基于患者特异性集总参数模型的现场冠状动脉CT血管造影衍生血流储备分数的诊断性能
Diagnostic Performance of On-Site Coronary CT Angiography-derived Fractional Flow Reserve Based on Patient-specific Lumped Parameter Models.
作者信息
van Hamersvelt Robbert W, Voskuil Michiel, de Jong Pim A, Willemink Martin J, Išgum Ivana, Leiner Tim
机构信息
Departments of Radiology (R.W.v.H., P.A.d.J., M.J.W., T.L.) and Cardiology (M.V.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508GA Utrecht, the Netherlands; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.J.W.); and Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands (I.I.).
出版信息
Radiol Cardiothorac Imaging. 2019 Oct 31;1(4):e190036. doi: 10.1148/ryct.2019190036. eCollection 2019 Oct.
PURPOSE
To evaluate the diagnostic performance of a prototype on-site coronary CT angiography-derived fractional flow reserve (CT FFR) algorithm, based on patient-specific lumped parameter models, for the detection of functionally significant stenosis defined by invasive FFR, and to compare the performance to anatomic evaluation of stenosis degree.
MATERIALS AND METHODS
In this retrospective feasibility study, 77 vessels in 57 patients (42 of 57 [74%]) men; mean age, 58.5 years ± 9.2 [standard deviation]) who underwent clinically indicated coronary CT angiography within 60 days prior to an invasive FFR measurement were analyzed. Invasive FFR less than or equal to 0.80 was used to indicate a functionally significant stenosis. Diagnostic performance of CT FFR was evaluated and compared with evaluation of stenosis degree. Analysis was performed on a per-vessel basis.
RESULTS
Invasive FFR revealed functionally significant stenoses in 37 vessels (48%). CT FFR showed a significantly increased ability to indicate functionally significant stenosis (area under the receiver operating characteristic curve [AUC], 0.87) compared with degree of stenosis at coronary CT angiography (AUC, 0.70; ΔAUC 0.17; < .01). Using a cutoff of less than or equal to 0.80 for CT FFR and greater than or equal to 50% degree of stenosis at coronary CT angiography to indicate a significant stenosis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 33 of 37 (89.2%), 31 of 40 (77.5%), 33 of 42 (78.6%), 31 of 35 (88.6%), and 64 of 77 (83.1%), respectively, for CT FFR, and 33 of 37 (89.2%), 17 of 40 (42.5%), 33 of 56 (58.9%), 17 of 21 (81.0%), and 50 of 77 (64.9%), respectively, for degree of stenosis at coronary CT angiography.
CONCLUSION
Diagnostic performance of on-site CT FFR was superior to stenosis evaluation at coronary CT angiography for identification of functionally significant coronary artery stenosis in patients suspected of having or known to have coronary artery disease.© RSNA, 2019See also commentary by Schoepf et al.
目的
基于患者特异性集总参数模型，评估一种现场冠状动脉CT血管造影衍生的血流储备分数（CT FFR）算法原型对检测由有创FFR定义的功能显著狭窄的诊断性能，并将其性能与狭窄程度的解剖学评估进行比较。
材料与方法
在这项回顾性可行性研究中，分析了57例患者（57例中的42例[74%]为男性；平均年龄58.5岁±9.2[标准差]）的77条血管，这些患者在有创FFR测量前60天内接受了临床指征的冠状动脉CT血管造影。有创FFR小于或等于0.80用于指示功能显著狭窄。评估CT FFR的诊断性能并与狭窄程度评估进行比较。分析以每条血管为基础进行。
结果
有创FFR显示37条血管（48%）存在功能显著狭窄。与冠状动脉CT血管造影的狭窄程度相比，CT FFR显示出指示功能显著狭窄的能力显著提高（受试者操作特征曲线下面积[AUC]为0.87）（AUC为0.70；ΔAUC为0.17；P<0.01）。使用CT FFR小于或等于0.80以及冠状动脉CT血管造影狭窄程度大于或等于50%作为显著狭窄的截断值，CT FFR的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为37例中的33例（89.2%）、40例中的31例（77.5%）、42例中的33例（78.6%）、35例中的31例（88.6%）和77例中的64例（83.1%），冠状动脉CT血管造影狭窄程度的相应数值分别为37例中的33例（89.2%）、40例中的17例（42.5%）、56例中的33例（58.9%）、21例中的17例（81.0%）和77例中的50例（64.9%）。
结论
对于疑似或已知患有冠状动脉疾病的患者，现场CT FFR的诊断性能在识别功能显著的冠状动脉狭窄方面优于冠状动脉CT血管造影的狭窄评估。©RSNA，2019另见Schoepf等人的评论。
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