The use of lesion-specific calcium morphology to guide the appropriate use of dynamic CT myocardial perfusion imaging and CT fractional flow reserve

Xu, Da-Zhong; Lu, Zhigang; Yu, Yarong; Yu, Li; Xu, Hao; Zhang, Jiayin

doi:10.21037/qims-21-491

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Intraclass correlation coefficient and Bland-Altman methods were used to evaluate the agreement of scores derived from the CCTA and ICA of each lesion and patient. Patients were categorized into tertiles based on their anatomic SS and FSS, with categories defined as low (0-22), intermediate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and high (>32). 20 The consistency between FSS invasive and noninvasive FSS across different risk groups was assessed using weighted κ values.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies demonstrated the impact of the degree of calcification on CT-FFR in detecting hemodynamically significant lesions, with heavily calcified lesions typically exhibiting a lower positive predictive value. 24,25 In a comparative study evaluating the diagnostic performance of CT-MPI and CT-FFR for the detection of ischemic stenosis, the specificity, negative predictive value, and positive predictive value of CT-FFR were inferior to those of CT-MPI in calcified lesions with a calcium arc >180°. 25 In the present study, the mean difference between FSS CT-MPI and FSS invasive was lower compared with the difference observed between FSS CT-FFR and FSS invasive among patients with CACS ≥400.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 In a comparative study evaluating the diagnostic performance of CT-MPI and CT-FFR for the detection of ischemic stenosis, the specificity, negative predictive value, and positive predictive value of CT-FFR were inferior to those of CT-MPI in calcified lesions with a calcium arc >180°. 25 In the present study, the mean difference between FSS CT-MPI and FSS invasive was lower compared with the difference observed between FSS CT-FFR and FSS invasive among patients with CACS ≥400. Furthermore, the AUC value of FSS CT-MPI to classify intermediate- to high-score patients was significantly higher than FSS CT-FFR among patients with CACS ≥400.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Diagnostic Performance of Functional SYNTAX Score Derived From Dynamic CT Myocardial Perfusion Imaging

Dai,

Yu,

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Computed tomography (CT) fractional flow reserve (FFR)–derived functional SYNTAX score (FSS CT-FFR ) is a valuable method for guiding treatment strategy in patients with multivessel coronary artery disease. Dynamic CT myocardial perfusion imaging (CT-MPI) demonstrates higher diagnostic accuracy than CT-FFR in identifying hemodynamically significant coronary artery disease. We aimed to evaluate the feasibility of CT-MPI–derived FSS (FSS CT-MPI ) with reference to invasive FSS. METHODS: In this retrospective study, patients with multivessel coronary artery disease who underwent dynamic CT-MPI+ coronary CT angiography and invasive coronary angiography or FFR within 4 weeks were consecutively included. Invasive (FSS invasive ) and noninvasive FSS (FSS CT-MPI and FSS CT-FFR ) were calculated by an online calculator, which assigned points to lesions with hemodynamic significance (defined as FFR invasive ≤0.80, invasive coronary angiography diameter stenosis ≥90%, CT-FFR ≤0.80, and myocardial ischemia on CT-MPI). Weighted κ value and net reclassification index were calculated to determine the consistency and incremental discriminatory power of FSS CT-MPI . Receiver operating characteristic curve analysis was used for the comparison of FSS CT-MPI and FSS CT-FFR in detecting intermediate- to high-risk patients. RESULTS: A total of 119 patients (96 men; 64.6±10.6 years) with 305 obstructive lesions were included. The average FSS CT-MPI , FSS CT-FFR , and FSS invasive were 15.58±13.03, 16.18±13.30, and 13.11±12.22, respectively. The agreement on risk classification based on the FSS CT-MPI tertiles was good (weighted κ, 0.808). With reference to FSS invasive , FSS CT-MPI correctly reclassified 27 (22.7%) patients from the intermediate- to high SYNTAX score group to the low-score group (net reclassification index, 0.30; P <0.001). In patients with severe calcification, FSS CT-MPI had better diagnostic value than FSS CT-FFR in detecting intermediate- to high-risk patients when compared with FSS invasive (area under the curve, 0.976 versus 0.884; P <0.001). CONCLUSIONS: Noninvasive FSS derived from CT-MPI is feasible and has strong concordance with FSS invasive . It allows accurate categorization of FSS in patients with multivessel coronary artery disease, in particular with severe calcification.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility and Diagnostic Performance of Functional SYNTAX Score Derived From Dynamic CT Myocardial Perfusion Imaging

Dai,

Yu,

et al. 2024

Circ: Cardiovascular Imaging

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“…Then, computational fluid dynamics (CFD) and the Navier-Stokes equation are used to perform the operation on the CCTA model ( 9 ). Through this algorithm, the maximal hyperemia could be simulated by the effect of intravenous adenosine ( 10 ). The computing results are visualized, with areas measured as having identical CT-FFR values endowed with the same color.…”

