title: Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis.
abstract: OBJECTIVE
  To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization.
  
  
  METHODS
  160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8).
  
  
  RESULTS
  210 coronary segments were included (59 % positive). MLA of ≤1.8 mm2was identified as the optimal cut-off (c = 0.97, p < 0.001; 95 % CI 0.94-0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm2sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c = 0.92; p < 0.001; 95 % CI 0.88-95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95 % CI 0.84-93, c = 0.87; 95 % CI 0.82-92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c = 0.74 (95 % CI 0.67-81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84.
  
  
  CONCLUSIONS
  MLA ≤1.8 mm2and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis.
  
  
  CONCLUSIONS
  • Quantitative coronary CT-angiography is accurate for prediction of functional relevant stenosis. • Absolute lumen area and diameter rather than %stenosis predict functional relevance. • Lumen area <1.8 mm2and diameter <1.2 mm are the most accurate cut-offs. • Quantitative parameters are helpful for decision-making in terms of patient management.
authors: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.|Department of Internal Medicine III - Cardiology, Innsbruck Medical University, Innsbruck, Austria.
authors: Fabian
authors: F
authors: Plank
authors: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.
authors: Philipp
authors: P
authors: Burghard
authors: Department of Internal Medicine III - Cardiology, Innsbruck Medical University, Innsbruck, Austria.
authors: Guy
authors: G
authors: Friedrich
authors: Department of Internal Medicine III - Cardiology, Innsbruck Medical University, Innsbruck, Austria.
authors: Wolfgang
authors: W
authors: Dichtl
authors: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.
authors: Agnes
authors: A
authors: Mayr
authors: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.
authors: Andrea
authors: A
authors: Klauser
authors: Department of Cardiovascular and Interventional Radiology, Vienna Medical University, Vienna, Austria.
authors: Florian
authors: F
authors: Wolf
authors: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria. gudrun.feuchtner@gmail.com.
authors: Gudrun
authors: G
authors: Feuchtner
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Atherosclerosis; Computed tomography (CT); Coronary CT angiography; Coronary artery disease; Stenosis quantification