Michèle Hamon1,2, Damien Geindreau3,4, Lydia Guittet4,5, Christophe Bauters6,7, Martial Hamon4. 1. Departement de Radiologie, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033, Caen, Normandie, France. michele.hamon@unicaen.fr. 2. Université de Caen, UFR de Médecine, Caen, Normandie, France. michele.hamon@unicaen.fr. 3. Departement de Radiologie, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033, Caen, Normandie, France. 4. Université de Caen, UFR de Médecine, Caen, Normandie, France. 5. Departement d'Information Médicale, Centre Hospitalier Universitaire de Caen, Caen, Normandie, France. 6. Departement de Cardiologie, Centre Hospitalier Universitaire Regional de Lille, Lille, Hauts de France, France. 7. INSERM U1167, Université de Lille, UFR de Médecine, Lille, Hauts de France, France.
Abstract
OBJECTIVES: To determine the diagnostic performance of cardiac computed tomography (CT)-based modalities including coronary CT angiography (CTA), stress myocardial CT perfusion (stress CTP), computer simulation of fractional flow reserve by CT (FFRCT), and transluminal attenuation gradients (TAG), for the diagnosis of hemodynamic significant coronary artery disease (CAD), using invasive fractional flow reserve as the reference standard. METHODS: PubMed and Cochrane databases were searched for original articles until July 2018. Diagnostic accuracy results were pooled at per-patient and per-vessel level using random effect models. RESULTS: Fifty articles were included in the meta-analysis (3024 subjects). The per-patient analysis per imaging modality demonstrated a pooled positive likelihood ratio (PLR) of 1.78 (95% confidence interval CI 1.49-2.11), 4.58 (95% CI 3.54-5.91), and 3.45 (95% CI 2.38-5.00) for CTA, stress CTP, and FFRCT respectively. Per-patient specificity of stress CTP (82%, 95% CI 76-86) and FFRCT (72%, 95% CI 68-76) were higher than for CTA (48%, 95% CI 44-51). At the vessel level, PLR was 2.42 (95% CI 1.93-3.02), 7.72 (95% CI 5.50-10.83), 3.50 (95% CI 2.73-4.78), 1.97 (95% CI 1.32-2.93) for CTA, stress CTP, FFRCT, and TAG respectively. CONCLUSION: With improved PLR and specificity, stress CTP and FFRCT have incremental value over CTA for the detection of functionally significant CAD. KEY POINTS: • New functional CT imaging techniques, such as stress CTP and FFRCT, improve diagnostic accuracy of coronary CTA to predict hemodynamically relevant stenosis. • TAG yields poor diagnostic performance. • Combination of CTA and some functional CT techniques (stress CTP and FFRCT) might become a "must" to improve diagnostic accuracy of CAD and to reduce unnecessary invasive coronary angiography.
OBJECTIVES: To determine the diagnostic performance of cardiac computed tomography (CT)-based modalities including coronary CT angiography (CTA), stress myocardial CT perfusion (stress CTP), computer simulation of fractional flow reserve by CT (FFRCT), and transluminal attenuation gradients (TAG), for the diagnosis of hemodynamic significant coronary artery disease (CAD), using invasive fractional flow reserve as the reference standard. METHODS: PubMed and Cochrane databases were searched for original articles until July 2018. Diagnostic accuracy results were pooled at per-patient and per-vessel level using random effect models. RESULTS: Fifty articles were included in the meta-analysis (3024 subjects). The per-patient analysis per imaging modality demonstrated a pooled positive likelihood ratio (PLR) of 1.78 (95% confidence interval CI 1.49-2.11), 4.58 (95% CI 3.54-5.91), and 3.45 (95% CI 2.38-5.00) for CTA, stress CTP, and FFRCT respectively. Per-patient specificity of stress CTP (82%, 95% CI 76-86) and FFRCT (72%, 95% CI 68-76) were higher than for CTA (48%, 95% CI 44-51). At the vessel level, PLR was 2.42 (95% CI 1.93-3.02), 7.72 (95% CI 5.50-10.83), 3.50 (95% CI 2.73-4.78), 1.97 (95% CI 1.32-2.93) for CTA, stress CTP, FFRCT, and TAG respectively. CONCLUSION: With improved PLR and specificity, stress CTP and FFRCT have incremental value over CTA for the detection of functionally significant CAD. KEY POINTS: • New functional CT imaging techniques, such as stress CTP and FFRCT, improve diagnostic accuracy of coronary CTA to predict hemodynamically relevant stenosis. • TAG yields poor diagnostic performance. • Combination of CTA and some functional CT techniques (stress CTP and FFRCT) might become a "must" to improve diagnostic accuracy of CAD and to reduce unnecessary invasive coronary angiography.
