title: Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of CCTA-derived stenosis predictors including CT-FFR for the detection of ischemia-inducing stenosis compared to invasive FFR.
  
  
  METHODS
  Stenosis parameters were assessed using dual-source CT (DSCT). All patients underwent both CCTA and invasive FFR within 3 months and were retrospectively analyzed. Observers visually assessed all CCTA studies and performed multiple lesion measurements. Lesion length/minimal luminal diameter(4) (LL/MLD(4)), transluminal attenuation gradient (TAG), corrected coronary attenuation (CCO) and CT-FFR were calculated.
  
  
  RESULTS
  The cohort included 32 patients (58±12 years, 66%male). Among 32 coronary lesions, 8 (25%) were considered hemodynamically significant with an FFR <0.80. Compared to invasive FFR, the per-vessel sensitivity and specificity of CCTA, CT-FFR, LL/MLD(4), CCO and TAG for detecting hemodynamically significant lesions were 100% and 54%, 100% and 91%, 85% and 92%, 66% and 88%, 37% and 58%, respectively. Receiver operating characteristics analysis resulted in an area under the curve of 0.91 for CT-FFR (p=0.0005), 0.88 for LL/MLD(4) (p<0.0001), 0.85 for CCO (p<0.0001). TAG with an AUC of 0.67 (p=0.152) was unable to discriminate between vessels with or without hemodynamically significant lesions.
  
  
  CONCLUSIONS
  CT-FFR, LL/MLD(4) and CCO provide enhanced diagnostic performance over CCTA analysis alone for discrimination of hemodynamically significant coronary stenosis.
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Renker
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Fuller
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Rier
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; Departments of Radiological Sciences, Oncology, and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Viale Regina Elena, 324-00161 Roma, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA; First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baumann
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Coronary angiography; Coronary artery disease; Coronary computed tomography angiography; Fractional flow reserve