A novel CT-FFR method for the coronary artery based on 4D-CT image analysis and structural and fluid analysis

Abstract

Non invasive fractional flow reserve derived from CT coronary angiography (CT-FFR) has to date been typically performed using the principles of fluid analysis in which a lumped parameter coronary vascular bed model is assigned to represent the impedance of the downstream coronary vascular networks absent in the computational domain for each coronary outlet. This approach may have a number of limitations. It may not account for the impact of the myocardial contraction and relaxation during the cardiac cycle, patient-specific boundary conditions for coronary artery outlets and vessel stiffness. We have developed a novel approach based on 4D-CT image tracking (registration) and structural and fluid analysis, to address these issues. In our approach, we analyzed the deformation variation of vessels and the volume variation of vessels, primarily from 70% to 100% of cardiac phase, to better define boundary conditions and stiffness of vessels. We used a statistical estimation method based on a hierarchical Bayes model to integrate 4D-CT measurements and structural and fluid analysis data. Under these analysis conditions, we performed structural and fluid analysis to determine pressure, flow rate and CT-FFR. The consistency of this method has been verified by a comparison of 4D-CT-FFR analysis results derived from five clinical 4D-CT datasets with invasive measurements of FFR. Additionally, phantom experiments of flexible tubes with/without stenosis using pulsating pumps, flow sensors and pressure sensors were performed. Our results show that the proposed 4D-CT-FFR analysis method has the potential to accurately estimate the effect of coronary artery stenosis on blood flow.

Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve

“…After the procedure, CT-FFR was calculated using the analysis software (Canon Medial Systems Corporation, Otawara, Japan), which allows the computation of CT-FFR values at any selected points of the coronary tree. CT-FFR was calculated according to the fluid structure interaction, in consideration of changes in the shape, movement, cross-sectional area, and volume of the coronary artery using several optimal cardiac phases to acquire 70-99% of the cardiac phase [16,17]. Hierarchical Bayes & Markov-Chain Monte Carlo Methods were applied to determine conditions for the analysis.…”

Computed tomographic evaluation of myocardial ischemia

“…9). On-site vendor-based platforms are also available in some institutions, including a machine learning-based algorithm [102,103], four-dimensional CT image tracking (registration) and structural and fluid analysis [104,105], and patientspecific lumped parameter models [106,107]. However, the off-site CT-FFR using a remote analysis service is recently received with national reimbursement approval in Japan, but the available facilities are strictly limited by requirements.…”

Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

“…A FFR calculation algorithm was developed from CCTA acquired via 320-row area detector CT (320-ADCT) using fluid–structure interaction as a method for CT-derived FFR (CT-FFR). This is considered to be capable of setting conditions unique to each patient in CT-FFR calculations, based on the shape, movement, cross-sectional area, and changes in the volume of the coronary artery, by acquiring multiple optimum cardiac phases from 70–99% of the cardiac phase data within one heartbeat and analyzing these data based on the hierarchical Bayes and Markov chain Monte Carlo method [ 10 , 11 ]. In addition, on-site analysis at a workstation is possible by calculating the 1D computational fluid dynamics.…”