Department of Radiology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, 271199, China.
Department of Nephropathy and Rheumatology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, 271199, China.
Eur J Radiol. 2021 Jun;139:109712. doi: 10.1016/j.ejrad.2021.109712. Epub 2021 Apr 14.
To assess the diagnostic role of coronary computed tomography angiography (CCTA) and fractional flow reserve computed tomography (FFRCT) in confirming or excluding ischemic coronary artery disease (CAD) and to provide a rational use of CCTA and FFRCT in different pre-test probability (PTP) of CAD.
We searched the electronic databases from the earliest relevant literature to July 2020 comparing FFRCT or CCTA with FFR. The bivariate random-effects models and Bayes' theorem were used to investigate the diagnostic performance of CCTA and FFRCT with the sensitivity, specificity, pre- and post-test probability.
Fifty-three articles with 4817 patients and 7026 vessels finally met our inclusion criteria. At the patient level, the sensitivity and specificity of CCTA were (0.94, 0.89-0.97), and (0.50, 0.43-0.58), respectively. For FFRCT, the sensitivity and specificity were (0.90, 0.87-0.93) and (0.81, 0.73-0.87). CCTA or FFRCT could increase the post-test probability to >85 % in patients with a PTP > 74.9 % or 54.5 %; CCTA or FFRCT could decrease the post-test probability to <15 % in patients with a pre-test probability <61.3 % or 59.3 %.
In patients with low to intermediate PTP, CCTA is suggested to exclude CAD, while the time-consuming calculation of FFRCT may be unnecessary. If CCTA detects significant or uncertain stenosis with intermediate to high PTP of CAD, further FFRCT is suggested. The advantages of FFRCT for guiding CAD treatment have sufficiently been demonstrated.
评估冠状动脉计算机断层血管造影术（CCTA）和血流储备分数计算机断层血管造影术（FFRCT）在确诊或排除缺血性冠状动脉疾病（CAD）方面的诊断作用，并为不同 CAD 术前概率（PTP）患者提供 CCTA 和 FFRCT 的合理应用。
我们检索了电子数据库中最早的相关文献，对比了 FFRCT 或 CCTA 与 FFR 的检测结果。采用双变量随机效应模型和贝叶斯定理，计算 CCTA 和 FFRCT 的诊断效能，包括敏感度、特异度、术前和术后概率。
共有 53 篇文章，涉及 4817 名患者和 7026 支血管，最终符合纳入标准。在患者层面，CCTA 的敏感度和特异度分别为（0.94，0.89-0.97）和（0.50，0.43-0.58），FFRCT 的敏感度和特异度分别为（0.90，0.87-0.93）和（0.81，0.73-0.87）。在术前概率（PTP）＞74.9％或＞54.5％的患者中，CCTA 或 FFRCT 可将术后概率提高至＞85％；在术前概率（PTP）＜61.3％或＜59.3％的患者中，CCTA 或 FFRCT 可将术后概率降低至＜15％。
在低至中等 PTP 的患者中，建议使用 CCTA 排除 CAD，而耗时的 FFRCT 计算可能不必要。如果 CCTA 检测到具有中等至高度 CAD 术前概率且存在显著或不确定狭窄，建议进一步进行 FFRCT。FFRCT 用于指导 CAD 治疗的优势已得到充分证明。