Authors: Brian S Ko; James D Cameron; Ian T Meredith; Michael Leung; Paul R Antonis; Arthur Nasis; Marcus Crossett; Sarah A Hope; Sam J Lehman; John Troupis; Tony DeFrance; Sujith K Seneviratne Journal: Eur Heart J Date: 2011-08-02 Impact factor: 29.983
Authors: Giovanna Sarno; Isabel Decraemer; Piet K Vanhoenacker; Bernard De Bruyne; Michalis Hamilos; Thomas Cuisset; Eric Wyffels; Jozef Bartunek; Guy R Heyndrickx; William Wijns Journal: JACC Cardiovasc Interv Date: 2009-06 Impact factor: 11.195
Authors: William E Boden; Robert A O'Rourke; Koon K Teo; Pamela M Hartigan; David J Maron; William J Kostuk; Merril Knudtson; Marcin Dada; Paul Casperson; Crystal L Harris; Bernard R Chaitman; Leslee Shaw; Gilbert Gosselin; Shah Nawaz; Lawrence M Title; Gerald Gau; Alvin S Blaustein; David C Booth; Eric R Bates; John A Spertus; Daniel S Berman; G B John Mancini; William S Weintraub Journal: N Engl J Med Date: 2007-03-26 Impact factor: 91.245
Authors: Michèle Hamon; Giuseppe G L Biondi-Zoccai; Patrizia Malagutti; Pierfrancesco Agostoni; Rémy Morello; Marco Valgimigli; Martial Hamon Journal: J Am Coll Cardiol Date: 2006-09-26 Impact factor: 24.094
Authors: Pim A L Tonino; Bernard De Bruyne; Nico H J Pijls; Uwe Siebert; Fumiaki Ikeno; Marcel van' t Veer; Volker Klauss; Ganesh Manoharan; Thomas Engstrøm; Keith G Oldroyd; Peter N Ver Lee; Philip A MacCarthy; William F Fearon Journal: N Engl J Med Date: 2009-01-15 Impact factor: 91.245
Authors: Alessandro Liberati; Douglas G Altman; Jennifer Tetzlaff; Cynthia Mulrow; Peter C Gøtzsche; John P A Ioannidis; Mike Clarke; P J Devereaux; Jos Kleijnen; David Moher Journal: BMJ Date: 2009-07-21
Authors: Jacob M van Werkhoven; Joanne D Schuijf; J Wouter Jukema; Gabija Pundziute; Albert de Roos; Martin J Schalij; Ernst E van der Wall; Jeroen J Bax Journal: Am J Cardiol Date: 2009-06-24 Impact factor: 2.778
Authors: W Bob Meijboom; Carlos A G Van Mieghem; Niels van Pelt; Annick Weustink; Francesca Pugliese; Nico R Mollet; Eric Boersma; Eveline Regar; Robert J van Geuns; Peter J de Jaegere; Patrick W Serruys; Gabriel P Krestin; Pim J de Feyter Journal: J Am Coll Cardiol Date: 2008-08-19 Impact factor: 24.094
Authors: Thomas Skaarup Kristensen; Thomas Engstrøm; Henning Kelbæk; Peter von der Recke; Michael Bachmann Nielsen; Klaus Fuglsang Kofoed Journal: Int J Cardiol Date: 2009-05-09 Impact factor: 4.164
Authors: Javier Zamora; Victor Abraira; Alfonso Muriel; Khalid Khan; Arri Coomarasamy Journal: BMC Med Res Methodol Date: 2006-07-12 Impact factor: 4.615
Authors: Fay M A Nous; Ricardo P J Budde; Marisa M Lubbers; Yuzo Yamasaki; Isabella Kardys; Tobias A Bruning; Jurgen M Akkerhuis; Marcel J M Kofflard; Bas Kietselaer; Tjebbe W Galema; Koen Nieman Journal: Eur Radiol Date: 2020-03-12 Impact factor: 5.315
Authors: Arlene Sirajuddin; S Mojdeh Mirmomen; Seth J Kligerman; Daniel W Groves; Allen P Burke; Faraz Kureshi; Charles S White; Andrew E Arai Journal: Radiographics Date: 2021-05-21 Impact factor: 6.312
Authors: S H Kim; J Rübenthaler; D Nörenberg; T Huber; W G Kunz; W H Sommer; S O Schoenberg; S Janssen; D Overhoff; M F Froelich Journal: Eur Radiol Date: 2020-09-03 Impact factor: 5.315