Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease

Coenen, Adriaan; Rossi, Alexia; Lubbers, Marisa; Kurata, Akira; Kono, Atsushi K.; Chelu, Raluca G.; Segreto, Sabrina; Dijkshoorn, Marcel L.; Wragg, Andrew; Geuns, Robert Jan van; Pugliese, Francesca; Nieman, Koen

doi:10.1016/j.jcmg.2016.09.028

Cited by 140 publications

(95 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, a rest-stress-DECT-P protocol, or a CT-based FFR calculation seems to be a promising concept to improve diagnostic accuracy in a real clinical setting (12).…”

Section: Resultsmentioning

confidence: 99%

Clinical Impact of Rest Dual–energy Computed Tomography Myocardial Perfusion in Patients with Coronary Artery Disease

Baumann

Rutsch

Becher

et al. 2017

View full text Add to dashboard Cite

Abstract. Background/Aim: To evaluate the hypothesis that patients with suspected coronary artery disease (CAD) assessed using rest dual-energy computed tomography-derived myocardial perfusion imaging (DECT-P), could have fewer invasive coronary angiographies (ICA),Current guidelines in the management of stable coronary artery disease (CAD) recommend a non-invasive functional test before considering invasive coronary angiography (ICA) for patients with intermediate pre-test probability (1). Due to the high sensitivity and negative predictive value, coronary computed tomography angiography (cCTA) is a clinically-established noninvasive diagnostic imaging modality to rule-out CAD. However, the specificity and positive predictive value of cCTA is still limited due to the poor correlation of cCTA-detected coronary artery stenosis and myocardial ischaemia.One avenue for assessment of the myocardial blood supply consists of dual-energy computed tomography (DECT) acquisitions during first-pass arterial enhancement. Dualenergy computed tomography-derived myocardial perfusion imaging (DECT-P) is a "one-stop shop" approach closing the gap between anatomical and functional aspects within a single imaging modality and could reduce false-positive results of cCTA (2). As rest DECT-P is derived from the same datasets as standard cCTA, it requires no additional contrast media, radiation exposure, or stress agents, which represents a substantial advantage, when compared to stress protocols. Studies have compared DECT-P with single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and ICA in rest or rest-stress acquisition with first or second generation dual-source scanners and found an incremental value over cCTA alone (3-6). However, the data for rest-only acquisition in DECT-P is rather sparse and needs further investigation regarding the clinical utility and its effect on patient care in a real clinical setting.Thus, the purpose of the present study was to test the hypothesis that patients with suspected CAD evaluated using a rest DECT-P strategy would potentially have fewer coronary angiographies without obstructive CAD than patients who were evaluated based on standard cCTA protocols.

show abstract

“…Thus, a rest-stress-DECT-P protocol, or a CT-based FFR calculation seems to be a promising concept to improve diagnostic accuracy in a real clinical setting (12).…”

Section: Resultsmentioning

confidence: 99%

Clinical Impact of Rest Dual–energy Computed Tomography Myocardial Perfusion in Patients with Coronary Artery Disease

Baumann

Rutsch

Becher

et al. 2017

View full text Add to dashboard Cite

show abstract

“…2) and CT perfusion (CTP) in a stepwise manner may significantly improve diagnostic accuracy. 11 Further analysis of the CORE-320 multicentre registry data, demonstrated that results from CTA and CTP were similarly predictive of major adverse cardiac events to those of combined invasive coronary angiography and SPECT findings. 12 These studies combined with a recent meta-analysis showing largely equivocal sensitivity and specificities between PET, CMR and CTP, and with all three outperforming SPECT, 13 support a promising future for CTP.…”

Section: Coronary Artery Diseasementioning

confidence: 98%

Highlights of the Twelfth Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography

Weir‐McCall

Villines

Shaw

et al. 2018

Journal of Cardiovascular Computed Tomography

Self Cite

View full text Add to dashboard Cite

The 12th Annual Scientific Meeting of the SCCT, held from July 6 to July 9 in Washington, DC, was one of the largest to date with 724 attendants from 34 countries, 130 invited talks, 4 "Read with the Experts" sessions, 42 oral abstracts presented, 20 rapid fire posters and 164 poster presentations with the abstracts of all of these published in the JCCT. This article summarises the many themes and topics of presentation and discussion in this meeting, and the many technical advances that are likely to impact future clinical practice and feature in future meetings.

show abstract

“…To date, the validation of noninvasive FFR derivation from CT for the detection of lesion-specific ischemia has been largely restricted to comparisons with invasive FFR alone or with coronary CT angiography or coronary CT angiography-derived approaches based on image postprocessing, that is, the transluminal attenuation gradient or plaque characterization (3,61). To date, only smaller scale, preliminary evidence is available on the performance of FFR CT relative to other functional imaging tests (89,106). However, several large-scale trials are currently studying the merits of FFR CT in comparison with other invasive and noninvasive functional imaging modalities.…”

Section: Contextualization and Comparison Of Ffr Ct With Other Noninvmentioning

confidence: 99%

Coronary CT Angiography–derived Fractional Flow Reserve

et al. 2017

View full text Add to dashboard Cite

Invasive coronary angiography (ICA) with measurement of fractional flow reserve (FFR) by means of a pressure wire technique is the established reference standard for the functional assessment of coronary artery disease (CAD) ( 1 , 2 ). Coronary computed tomographic (CT) angiography has emerged as a noninvasive method for direct assessment of CAD and plaque characterization with high diagnostic accuracy compared with ICA ( 3 , 4 ). However, the solely anatomic assessment provided with both coronary CT angiography and ICA has poor discriminatory power for ischemia-inducing lesions. FFR derived from standard coronary CT angiography (FFR) data sets by using any of several advanced computational analytic approaches enables combined anatomic and hemodynamic assessment of a coronary lesion by a single noninvasive test. Current technical approaches to the calculation of FFR include algorithms based on full- and reduced-order computational fluid dynamic modeling, as well as artificial intelligence deep machine learning ( 5 , 6 ). A growing body of evidence has validated the diagnostic accuracy of FFR techniques compared with invasive FFR. Improved therapeutic guidance has been demonstrated, showing the potential of FFR to streamline and rationalize the care of patients suspected of having CAD and improve outcomes while reducing overall health care costs ( 7 , 8 ). The purpose of this review is to describe the scientific principles, clinical validation, and implementation of various FFR approaches, their precursors, and related imaging tests. RSNA, 2017.

show abstract

Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease

Cited by 140 publications

References 30 publications

Clinical Impact of Rest Dual–energy Computed Tomography Myocardial Perfusion in Patients with Coronary Artery Disease

Clinical Impact of Rest Dual–energy Computed Tomography Myocardial Perfusion in Patients with Coronary Artery Disease

Highlights of the Twelfth Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography

Coronary CT Angiography–derived Fractional Flow Reserve

Contact Info

Product

Resources

About