Coronary CT Angiography-derived Fractional Flow Reserve: Machine Learning Algorithm versus Computational Fluid Dynamics Modeling.

Journal: Radiology
Published Date: Apr 10, 2018

Abstract

Purpose To compare two technical approaches for determination of coronary computed tomography (CT) angiography-derived fractional flow reserve (FFR)-FFR derived from coronary CT angiography based on computational fluid dynamics (hereafter, FFR) and FFR derived from coronary CT angiography based on machine learning algorithm (hereafter, FFR)-against coronary CT angiography and quantitative coronary angiography (QCA). Materials and Methods A total of 85 patients (mean age, 62 years ± 11 [standard deviation]; 62% men) who had undergone coronary CT angiography followed by invasive FFR were included in this single-center retrospective study. FFR values were derived on-site from coronary CT angiography data sets by using both FFR and FFR. The performance of both techniques for detecting lesion-specific ischemia was compared against visual stenosis grading at coronary CT angiography, QCA, and invasive FFR as the reference standard. Results On a per-lesion and per-patient level, FFR showed a sensitivity of 79% and 90% and a specificity of 94% and 95%, respectively, for detecting lesion-specific ischemia. Meanwhile, FFR resulted in a sensitivity of 79% and 89% and a specificity of 93% and 93%, respectively, on a per-lesion and per-patient basis (P = .86 and P = .92). On a per-lesion level, the area under the receiver operating characteristics curve (AUC) of 0.89 for FFR and 0.89 for FFR showed significantly higher discriminatory power for detecting lesion-specific ischemia compared with that of coronary CT angiography (AUC, 0.61) and QCA (AUC, 0.69) (all P < .0001). Also, on a per-patient level, FFR (AUC, 0.91) and FFR (AUC, 0.91) performed significantly better than did coronary CT angiography (AUC, 0.65) and QCA (AUC, 0.68) (all P < .0001). Processing time for FFR was significantly shorter compared with that of FFR (40.5 minutes ± 6.3 vs 43.4 minutes ± 7.1; P = .042). Conclusion The FFR algorithm performs equally in detecting lesion-specific ischemia when compared with the FFR approach. Both methods outperform accuracy of coronary CT angiography and QCA in the detection of flow-limiting stenosis.

Authors

  • Christian Tesche
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.).
  • Carlo N De Cecco
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.).
  • Stefan Baumann
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Matthias Renker
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Tindal W McLaurin
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Taylor M Duguay
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
  • Richard R Bayer
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.).
  • Daniel H Steinberg
    Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
  • Katharine L Grant
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Christian Canstein
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Chris Schwemmer
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Max Schoebinger
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Lucian M Itu
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Saikiran Rapaka
    From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (C.T., C.N.D.C., S.B., M.R., T.W.M., T.M.D., R.R.B., U.J.S.), and Division of Cardiology, Department of Medicine (R.R.B., D.H.S., U.J.S.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Computed Tomography-Research & Development, Siemens Healthcare GmbH, Forchheim, Germany (K.L.G., C.C., C.S., M.S.); Department of Corporate Technology, Siemens SRL, Brasov, Romania (L.M.I.); and Department of Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ (S.R., P.S.).
  • Puneet Sharma
    Digital Technologies and Innovation, Siemens Healthineers, Princeton, NJ, United States.
  • U Joseph Schoepf
    Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.).

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