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Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis

  • Michèle HamonEmail author
  • Damien Geindreau
  • Lydia Guittet
  • Christophe Bauters
  • Martial Hamon
Cardiac

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.

Keywords

Coronary angiography Myocardial perfusion imaging Computed tomography angiography Myocardial fractional flow reserve Coronary artery disease 

Abbreviations

AUC

Area under the curve

CABG

Coronary artery bypass grafting

CAD

Coronary artery disease

CT

Computed tomography

CTA

Coronary computed tomography angiography

CTP

Computed tomography perfusion

FFRCT

Computer simulation of fractional flow reserve based on computed tomography

FN

False negative

FP

False positive

HU

Hounsfield units

iFFR

Invasive fractional flow reserve

mSv

milliSievert

NLR

Negative likelihood ratio

NPV

Negative predictive value

PLR

Positive likelihood ratio

PPV

Positive predictive value

TAG

Transluminal attenuation gradient

TN

True negative

TP

True positive

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Michele Hamon (M.D.).

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because it is a meta-analysis.

Ethical approval

Institutional Review Board approval was not required because it is a meta-analysis.

Methodology

• Meta-analysis

Supplementary material

330_2018_5919_MOESM1_ESM.docx (130 kb)
ESM 1 (DOCX 129 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Departement de RadiologieCentre Hospitalier Universitaire de CaenCaenFrance
  2. 2.Université de Caen, UFR de MédecineCaenFrance
  3. 3.Departement d’Information MédicaleCentre Hospitalier Universitaire de CaenCaenFrance
  4. 4.Departement de CardiologieCentre Hospitalier Universitaire Regional de LilleLilleFrance
  5. 5.INSERM U1167Université de Lille, UFR de MédecineLilleFrance

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