Related Experiment Video
Updated: May 5, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Quantitative computed tomographic coronary angiography: does it predict functionally significant coronary stenoses?
Alexia Rossi1, Stella-Lida Papadopoulou, Francesca Pugliese
1Department of Radiology.
Insights
Quantitative computed tomographic coronary angiography (CTCA) offers improved specificity over visual CTCA for detecting functionally significant coronary lesions. However, functional assessment remains crucial for moderate stenosis to accurately identify impaired fractional flow reserve (FFR).
Area of Science:
- Cardiovascular imaging
- Interventional cardiology
- Diagnostic accuracy studies
Background:
- Coronary lesions with ≥50% diameter narrowing on visual CTCA typically warrant invasive angiography.
- Visual CTCA, like invasive methods, can be inaccurate in identifying functionally significant coronary artery disease.
- Fractional flow reserve (FFR) serves as the gold standard for assessing lesion significance.
Purpose of the Study:
- To compare the diagnostic performance of quantitative CTCA versus visual CTCA.
- To determine the accuracy of quantitative CTCA parameters in detecting functionally significant coronary lesions.
- To utilize FFR as the reference standard for functional significance.
Main Methods:
- 99 symptomatic patients underwent CTCA and FFR measurements.
- 144 coronary lesions were assessed using visual grading and quantitative CTCA analysis.
- Quantitative CTCA parameters included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden.
- Optimal cutoff values were determined for quantitative CTCA parameters to predict FFR ≤0.80.
Main Results:
- No significant difference in sensitivity was observed between visual and quantitative CTCA.
- Quantitative CTCA parameters, particularly minimal area diameter and % area stenosis, showed significantly higher specificity than visual CTCA.
- Specificity for visual CTCA was 42%, compared to 68% for minimal area diameter and 76% for % area stenosis.
- Lesion length specificity was comparable to visual CTCA.
Conclusions:
- Quantitative CTCA enhances the prediction of functionally significant coronary lesions compared to visual assessment.
- Despite improvements, quantitative CTCA alone is insufficient for definitive assessment.
- Functional assessment (FFR) is still necessary for lesions with moderate stenosis to accurately detect impaired blood flow.
Background:
Coronary lesions with a diameter narrowing ≥50% on visual computed tomographic coronary angiography (CTCA) are generally considered for referral to invasive coronary angiography. However, similar to invasive coronary angiography, visual CTCA is often inaccurate in detecting functionally significant coronary lesions. We sought to compare the diagnostic performance of quantitative CTCA with visual CTCA for the detection of functionally significant coronary lesions using fractional flow reserve (FFR) as the reference standard.
Methods And Results:
CTCA and FFR measurements were obtained in 99 symptomatic patients. In total, 144 coronary lesions detected on CTCA were visually graded for stenosis severity. Quantitative CTCA measurements included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden [(vessel area-lumen area)/vessel area×100]. Optimal cutoff values of CTCA-derived parameters were determined, and their diagnostic accuracy for the detection of flow-limiting coronary lesions (FFR≤0.80) was compared with visual CTCA. FFR was ≤0.80 in 54 of 144 (38%) coronary lesions. Optimal cutoff values to predict flow-limiting coronary lesion were 10 mm for lesion length, 1.8 mm2 for minimal area diameter, 73% for % area stenosis, 1.5 mm for minimal lumen diameter, 48% for % diameter stenosis, and 76% for plaque burden. No significant difference in sensitivity was found between visual CTCA and quantitative CTCA parameters (P>0.05). The specificity of visual CTCA (42%; 95% confidence interval [CI], 31%-54%) was lower than that of minimal area diameter (68%; 95% CI, 57%-77%; P=0.001), % area stenosis (76%; 95% CI, 65%-84%; P<0.001), minimal lumen diameter (67%; 95% CI, 55%-76%; P=0.001), % diameter stenosis (72%; 95% CI, 62%-80%; P<0.001), and plaque burden (63%; 95% CI, 52%-73%; P=0.004). The specificity of lesion length was comparable with that of visual CTCA.
Conclusions:
Quantitative CTCA improves the prediction of functionally significant coronary lesions compared with visual CTCA assessment but remains insufficient. Functional assessment is still required in lesions of moderate stenosis to accurately detect impaired FFR.
More Related Videos
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
09:57Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
Published on: January 20, 2022
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Imaging Studies for Cardiovascular System V: CT
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:27Imaging Studies III: Computed Tomography
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...