Coronary computed tomography angiography imaging features combined with computed tomography-fractional flow reserve, pericoronary fat attenuation index, and radiomics for the prediction of myocardial ischemia

Abstract

BackgroundThis study aimed to predict myocardial ischemia (MIS) by constructing models with imaging features, CT-fractional flow reserve (CT-FFR), pericoronary fat attenuation index (pFAI), and radiomics based on coronary computed tomography angiography (CCTA). Methods and resultsThis study included 96 patients who underwent CCTA and single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI). According to SPECT-MPI results, there were 72 vessels with MIS in corresponding supply area and 105 vessels with no-MIS. The conventional model [lesion length (LL), MDS (maximum stenosis diameter × 100% / reference vessel diameter), MAS (maximum stenosis area × 100% / reference vessel area) and CT value], radiomics model (radiomics features), and multi-faceted model (all features) were constructed using support vector machine. Conventional and radiomics models showed similar predictive efficacy [AUC: 0.76, CI 0.62–0.90 vs. 0.74, CI 0.61–0.88; p >0.05]. Adding pFAI to the conventional model showed better predictive efficacy than adding CT-FFR (AUC: 0.88, CI 0.79–0.97 vs. 0.80, CI 0.68–0.92; p <0.05). Compared with conventional and radiomics model, the multi-faceted model showed the highest predictive efficacy (AUC: 0.92, CI 0.82–0.98, p <0.05). ConclusionpFAI is more effective for predicting MIS than CT-FFR. A multi-faceted model combining imaging features, CT-FFR, pFAI, and radiomics is a potential diagnostic tool for MIS.