基于能量积分探测器CT系统和光子计数探测器CT系统的冠状动脉CT血管造影FFR的个体内比较。

Intra-individual comparison of coronary CT angiography-based FFR between energy-integrating and photon-counting detector CT systems.

作者信息

Zsarnoczay Emese, Pinos Daniel, Schoepf U Joseph, Fink Nicola, O'Doherty Jim, Gnasso Chiara, Griffith Joseph, Vecsey-Nagy Milán, Suranyi Pal, Maurovich-Horvat Pál, Emrich Tilman, Varga-Szemes Akos

机构信息

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA.

出版信息

Int J Cardiol. 2024 Mar 15;399:131684. doi: 10.1016/j.ijcard.2023.131684. Epub 2023 Dec 25.

DOI:10.1016/j.ijcard.2023.131684

PMID:38151162

Abstract

BACKGROUND

Coronary computed tomography angiography (CCTA)-based fractional flow reserve (CT-FFR) allows for noninvasive determination of the functional severity of anatomic lesions in patients with coronary artery disease. The aim of this study was to intra-individually compare CT-FFR between photon-counting detector (PCD) and conventional energy-integrating detector (EID) CT systems.

METHODS

In this single-center prospective study, subjects who underwent clinically indicated CCTA on an EID-CT system were recruited for a research CCTA on PCD-CT within 30 days. Image reconstruction settings were matched as closely as possible between EID-CT (Bv36 kernel, iterative reconstruction strength level 3, slice thickness 0.5 mm) and PCD-CT (Bv36 kernel, quantum iterative reconstruction level 3, virtual monoenergetic level 55 keV, slice thickness 0.6 mm). CT-FFR was measured semi-automatically using a prototype on-site machine learning algorithm by two readers. CT-FFR analysis was performed per-patient and per-vessel, and a CT-FFR ≤ 0.75 was considered hemodynamically significant.

RESULTS

A total of 22 patients (63.3 ± 9.2 years; 7 women) were included. Median time between EID-CT and PCD-CT was 5.5 days. Comparison of CT-FFR values showed no significant difference and strong agreement between EID-CT and PCD-CT in the per-vessel analysis (0.88 [0.74-0.94] vs. 0.87 [0.76-0.93], P = 0.096, mean bias 0.02, limits of agreement [LoA] -0.14/0.19, r = 0.83, ICC = 0.92), and in the per-patient analysis (0.81 [0.60-0.86] vs. 0.76 [0.64-0.86], P = 0.768, mean bias 0.02, LoA -0.15/0.19, r = 0.90, ICC = 0.93). All included patients were classified into the same category (CT-FFR > 0.75 vs ≤0.75) with both CT systems.

CONCLUSIONS

CT-FFR evaluation is feasible with PCD-CT and it shows a strong agreement with EID-CT-based evaluation when images are similarly reconstructed.

摘要

背景

基于冠状动脉计算机断层扫描血管造影（CCTA）的血流储备分数（CT-FFR）可用于无创性确定冠心病患者解剖病变的功能严重程度。本研究的目的是在个体内比较光子计数探测器（PCD）和传统能量积分探测器（EID）CT系统之间的CT-FFR。

方法

在这项单中心前瞻性研究中，在EID-CT系统上接受临床指征CCTA的受试者在30天内被招募进行PCD-CT的研究性CCTA。EID-CT（Bv36内核，迭代重建强度等级3，层厚0.5mm）和PCD-CT（Bv36内核，量子迭代重建等级3，虚拟单能水平55keV，层厚0.6mm）之间的图像重建设置尽可能匹配。由两名读者使用原型现场机器学习算法半自动测量CT-FFR。对每位患者和每支血管进行CT-FFR分析，CT-FFR≤0.75被认为具有血流动力学意义。

结果

共纳入22例患者（63.3±9.2岁；7名女性）。EID-CT和PCD-CT之间的中位时间为5.5天。CT-FFR值的比较显示，在每支血管分析中，EID-CT和PCD-CT之间无显著差异且一致性良好（0.88[0.74-0.94]对0.87[0.76-0.93]，P=0.096，平均偏差0.02，一致性界限[LoA]-0.14/0.19，r=0.83，ICC=0.92），在每位患者分析中也是如此（0.81[0.60-0.86]对0.76[0.64- .86]，P=0.768，平均偏差0.02，LoA -0.15/0.19，r=0.90，ICC=0.93）。所有纳入的患者在两种CT系统中都被分类到同一类别（CT-FFR>0.75对≤0.75）。