Zhu Tingting, Li Yanhui, Wang Yujin, Guan Hanxiong, Li Qian, Li Defu
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
BMC Med Imaging. 2025 Aug 18;25(1):332. doi: 10.1186/s12880-025-01874-z.
Fractional flow reserve with computed tomography (FFR-CT) is influenced by calcified plaque artifacts, which can reduce its accuracy in predicting myocardial ischemia. Subtraction techniques can mitigate these artifacts, thereby enhancing diagnostic precision. However, the potential of subtraction FFR-CT and the pericoronary fat attenuation index (FAI) to improve the prediction of revascularization in patients with coronary artery disease (CAD) remains unclear. We aimed to evaluate the diagnostic performance of FFR-CT and pericoronary FAI in identifying the need for revascularization in patients with CAD.
We retrospectively analyzed coronary computed tomography angiography (CCTA) data from 76 patients with CAD (142 branches) using both conventional and subtraction CCTA images. The diagnostic performance of FFR-CT and FAI in identifying revascularization needs was assessed using receiver operating characteristic curves.
Among the 76 patients, 54 underwent revascularization. Patients who underwent revascularization had higher pericoronary FAI and lower FFR-CT values. Subtraction FFR-CT values were higher than those obtained using conventional methods. Models 4 (subtraction CCTA), 5 (Model 4 + subtraction FFR-CT), and 6 (Model 5 + subtraction FAI) showed significantly better diagnostic efficacy for revascularization needs than compared to the Models 1 (conventional CCTA), 2 (Model 1 + conventional FFR-CT), and 3 (Model 2 + conventional FAI) (all < 0.05). In the subtraction models, Model 6 and 5 were significantly more effective than Models 4 (all < 0.05). Additionally, when clinical variables (male, age, body mass index, hypertension, dyslipidemia, diabetes mellitus, and smoking) were incorporated into Models 3 and 6, the resulting Models 7 and 8 performed significantly better than Model 3 (all < 0.05).
Subtraction techniques have significantly improved the efficacy of CCTA with FFR-CT in assessing the need for revascularization in patients with CAD. By integrating clinical variables, CCTA, FFR-CT, and pericoronary FAI, individualized therapeutic decisions for CAD patients can be further optimized.
计算机断层扫描血流储备分数（FFR-CT）受钙化斑块伪影影响，这会降低其预测心肌缺血的准确性。减法技术可减轻这些伪影，从而提高诊断精度。然而，减法FFR-CT和冠状动脉周围脂肪衰减指数（FAI）在改善冠状动脉疾病（CAD）患者血运重建预测方面的潜力仍不明确。我们旨在评估FFR-CT和冠状动脉周围FAI在识别CAD患者血运重建需求方面的诊断性能。
我们使用传统和减法冠状动脉计算机断层扫描血管造影（CCTA）图像，回顾性分析了76例CAD患者（142个分支）的冠状动脉CCTA数据。使用受试者工作特征曲线评估FFR-CT和FAI在识别血运重建需求方面的诊断性能。
76例患者中，54例接受了血运重建。接受血运重建的患者冠状动脉周围FAI较高，FFR-CT值较低。减法FFR-CT值高于使用传统方法获得的值。模型4（减法CCTA）、模型5（模型4 + 减法FFR-CT）和模型6（模型5 + 减法FAI）在识别血运重建需求方面的诊断效能显著优于模型1（传统CCTA）、模型2（模型1 + 传统FFR-CT）和模型3（模型2 + 传统FAI）（均P < 0.05）。在减法模型中，模型6和模型5比模型4显著更有效（均P < 0.05）。此外，将临床变量（男性、年龄、体重指数、高血压、血脂异常、糖尿病和吸烟）纳入模型3和模型6时，得到的模型7和模型8的表现显著优于模型3（均P < 0.05）。
减法技术显著提高了CCTA联合FFR-CT评估CAD患者血运重建需求的效能。通过整合临床变量、CCTA、FFR-CT和冠状动脉周围FAI，可以进一步优化CAD患者的个体化治疗决策。
