Di Jiang Meng, Zhang Xiao Lei, Liu Hui, Tang Chun Xiang, Li Jian Hua, Wang Yi Ning, Xu Peng Peng, Zhou Chang Sheng, Zhou Fan, Lu Meng Jie, Zhang Jia Yin, Yu Meng Meng, Hou Yang, Zheng Min Wen, Zhang Bo, Zhang Dai Min, Yi Yan, Xu Lei, Hu Xiu Hua, Yang Jian, Lu Guang Ming, Ni Qian Qian, Zhang Long Jiang
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
Department of Radiology, Guangdong General Hospital, Guangzhou, 510080, China.
Eur Radiol. 2021 Mar;31(3):1482-1493. doi: 10.1007/s00330-020-07261-2. Epub 2020 Sep 14.
To investigate the effect of coronary calcification morphology and severity on the diagnostic performance of machine learning (ML)-based coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) with FFR as a reference standard.
A total of 442 patients (61.2 ± 9.1 years, 70% men) with 544 vessels who underwent CCTA, ML-based CT-FFR, and invasive FFR from China multicenter CT-FFR study were enrolled. The effect of calcification arc, calcification remodeling index (CRI), and Agatston score (AS) on the diagnostic performance of CT-FFR was investigated. CT-FFR ≤ 0.80 and lumen reduction ≥ 50% determined by CCTA were identified as vessel-specific ischemia with invasive FFR as a reference standard.
Compared with invasive FFR, ML-based CT-FFR yielded an overall sensitivity of 0.84, specificity of 0.94, and accuracy of 0.90 in a total of 344 calcification lesions. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of CT-FFR across different calcification arc, CRI, or AS levels. CT-FFR exhibited improved discrimination of ischemia compared with CCTA alone in lesions with mild-to-moderate calcification (AUC, 0.89 vs. 0.69, p < 0.001) and lesions with CRI ≥ 1 (AUC, 0.89 vs. 0.71, p < 0.001). The diagnostic accuracy and specificity of CT-FFR were higher than CCTA alone in patients and vessels with mid (100 to 299) or high (≥ 300) AS.
Coronary calcification morphology and severity did not influence diagnostic performance of CT-FFR in ischemia detection, and CT-FFR showed marked improved discrimination of ischemia compared with CCTA alone in the setting of calcification.
• CT-FFR provides superior diagnostic performance than CCTA alone regardless of coronary calcification. • No significant differences in the diagnostic performance of CT-FFR were observed in coronary arteries with different coronary calcification arcs and calcified remodeling indexes. • No significant differences in the diagnostic accuracy of CT-FFR were observed in coronary arteries with different coronary calcification score levels.
以血流储备分数（FFR）作为参考标准，研究冠状动脉钙化形态和严重程度对基于机器学习（ML）的冠状动脉CT血管造影（CCTA）衍生的血流储备分数（CT-FFR）诊断性能的影响。
纳入来自中国多中心CT-FFR研究的442例患者（61.2±9.1岁，70%为男性），共544支血管，这些患者均接受了CCTA、基于ML的CT-FFR和有创FFR检查。研究钙化弧、钙化重塑指数（CRI）和阿加斯顿评分（AS）对CT-FFR诊断性能的影响。以有创FFR为参考标准，将CT-FFR≤0.80且CCTA确定的管腔狭窄≥50%定义为血管特异性缺血。
在总共344个钙化病变中，与有创FFR相比，基于ML的CT-FFR的总体敏感性为0.84，特异性为0.94，准确性为0.90。在不同的钙化弧、CRI或AS水平下，CT-FFR的诊断准确性、敏感性或特异性无统计学差异。在轻度至中度钙化病变（AUC，0.89对0.69，p<0.001）和CRI≥1的病变（AUC，0.89对0.71，p<0.001）中，与单独的CCTA相比，CT-FFR对缺血的鉴别能力有所提高。在AS为中度（100至299）或高度（≥300）的患者和血管中，CT-FFR的诊断准确性和特异性高于单独的CCTA。
冠状动脉钙化形态和严重程度不影响CT-FFR在缺血检测中的诊断性能，并且在存在钙化的情况下，与单独的CCTA相比，CT-FFR对缺血的鉴别能力有显著提高。
• 无论冠状动脉钙化情况如何，CT-FFR均比单独的CCTA具有更高的诊断性能。• 在具有不同冠状动脉钙化弧和钙化重塑指数的冠状动脉中，未观察到CT-FFR诊断性能的显著差异。• 在具有不同冠状动脉钙化评分水平的冠状动脉中，未观察到CT-FFR诊断准确性的显著差异。
