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Diagnostic value of coronary CT angiography in comparison with invasive coronary angiography and intravascular ultrasound in patients with intermediate coronary artery stenosis: results from the prospective multicentre FIGURE-OUT (Functional Imaging criteria for GUiding REview of invasive coronary angiOgraphy, intravascular Ultrasound, and coronary computed Tomographic angiography) study.

ABSTRACT: The anatomical criteria for the diagnosis of ischaemia referenced by fractional flow reserve (FFR) from non-invasive coronary computed tomographic angiography (CCTA), invasive coronary angiography (ICA), and intravascular ultrasound (IVUS) have not been evaluated contemporarily in a large-scale study. The aim of this study was to assess the diagnostic value of CCTA compared with ICA and IVUS in patients with intermediate coronary stenosis.CCTA, ICA, IVUS, and FFR were performed in 181 coronary lesions with intermediate severity. Minimal lumen diameter (MLD) and per cent diameter stenosis (%DS) were determined by CCTA and ICA, whereas minimal lumen area (MLA) was determined by CCTA and IVUS. Inducible ischaemia was defined by FFR ? 0.80. Diagnostic performances from non-invasive and invasive methods were compared. FFR ? 0.80 was observed in 49 (27.1%) lesions. CCTA MLD was smaller than ICA MLD (1.3 ± 0.5 vs. 1.5 ± 0.4 mm, P < 0.001), CCTA %DS was higher than ICA %DS (54.0 ± 14.0 vs. 50.3 ± 12.8%, P < 0.001), and CCTA MLA was smaller than IVUS MLA (2.2 ± 1.2 vs. 3.2 ± 1.2 mm(2), P < 0.001). This trend was consistent irrespective of lesion location, lesion severity, and plaque characteristics. For the determination of ischaemia, diagnostic performance of CCTA %DS was lower than ICA %DS [area under the curve (AUC) 0.657 vs. 0.765, P = 0.04], and that of CCTA MLA was lower than IVUS MLA (AUC 0.712 vs. 0.801, P = 0.03).Anatomical criteria for the diagnosis of ischaemia-producing coronary stenosis differ by non-invasive and invasive methods. Compared with invasive methods, CCTA presents overestimation in assessing lesion severity and lower diagnostic performance in assessing ischaemia.

SUBMITTER: Doh JH

PROVIDER: S-EPMC4110885 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Diagnostic value of coronary CT angiography in comparison with invasive coronary angiography and intravascular ultrasound in patients with intermediate coronary artery stenosis: results from the prospective multicentre FIGURE-OUT (Functional Imaging criteria for GUiding REview of invasive coronary angiOgraphy, intravascular Ultrasound, and coronary computed Tomographic angiography) study.

Doh Joon-Hyung JH Koo Bon-Kwon BK Nam Chang-Wook CW Kim Ji-Hyun JH Min James K JK Nakazato Ryo R Silalahi Todung T Prawira Hardjo H Choi Hyunmin H Lee Sung Yun SY Namgung June J Kwon Sung Uk SU Kwak Jae-Jin JJ Lee Won Ro WR

European heart journal. Cardiovascular Imaging 20140209 8

<h4>Aims</h4>The anatomical criteria for the diagnosis of ischaemia referenced by fractional flow reserve (FFR) from non-invasive coronary computed tomographic angiography (CCTA), invasive coronary angiography (ICA), and intravascular ultrasound (IVUS) have not been evaluated contemporarily in a large-scale study. The aim of this study was to assess the diagnostic value of CCTA compared with ICA and IVUS in patients with intermediate coronary stenosis.<h4>Methods and results</h4>CCTA, ICA, IVUS, ...[more]

PMID: 24513881

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Project description:OBJECTIVES:We sought to evaluate the accuracy of standardized total plaque volume (TPV) measurement and low-density non-calcified plaque (LDNCP) assessment from coronary CT angiography (CTA) in comparison with intravascular ultrasound (IVUS). METHODS:We analyzed 118 plaques without extensive calcifications from 77 consecutive patients who underwent CTA prior to IVUS. CTA TPV was measured with semi-automated software comparing both scan-specific (automatically derived from scan) and fixed attenuation thresholds. From CTA, %LDNCP was calculated voxels below multiple LDNCP thresholds (30, 45, 60, 75, and 90 Hounsfield units [HU]) within the plaque. On IVUS, the lipid-rich component was identified by echo attenuation, and its size was measured using attenuation score (summed score ? analysis length) based on attenuation arc (1?=?<?90°; 2?=?90-180°; 3?=?180-270°; 4?=?270-360°) every 1 mm. RESULTS:TPV was highly correlated between CTA using scan-specific thresholds and IVUS (r?=?0.943, p?<?0.001), with no significant difference (2.6 mm3, p?=?0.270). These relationships persisted for calcification patterns (maximal IVUS calcium arc of 0°, <?90°, or ??90°). The fixed thresholds underestimated TPV (-?22.0 mm3, p?<?0.001) and had an inferior correlation with IVUS (p?<?0.001) compared with scan-specific thresholds. A 45-HU cutoff yielded the best diagnostic performance for identification of lipid-rich component, with an area under the curve of 0.878 vs. 0.840 for <?30 HU (p?=?0.023), and corresponding %LDNCP resulted in the strongest correlation with the lipid-rich component size (r?=?0.691, p?<?0.001). CONCLUSIONS:Standardized noninvasive plaque quantification from CTA using scan-specific thresholds correlates highly with IVUS. Use of a <?45-HU threshold for LDNCP quantification improves lipid-rich plaque assessment from CTA. KEY POINTS:• Standardized scan-specific threshold-based plaque quantification from coronary CT angiography provides an accurate total plaque volume measurement compared with intravascular ultrasound. • Attenuation histogram-based low-density non-calcified plaque quantification can improve lipid-rich plaque assessment from coronary CT angiography.

Project description:Background The commercial coronary computed tomographic angiography artificial intelligence (CCTA-AI) platform has made great progress in clinical application. However, research is needed to elucidate the current stage of commercial AI platforms and the role of radiologists. This study compared the diagnostic performance of the commercial CCTA-AI platform with that of a reader based on a multicenter and multidevice sample. Methods A total of 318 patients with suspected coronary artery disease (CAD) who underwent both CCTA and invasive coronary angiography (ICA) were included in a multicenter and multidevice validation cohort between 2017 and 2021. The commercial CCTA-AI platform was used to automatically assess coronary artery stenosis by using ICA findings as the gold standard. The CCTA reader was completed by radiologists. The diagnostic performance of the commercial CCTA-AI platform and CCTA reader was evaluated at the patient and segment levels. The cutoff values of models 1 and 2 were 50% and 70% stenosis, respectively. Results It took 20.4 seconds to accomplish post-processing per patient when using the CCTA-AI platform, which was significantly shorter than the time taken to complete this task with the CCTA reader (1,112.1 s). In the patient-based analysis, the area under the curve (AUC) was 0.85 using the CCTA-AI platform and 0.61 using the CCTA reader in model 1 (stenosis ratio: 50%). In contrast, the AUC was 0.78 using the CCTA-AI platform and 0.64 using the CCTA reader in model 2 (stenosis ratio: 70%). In the segment-based analysis, the AUCs of CCTA-AI were slightly better than those of the readers. The negative predictive value (NPV) increased from model 1 to model 2. Furthermore, the diagnostic performance was better for larger-diameter arteries. Conclusions The commercial CCTA-AI platform may provide a feasible solution for the diagnosis of coronary artery stenosis, and it has a diagnostic performance that is slightly better than that of a radiologist with a moderate level of experience (5–10 years of experience).

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