So Aaron, Choo Ki Seok, Lee Ji Won, Kim Yun-Hyeon, Haider Mustafa, Hasan Mahmud, El-Ganga Serag, Goela Akshaye, Teefy Patrick, Choe Yeon Hyeon
Imaging, Lawson Research Institute, London, ON N6A 4V2, Canada.
Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada.
Radiol Adv. 2024 Nov 25;1(4):umae031. doi: 10.1093/radadv/umae031. eCollection 2024 Oct.
The objective was to evaluate the accuracy of a novel CT dynamic angiographic imaging (CT-DAI) algorithm for rapid fractional flow reserve (FFR) measurement in patients with coronary artery disease (CAD).
This retrospective study included 14 patients (age 58.5 ± 10.6 years, 11 males) with CAD who underwent stress dynamic CT myocardial perfusion scanning with a dual-source CT scanner. The included patients had analyzable proximal and distal coronary artery segments adjacent to the stenosis in the perfusion images and had corresponding invasive catheter-based FFR measurements for that stenosis. An in-house software based on the CT-DAI algorithm was used to compute FFR using the pre- and post- lesion coronary time-enhancement curves obtained from the stress myocardial perfusion images. The CT-DAI derived FFR values were then compared to the corresponding catheter-based invasive FFR values. A coronary artery stenosis was considered functionally significant for FFR value <0.8.
The CT-DAI derived FFR values were in agreement with the invasive FFR values in all 15 coronary arteries in 14 patients, resulting in 100% per-vessel and per-patient diagnostic accuracy. FFR derived using CT-DAI ( = 0.768, SD = 0.156) showed an excellent linear correlation ( = 0.910, < .001) and statistical indifference (= .655) with that measured using invasive catheter-based method ( = 0.796, SD = 0.149). Bland-Altman analysis showed no significant proportional bias.
The novel CT-DAI algorithm can reliably compute FFR across a coronary artery stenosis directly from dynamic CT myocardial perfusion images, facilitating rapid on-site hemodynamic assessment of the epicardial coronary artery stenosis in patients with CAD.
本研究旨在评估一种新型CT动态血管造影成像（CT-DAI）算法在冠心病（CAD）患者中快速测量血流储备分数（FFR）的准确性。
本回顾性研究纳入了14例CAD患者（年龄58.5±10.6岁，男性11例），这些患者使用双源CT扫描仪进行了负荷动态CT心肌灌注扫描。纳入的患者在灌注图像中有可分析的、与狭窄相邻的冠状动脉近端和远端节段，并且针对该狭窄进行了基于侵入性导管的FFR测量。使用基于CT-DAI算法的内部软件，通过从负荷心肌灌注图像中获得的病变前后冠状动脉时间增强曲线来计算FFR。然后将CT-DAI得出的FFR值与相应的基于导管的侵入性FFR值进行比较。当FFR值<0.8时，冠状动脉狭窄被认为具有功能意义。
在14例患者的所有15条冠状动脉中，CT-DAI得出的FFR值与侵入性FFR值一致，血管和患者的诊断准确率均为100%。使用CT-DAI得出的FFR（=0.768，标准差=0.156）与使用基于侵入性导管的方法测量的FFR（=0.796，标准差=0.149）显示出极好的线性相关性（=0.910，<0.001）和统计学无差异（=0.655）。Bland-Altman分析显示无显著比例偏差。
新型CT-DAI算法能够直接从动态CT心肌灌注图像可靠地计算冠状动脉狭窄处的FFR，有助于对CAD患者的心外膜冠状动脉狭窄进行快速现场血流动力学评估。
