Differentiating Macrovascular and Microvascular Ischemia Using Fractal Analysis of Dynamic Myocardial Perfusion Stress-CT.

IF 7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Investigative Radiology Pub Date : 2024-05-01 Epub Date: 2023-10-09 DOI:10.1097/RLI.0000000000001027

Florian Michallek, Satoshi Nakamura, Tairo Kurita, Hideki Ota, Kensuke Nishimiya, Ryo Ogawa, Takehito Shizuka, Hitoshi Nakashima, Yi-Ning Wang, Tatsuro Ito, Hajime Sakuma, Marc Dewey, Kakuya Kitagawa

{"title":"Differentiating Macrovascular and Microvascular Ischemia Using Fractal Analysis of Dynamic Myocardial Perfusion Stress-CT.","authors":"Florian Michallek, Satoshi Nakamura, Tairo Kurita, Hideki Ota, Kensuke Nishimiya, Ryo Ogawa, Takehito Shizuka, Hitoshi Nakashima, Yi-Ning Wang, Tatsuro Ito, Hajime Sakuma, Marc Dewey, Kakuya Kitagawa","doi":"10.1097/RLI.0000000000001027","DOIUrl":null,"url":null,"abstract":"Objectives: Fractal analysis of dynamic myocardial stress computed tomography perfusion imaging (4D-CTP) has shown potential to noninvasively differentiate obstructive coronary artery disease (CAD) and coronary microvascular disease (CMD). This study validates fractal analysis of 4D-CTP in a multicenter setting and assesses its diagnostic accuracy in subgroups with ischemia and nonobstructed coronary arteries (INOCA) and with mild to moderate stenosis.Materials and methods: From the AMPLIFiED multicenter trial, patients with suspected or known chronic myocardial ischemia and an indication for invasive coronary angiography were included. Patients underwent dual-source CT angiography, 4D-CTP, and CT delayed-enhancement imaging. Coronary artery disease, CMD, and normal perfusion were defined by a combined reference standard comprising invasive coronary angiography with fractional flow reserve, and absolute or relative CT-derived myocardial blood flow. Nonobstructed coronary arteries were defined as ≤25% stenosis and mild to moderate stenosis as 26%-80%.Results: In 127 patients (27% female), fractal analysis accurately differentiated CAD (n = 61, 23% female), CMD (n = 23, 30% female), and normal perfusion (n = 34, 35% female) with a multiclass area under the receiver operating characteristic curve (AUC) of 0.92 and high agreement (multiclass κ = 0.89). In patients with ischemia (n = 84), fractal analysis detected CAD (n = 61) over CMD (n = 23) with sensitivity of 95%, specificity of 74%, accuracy of 89%, and AUC of 0.83. In patients with nonobstructed coronary arteries (n = 33), INOCA (n = 15) was detected with sensitivity of 100%, specificity of 78%, accuracy of 88%, and AUC of 0.94. In patients with mild to moderate stenosis (n = 27), fractal analysis detected CAD (n = 19) over CMD with sensitivity of 84%, specificity of 100%, accuracy of 89%, and AUC of 0.95.Conclusions: In this multicenter study, fractal analysis of 4D-CTP accurately differentiated CAD and CMD including subgroups with INOCA and with mild to moderate stenosis.","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":" ","pages":"413-423"},"PeriodicalIF":7.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Investigative Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/RLI.0000000000001027","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/10/9 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: Fractal analysis of dynamic myocardial stress computed tomography perfusion imaging (4D-CTP) has shown potential to noninvasively differentiate obstructive coronary artery disease (CAD) and coronary microvascular disease (CMD). This study validates fractal analysis of 4D-CTP in a multicenter setting and assesses its diagnostic accuracy in subgroups with ischemia and nonobstructed coronary arteries (INOCA) and with mild to moderate stenosis.

Materials and methods: From the AMPLIFiED multicenter trial, patients with suspected or known chronic myocardial ischemia and an indication for invasive coronary angiography were included. Patients underwent dual-source CT angiography, 4D-CTP, and CT delayed-enhancement imaging. Coronary artery disease, CMD, and normal perfusion were defined by a combined reference standard comprising invasive coronary angiography with fractional flow reserve, and absolute or relative CT-derived myocardial blood flow. Nonobstructed coronary arteries were defined as ≤25% stenosis and mild to moderate stenosis as 26%-80%.

Results: In 127 patients (27% female), fractal analysis accurately differentiated CAD (n = 61, 23% female), CMD (n = 23, 30% female), and normal perfusion (n = 34, 35% female) with a multiclass area under the receiver operating characteristic curve (AUC) of 0.92 and high agreement (multiclass κ = 0.89). In patients with ischemia (n = 84), fractal analysis detected CAD (n = 61) over CMD (n = 23) with sensitivity of 95%, specificity of 74%, accuracy of 89%, and AUC of 0.83. In patients with nonobstructed coronary arteries (n = 33), INOCA (n = 15) was detected with sensitivity of 100%, specificity of 78%, accuracy of 88%, and AUC of 0.94. In patients with mild to moderate stenosis (n = 27), fractal analysis detected CAD (n = 19) over CMD with sensitivity of 84%, specificity of 100%, accuracy of 89%, and AUC of 0.95.

Conclusions: In this multicenter study, fractal analysis of 4D-CTP accurately differentiated CAD and CMD including subgroups with INOCA and with mild to moderate stenosis.

查看原文本刊更多论文

应用动态心肌灌注应力CT分形分析区分大血管和微血管缺血。

目的：动态心肌应力计算机断层扫描灌注成像（4D-CTP）的分形分析显示出无创区分阻塞性冠状动脉疾病（CAD）和冠状微血管疾病（CMD）的潜力。本研究在多中心环境中验证了4D-CTP的分形分析，并评估了其在缺血性和非阻塞性冠状动脉（INOCA）亚组以及轻度至中度狭窄亚组中的诊断准确性。材料和方法：AMPLIFiED多中心试验纳入了疑似或已知慢性心肌缺血和有创冠状动脉造影指征的患者。患者接受了双源CT血管造影术、4D-CTP和CT延迟增强成像。冠状动脉疾病、CMD和正常灌注由联合参考标准定义，该标准包括具有血流储备分数的有创冠状动脉造影和绝对或相对CT衍生的心肌血流。结果：127例（27%女性）患者中，分形分析准确地区分了CAD（n=61，23%女性）、CMD（n=23，30%女性）、，和正常灌注（n=34，35%女性），受试者工作特征曲线下的多类面积（AUC）为0.92，高度一致（多类κ=0.89）。在缺血患者（n=84）中，分形分析检测到CAD（n=61）高于CMD（n=23），灵敏度为95%，特异性为74%，准确度为89%，AUC为0.83。在冠状动脉未阻塞的患者（n=33）中，INOCA（n=15）的检测灵敏度为100%，特异性为78%，准确率为88%，AUC为0.94。在轻度至中度狭窄患者（n=27）中，分形分析检测到CAD（n=19）高于CMD，灵敏度为84%，特异性为100%，准确率为89%，AUC为0.95。结论：在这项多中心研究中，4D-CTP的分形分析准确区分了CAD和CMD，包括INOCA亚组和轻度至中度狭窄症亚组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Investigative Radiology 医学-核医学

CiteScore

15.10

自引率

16.40%

发文量

188

审稿时长

4-8 weeks

期刊介绍： Investigative Radiology publishes original, peer-reviewed reports on clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, and related modalities. Emphasis is on early and timely publication. Primarily research-oriented, the journal also includes a wide variety of features of interest to clinical radiologists.