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Fractional flow reserve measurement using dynamic CT perfusion imaging in patients with coronary artery disease
Aaron So1,2, Ki Seok Choo3, Ji Won Lee4
1Imaging, Lawson Research Institute, London, ON N6A 4V2, Canada.
Insights
A new CT dynamic angiographic imaging (CT-DAI) algorithm accurately measures fractional flow reserve (FFR) in coronary artery disease (CAD) patients. This rapid CT-DAI method shows high diagnostic accuracy, matching invasive FFR measurements for reliable hemodynamic assessment.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Computational Physiology
Background:
- Coronary artery disease (CAD) diagnosis relies on assessing the hemodynamic significance of stenoses.
- Invasive fractional flow reserve (FFR) measurement is the gold standard but requires cardiac catheterization.
- Non-invasive methods for rapid FFR assessment are highly desirable.
Purpose of the Study:
- To evaluate the accuracy of a novel CT dynamic angiographic imaging (CT-DAI) algorithm for rapid FFR measurement.
- To compare CT-DAI derived FFR with invasive FFR in patients with CAD.
Main Methods:
- Retrospective analysis of 14 CAD patients undergoing stress dynamic CT myocardial perfusion scans.
- Utilized in-house software applying the CT-DAI algorithm to coronary time-enhancement curves.
- Compared CT-DAI derived FFR values against invasive catheter-based FFR measurements.
Main Results:
- The CT-DAI algorithm achieved 100% per-vessel and per-patient diagnostic accuracy.
- CT-DAI FFR demonstrated excellent linear correlation (R=0.910, P<.001) with invasive FFR.
- No significant proportional bias was observed via Bland-Altman analysis.
Conclusions:
- The novel CT-DAI algorithm reliably computes FFR from dynamic CT myocardial perfusion images.
- This facilitates rapid, on-site hemodynamic assessment of epicardial coronary artery stenosis.
- CT-DAI offers a promising non-invasive approach for CAD management.
Purposes:
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).
Materials And Methods:
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.
Results:
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 (M = 0.768, SD = 0.156) showed an excellent linear correlation (R = 0.910, P < .001) and statistical indifference (P= .655) with that measured using invasive catheter-based method (M = 0.796, SD = 0.149). Bland-Altman analysis showed no significant proportional bias.
Conclusion:
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.
