CT-FFR, LL/MLD 4 and CCO provide enhanced diagnostic performance over CCTA. CT-FFR was the best parameter. Abstract: Objective: To evaluate the diagnostic performance of CCTA-derived stenosis predictors including CT-FFR for the detection of ischemia-inducing stenosis compared to invasive FFR. Materials and methods: Stenosis parameters were assessed using dual-source CT (DSCT). All patients underwent both CCTA and invasive FFR within 3 months and were retrospectively analyzed. Observers visually assessed all CCTA studies and performed multiple lesion measurements. Lesion length/minimal luminal diameter 4 (LL/MLD 4 ), transluminal attenuation gradient (TAG), corrected coronary attenuation (CCO) and CT-FFR were calculated. Results: The cohort included 32 patients (58 ± 12 years, 66%male). Among 32 coronary lesions, 8 (25%) were considered hemodynamically significant with an FFR <0.80. Compared to invasive FFR, the per-vessel sensitivity and specificity of CCTA, CT-FFR, LL/MLD 4, CCO and TAG for detecting hemodynamically significant lesions were 100% and 54%, 100% and 91%, 85% and 92%, 66% and 88%, 37% and 58%, respectively. Receiver operating characteristics analysis resulted in an area under the curve of 0.91 for CT-FFR ( p = 0.0005), 0.88 for LL/MLD 4 ( p < 0.0001), 0.85 for CCO ( p < 0.0001). TAG with an AUC of 0.67 ( p = 0.152) was unable to discriminate between vessels with or without hemodynamically significant lesions. Conclusion: CT-FFR, LL/MLD 4 and CCO provide enhanced diagnostic performance over CCTA analysis alone for discrimination of hemodynamically significant coronary stenosis.