{"title":"基于冠状动脉 CT 血管造影的形态学指数,用于预测血流动力学意义上的冠状动脉狭窄。","authors":"Chenxi Wang, Shuang Leng, Ru-San Tan, Ping Chai, Jiang Ming Fam, Lynette Li San Teo, Chee Yang Chin, Ching Ching Ong, Lohendran Baskaran, Yung Jih Felix Keng, Adrian Fatt Hoe Low, Mark Yan-Yee Chan, Aaron Sung Lung Wong, Siang Jin Terrance Chua, Qinghua Wu, Swee Yaw Tan, Soo Teik Lim, Liang Zhong","doi":"10.1148/ryct.230064","DOIUrl":null,"url":null,"abstract":"<p><p>Purpose To develop a new coronary CT angiography (CCTA)-based index, α×LL/MLD<sup>4</sup>, that considers lesion entrance angle (α) in addition to lesion length (LL) and minimal lumen diameter (MLD) and to evaluate its efficacy in predicting hemodynamically significant coronary stenosis compared with invasive coronary angiography (ICA)-derived fractional flow reserve (FFR). Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD<sup>4</sup>. Diagnostic performance and accuracy of α×LL/MLD<sup>4</sup> and LL/MLD<sup>4</sup> in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD<sup>4</sup> was 54.0 degree/mm<sup>3</sup> (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm<sup>3</sup> (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (<i>P</i> < .001). The per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for discriminating ischemic lesions were 86.2%, 83.1%, 88.4%, 84.1%, and 87.7% for α×LL/MLD<sup>4</sup> and 80.5%, 66.3%, 90.9%, 84.3%, and 78.6% for LL/MLD<sup>4</sup>, respectively. Area under the receiver operating characteristic curve for discriminating hemodynamically significant stenosis was 0.93 for α×LL/MLD<sup>4</sup>, which was significantly greater than the values of 0.84 for LL/MLD<sup>4</sup> and 0.63 for diameter stenosis (both <i>P</i> < .001). Conclusion The new morphologic index, α×LL/MLD<sup>4</sup>, incorporating lesion entrance angle achieved higher diagnostic performance in detecting hemodynamically significant lesions compared with diameter stenosis and LL/MLD<sup>4</sup>. <b>Keywords:</b> CT Angiography, Cardiac, Coronary Arteries, Ischemia, Infarction, Technology Assessment Clinical trial registration no. NCT03054324 <i>Supplemental material is available for this article.</i> © RSNA, 2023 See also the commentary by Fairbairn and Nørgaard in this issue.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163246/pdf/","citationCount":"0","resultStr":"{\"title\":\"Coronary CT Angiography-based Morphologic Index for Predicting Hemodynamically Significant Coronary Stenosis.\",\"authors\":\"Chenxi Wang, Shuang Leng, Ru-San Tan, Ping Chai, Jiang Ming Fam, Lynette Li San Teo, Chee Yang Chin, Ching Ching Ong, Lohendran Baskaran, Yung Jih Felix Keng, Adrian Fatt Hoe Low, Mark Yan-Yee Chan, Aaron Sung Lung Wong, Siang Jin Terrance Chua, Qinghua Wu, Swee Yaw Tan, Soo Teik Lim, Liang Zhong\",\"doi\":\"10.1148/ryct.230064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Purpose To develop a new coronary CT angiography (CCTA)-based index, α×LL/MLD<sup>4</sup>, that considers lesion entrance angle (α) in addition to lesion length (LL) and minimal lumen diameter (MLD) and to evaluate its efficacy in predicting hemodynamically significant coronary stenosis compared with invasive coronary angiography (ICA)-derived fractional flow reserve (FFR). Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD<sup>4</sup>. Diagnostic performance and accuracy of α×LL/MLD<sup>4</sup> and LL/MLD<sup>4</sup> in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD<sup>4</sup> was 54.0 degree/mm<sup>3</sup> (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm<sup>3</sup> (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (<i>P</i> < .001). The per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for discriminating ischemic lesions were 86.2%, 83.1%, 88.4%, 84.1%, and 87.7% for α×LL/MLD<sup>4</sup> and 80.5%, 66.3%, 90.9%, 84.3%, and 78.6% for LL/MLD<sup>4</sup>, respectively. Area under the receiver operating characteristic curve for discriminating hemodynamically significant stenosis was 0.93 for α×LL/MLD<sup>4</sup>, which was significantly greater than the values of 0.84 for LL/MLD<sup>4</sup> and 0.63 for diameter stenosis (both <i>P</i> < .001). Conclusion The new morphologic index, α×LL/MLD<sup>4</sup>, incorporating lesion entrance angle achieved higher diagnostic performance in detecting hemodynamically significant lesions compared with diameter stenosis and LL/MLD<sup>4</sup>. <b>Keywords:</b> CT Angiography, Cardiac, Coronary Arteries, Ischemia, Infarction, Technology Assessment Clinical trial registration no. NCT03054324 <i>Supplemental material is available for this article.</i> © RSNA, 2023 See also the commentary by Fairbairn and Nørgaard in this issue.</p>\",\"PeriodicalId\":21168,\"journal\":{\"name\":\"Radiology. Cardiothoracic imaging\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2023-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163246/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiology. Cardiothoracic imaging\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1148/ryct.230064\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology. Cardiothoracic imaging","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1148/ryct.230064","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
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