title: Diagnostic performance of on-site CT-derived fractional flow reserve versus CT perfusion.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of on-site computed tomography (CT)-derived fractional flow reserve (FFR) and stress CT myocardial perfusion (CTP) in patients with coronary artery disease.
  
  
  RESULTS
  Using a prospective CTP registry, 72 patients with invasive FFR were enrolled. CT-derived FFR was computed on-site using rest-phase CTP data. The diagnostic accuracies of coronary CT angiography (CCTA), CT-derived FFR, and stress CTP were evaluated using an area under the receiver-operating characteristic curve (AUC) with invasive FFR as a reference standard. Logistic regression and the net reclassification index (NRI) were used to evaluate incremental differences in CT-derived FFR or CTP compared with CCTA alone. The per-vessel prevalence of haemodynamically significant stenosis (FFR ≤ 0.80) was 39% (54/138). Per-vessel sensitivity and specificity were 94 and 66% for CCTA, 87 and 77% for CT-derived FFR, and 79 and 91% for CTP, respectively. There was no significant difference in the AUC values of CT-derived FFR and CTP (P = 0.845). The diagnostic performance of CCTA (AUC = 0.856) was improved by combining it with CT-derived FFR (AUC = 0.919, P = 0.004, NRI = 1.01) or CTP (AUC = 0.913, P = 0.004, NRI = 0.66). CT-derived FFR values had a moderate correlation with invasive FFR (r = 0.671, P < 0.001).
  
  
  CONCLUSIONS
  On-site CT-derived FFR combined with CCTA provides an incremental diagnostic improvement over CCTA alone in identifying haemodynamically significant stenosis defined by invasive FFR, with a diagnostic accuracy comparable with CTP.
authors.affiliation: Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Roh
authors.affiliation: Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kweon
authors.affiliation: Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Seoul 138-736, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Lim
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: computed tomography; coronary artery disease; fractional flow reserve; sensitivity; specificity