Effect of image quality on diagnostic accuracy of noninvasive fractional flow reserve: Results from the prospective multicenter international DISCOVER-FLOW study

Background Fractional flow reserve calculated from coronary CT (FFRCT ) is a novel method for determining lesion-specific ischemia. Objective To assess the effect of CT quality on accuracy of FFRCT , we compared performance of FFRCT with severe stenosis by CT in relation to image quality; heart rate...

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Veröffentlicht in:Journal of cardiovascular computed tomography 2012-05, Vol.6 (3), p.191-199
Hauptverfasser: Min, James K., MD, Koo, Bon-Kwon, MD, Erglis, Andrejs, MD, Doh, Joon-Hyung, MD, Daniels, David V., MD, Jegere, Sanda, MD, Kim, Hyo-Soo, MD, Dunning, Allison, MS, Defrance, Tony, MD, Leipsic, Jonathan, MD
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Sprache:eng
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Zusammenfassung:Background Fractional flow reserve calculated from coronary CT (FFRCT ) is a novel method for determining lesion-specific ischemia. Objective To assess the effect of CT quality on accuracy of FFRCT , we compared performance of FFRCT with severe stenosis by CT in relation to image quality; heart rate; signal-to-noise ratio (SNR); and common CT artifacts, including calcification, motion, and poor contrast enhancement. Methods FFRCT was performed on 159 vessels in 103 patients undergoing CT, FFRCT , and FFR. Ischemia was defined as FFRCT and FFR ≤ 0.80, and severe stenosis by CT was defined by ≥50% reduction in luminal diameter. FFRCT and CT stenosis were compared with FFR, which served as the reference. Results On a vessel basis, accuracy of FFRCT was higher than CT stenosis for satisfactory or poor quality CTs (87.5% vs 64.6%), for heart rates > 65 beats/min (100% vs 52.9%), and for SNR less than the median (26.3) (84.4% vs 64.1%). Accuracy of FFRCT was superior to CT stenosis in the presence of calcification (85.7% vs 66.7%), motion (90.5% vs 57.1%), and poor contrast opacification (100.0% vs 71.4%). Similar relations were observed for exploratory analyses of FFRCT and CT stenosis on a patient basis. In 42 subjects who underwent coronary calcium scanning, accuracy of FFRCT was 77.8% (n = 18), 100% (n = 11), and 100% (n = 13) for coronary calcium scores of 0–100, 101–400, and >400, respectively. Conclusions Accuracy of FFRCT is superior to CT stenosis for determining lesion-specific ischemia. The performance of FFRCT remains robust across an array of factors known to adversely affect CT quality.
ISSN:1934-5925
1876-861X
DOI:10.1016/j.jcct.2012.04.010