Abstract
The purpose of this study was to evaluate the feasibility of the stenosis-related quantitative perfusion ratio (QPR) for detecting hemodynamically significant coronary artery disease (CAD). Twenty-seven patients were retrospectively enrolled. All patients underwent dynamic myocardial computed tomography perfusion (CTP) and coronary computed tomography angiography (CTA) before invasive coronary angiography (ICA) measuring the fractional flow reserve (FFR). Coronary lesions with FFR ≤ 0.8 were defined as hemodynamically significant CAD. The myocardial blood flow (MBF) was calculated using dynamic CTP data, and CT-QPR was calculated as the CT-MBF relative to the reference CT-MBF. The stenosis-related CT-MBF and QPR were calculated using Voronoi diagram-based myocardial segmentation from coronary CTA data. The relationships between FFR and stenosis-related CT-MBF or QPR and the diagnostic performance of the stenosis-related CT-MBF and QPR were evaluated. Of 81 vessels, FFR was measured in 39 vessels, and 20 vessels (51%) in 15 patients were diagnosed as hemodynamically significant CAD. The stenosis-related CT-QPR showed better correlation (r = 0.70, p < 0.05) than CT-MBF (r = 0.56, p < 0.05). Sensitivity and specificity for detecting hemodynamically significant CAD were 95% and 58% for CT-MBF, and 95% and 90% for CT-QPR, respectively. The area under the receiver operating characteristic curve for the CT-QPR was significantly higher than that for the CT-MBF (0.94 vs. 0.79; p < 0.05). The stenosis-related CT-QPR derived from dynamic myocardial CTP and coronary CTA showed a better correlation with FFR and a higher diagnostic performance for detecting hemodynamically significant CAD than the stenosis-related CT-MBF.
Highlights
Coronary computed tomography angiography (CTA) is widely used as a non-invasive tool for the assessment of coronary arteries [1, 2]
The main findings of this study were as follows: (1) The stenosis-related CT-quantitative perfusion ratio (QPR) showed a closer correlation with the Fractional flow reserve (FFR) than the stenosis-related CT-myocardial blood flow (MBF); (2) the stenosis-related CT-QPR had a significantly higher diagnostic performance for detecting hemodynamically significant coronary artery disease (CAD) than the stenosis-related CT-MBF
A recent meta-analysis showed that the diagnostic performance of myocardial computed tomography perfusion (CTP) for identifying hemodynamically significant CAD assessed by the FFR was comparable to magnetic resonance imaging or positron emission tomography (PET) and better than single-photon emission tomography [19]
Summary
Coronary computed tomography angiography (CTA) is widely used as a non-invasive tool for the assessment of coronary arteries [1, 2]. Fractional flow reserve (FFR) is the gold standard for the identification of hemodynamically significant CAD [4]; an invasive approach is required to measure FFR by invasive coronary angiography (ICA). Dynamic myocardial CTP imaging allows to provide quantitative hemodynamic parameters such as computed tomography-derived myocardial blood flow (CTMBF) [5,6,7]. We proposed the computed tomography-derived quantitative perfusion ratio (CTQPR) as a relative measure of CT-MBF and hypothesized that the CT-QPR would detect hemodynamically significant CAD more effectively than the absolute CT-MBF.
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