Section: Introductionmentioning

confidence: 99%

Science mapping analysis of computed tomography-derived fractional flow reverse: a bibliometric review from 2012 to 2022

Zhang,

Zhu,

Jiang

et al. 2023

Quant Imaging Med Surg

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Background Computed tomography-derived fractional flow reserve (CT-FFR) is a non-invasive imagological examination used for diagnosing suspected coronary atherosclerotic heart disease, providing the morphological and functional value on a three-dimensional (3D) coronary artery model. This article aimed to collate the existing knowledge and predict this novel technology’s future research hotspots. Methods To collect data, 1,712 articles were retrieved from the Web of Science Core Collection (WoSCC) database from 2012–2022. CiteSpace5.8.R3 was used to visually analyze the research status and predict future research hotspots. Results Firstly, the United States, China, and the Netherlands were identified as the countries having published the most articles about CT-FFR. Jonathan Leipsic’s group ranked first for the highest number of published articles. Secondly, the visualized analysis indicated that the exploration of CT-FFR is multi-disciplinary and involves cardiology, radiology, engineering, and computer science. Thirdly, the hotspots in this field, which were inferred from the keyword distribution and clustering, included the following: “diagnostic performance”, “accuracy”, and the “prognostic value” of CT-FFR, and comparison of CT-FFR and other imaging methods sharing similarities. The research frontiers included technologies utilized to obtain more accurate CT-FFR values, such as artificial intelligence (AI) and deep learning. Conclusions As the first visualized bibliometric analysis on CT-FFR, this study captured the current accumulated information in this field and offer more insight and guidance for future research.

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“…Calcification of the coronary artery is a significant independent risk factor in predicting cardiac events and death in patients with coronary heart disease (1)(2)(3)(4)(5). Microcalcification, spotty calcification, and calcified nodules are closely related to acute coronary syndrome (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

A comparison of computed tomography imaging with histopathology in the sensitivity and correlation of evaluating coronary arterial calcification

Liu¹,

Ma²,

Wang³

et al. 2023

Quant Imaging Med Surg

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Background: The sensitivity and correlation of coronary computed tomography angiography (CTA) as compared with histopathology are unknown in evaluating coronary arterial calcification. In this study, we retrospectively evaluated qualitatively and quantitatively the sensitivity and correlation of coronary CTA compared with histopathology in assessing coronary arterial calcification.Methods: This study was conducted on 12 randomly selected cadavers aged over 40 years at the time of death, and 53 segments of coronary arteries from these 12 cadavers were obtained from the Human Anatomy Laboratory of Tianjin Medical University. The artery segments were scanned using contrastedenhanced dual-source computed tomography (DSCT) with an axial slice thickness of 0.6 mm. Coronary artery calcification in a coronary segment was defined as the presence of 1 or more voxels with a CT density >130 Hounsfield units. According to the arc of calcification in the cross section of the coronary artery wall, calcified plaques were divided into three categories: mild, moderate, and severe calcification. The coronary artery stenosis caused by calcified plaque was observed and calculated with multiplanar reconstruction (MPR), maximum density projection, volume rendering (VR), and cross-sectional reconstruction. After CT enhancement scanning, the coronary artery specimens were cut into 4-mm long segments and embedded in paraffin for pathological staining. Pathological classification and coronary artery stenosis measured with pathological analysis were used as comparison criteria.Results: Histopathology detected 69 Vb-type plaques, while DSCT detected 57 calcified plaques. The sensitivity of CT for detecting mild, moderate, and severe calcified plaques were 88.3% [95% confidence interval (CI): 74.1-95.6%], 100% (95% CI: 69.8-100%), and 100% (95% CI: 73.2-100%), respectively.DSCT had a significant (P<0.001) correlation with histopathology in quantifying coronary artery stenosis caused by mild, moderate, and severe calcified plaques (r=0. 97, r=0.92, and r=0.79, respectively). Compared with histopathology, DSCT overestimated coronary artery stenosis caused by mild, moderate, and severe calcified plaques (3.2%±2.0%, 4.9%±4.7%, and 14.7%±8.2%, respectively; P<0.05).Conclusions: DSCT contrast enhancement scanning can detect and characterize coronary artery calcification with a good correlation with histopathologic quantification of coronary artery stenosis caused by different types of calcified plaques, even though coronary CTA may overestimate the stenosis.

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The use of lesion-specific calcium morphology to guide the appropriate use of dynamic CT myocardial perfusion imaging and CT fractional flow reserve

Cited by 5 publications

References 32 publications

Feasibility and Diagnostic Performance of Functional SYNTAX Score Derived From Dynamic CT Myocardial Perfusion Imaging

Feasibility and Diagnostic Performance of Functional SYNTAX Score Derived From Dynamic CT Myocardial Perfusion Imaging

Science mapping analysis of computed tomography-derived fractional flow reverse: a bibliometric review from 2012 to 2022

A comparison of computed tomography imaging with histopathology in the sensitivity and correlation of evaluating coronary arterial calcification

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