On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Abstract

Purpose Technical feasibility of CT-based calculation of fractional flow reserve (cFFR) using a 128-row computed tomography scanner in an everyday routine setting. Post-processing and everyday practicability should be analyzed on the scanner on-site in connection with clinical parameters.

Materials and Methods This single-center retrospective analysis included 230 patients (74 female; mean age 63.8 years) with CCTA within 21 months between 01/2018 and 09/2019 without non-pathological examinations. cFFR values were obtained using a deep learning-based non-commercial research prototype (cFFR Version3.5.0; Siemens Healthineers GmbH, Erlangen). cFFR values were evaluated at two points: at the maximum point of the stenosis and 1.0 cm distal to the stenosis. Comparison with invasive coronary angiography in 57/230 patients (24.7 %) was performed. CT parameters and quality were evaluated. Further subgroup classification concerning criteria of technical postprocessing was performed: no changes necessary, minor corrections necessary, major corrections necessary, and no evaluation was possible. The required time from starting the software to the final result was evaluated.

Results A total of 116/448 (25.9 %) mild, 223/448 (49.8 %) moderate, and 109/448 (24.3 %) obstructive stenoses was found. The mean cFFR at the maximum point of the stenosis was 0.92 ± 0.09 and significantly higher than the cFRR value of 0.89 ± 0.13 distal to the stenosis (p < 0.001*). The mean degree of stenosis was 44.02 ± 26.99 % (range: 1–99 %) with an area of 5.39 ± 3.30 mm2. In a total of 45 patients (19.1 %), a relevant reduction in cFFR below 0.80 was determined. Overall, in 57/230 patients (24.8 %), catheter angiography was performed. No significant difference in the degree of maximal stenosis (CAD-RADS 0–2/3/4) was detected between the classification of CCTA and ICA (p = 0.171). The mean post-processing time varied significantly with 8.34 ± 4.66 min. in single-vessel CAD vs. 12.91 ± 3.92 min. in two-vessel CAD vs. 21.80 ± 5.94 min. in three-vessel CAD (each p < 0.001).

Conclusion Noninvasive onsite quantification of cFFR is feasible with minimal observer interaction in a routine real-world setting on a 128-row scanner. Deep learning-based algorithms allow a robust and semi-automatic on-site determination of cFFR based on data from standard CT scanners.

Key Points:

• Non-invasive on-site quantification of cFFR is feasible with minimal observer interaction.

• Deep-learning based algorithms allow robust and semi-automatic on-site determination of cFFR.

• The mean follow-up time varied significantly with the extent of vascular CAD.

Zusammenfassung

Ziel Implementierung der technischen Machbarkeit von cFFR mittels eines 128-Zeilen-Computertomographen in der alltäglichen Routine. Nachbearbeitung und Alltagstauglichkeit sollen am Gerät vor Ort in Zusammenschau mit klinischen Parametern analysiert werden.

Material und Methoden Diese retrospektive Single-Center-Studie umfasste 230 Patienten (74 weiblich; Durchschnittsalter 63,8 Jahre) mit CCTA innerhalb von 21 Monaten zwischen 01/2018 und 09/2019. Es wurden nur Patienten mit KHK-Befunden eingeschlossen. Die cFFR-Werte wurden mit einem auf Deep Learning basierenden nicht-kommerziellen Forschungsprototyp (cFFR Version3.5.0; Siemens Healthineers GmbH, Erlangen) ermittelt. Die cFFR-Werte wurden an zwei Punkten ausgewertet: am Maximum einer Stenose und 1,0 cm distal der Stenose. Ein Vergleich mit der invasiven Koronarangiographie wurde bei 57/230 Patienten (24,7 %) durchgeführt. Es erfolgte eine weitere Untergruppeneinteilung nach dem Aufwand des Postprocessings: keine Änderungen erforderlich, geringfügige Korrekturen erforderlich, größere Korrekturen erforderlich und keine Auswertung möglich. Bewertet wurde zusätzlich die benötigte Zeit vom Start der Software bis zum Endergebnis.

Ergebnisse Insgesamt wurden 116/448 (25,9 %) leichte, 223/448 (49,8 %) mittelschwere und 109/448 (24,3 %) obstruktive Stenosen gefunden. Der mittlere cFFR-Wert am Maximum der Stenose betrug 0,92 ± 0,09 und war signifikant höher als der cFFR-Wert 0,89 ± 0,13 distal der Stenose (p < 0,001*), wobei eine signifikante Korrelation zwischen beiden Werten zu verzeichnen ist (r = 0,966, p = 0,001*). Der mittlere Stenosegrad betrug 44,02 ± 26,99 % (Range 1–99 %) mit einer Fläche von 5,39 ± 3,30 mm2. Bei insgesamt 45 Patienten (19,1 %) wurde eine relevante Verringerung der cFFR unter 0,80 festgestellt. Insgesamt wurde bei 57/230 Patienten (24,8 %) eine Katheterangiographie durchgeführt. Es wurde kein signifikanter Unterschied zwischen dem Grad der maximalen Stenose (CAD-RADS 0–2/3/4) zwischen der Klassifizierung von CCTA und ICA festgestellt (p = 0,171). Die mittlere Nachbearbeitungszeit zeigte signifikante Unterschiede mit 8,34 ± 4,66 min bei Ein-Gefäß-KHK vs. 12,91 ± 3,92 min bei Zwei-Gefäß-KHK vs. 21,80 ± 5,94 min bei Drei-Gefäß-KHK (jeweils p < 0,001).

Schlussfolgerung Die nicht-invasive Vor-Ort-Quantifizierung der cFFR ist mit minimaler Nachbearbeitung des Untersuchers im Alltag auf einem 128-Zeilen-Scanner für die cFFR möglich. DL-basierte Algorithmen ermöglichen eine robuste und halbautomatische Vor-Ort-Bestimmung der cFFR auf Daten von Standard-CT-Scannern.

Kernaussagen:

• Die nicht-invasive Vor-Ort-Qunatifizierung der cFFR ist mit minimalem Nachbearbeitungsaufwand möglich.

• Deep-Learning-basierte Algorithmen ermöglichen eine robuste und halbautomatische Bestimmung des cFFR vor Ort.

• Die Nachbearbeitungszeit variiert signifikant je nach Ausmaß der KHK.

Zitierweise

• Baumeister T, Kloth C, Schmidt S et al. On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner. Fortschr Röntgenstr 2024; 196: 62 – 71

Key words

CT - CT-angiography - cardiac

Publication History

Received: 27 November 2022

Accepted: 11 July 2023

Article published online:
11 October 2023

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