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

  • Cardiac
  • Published:
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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.

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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

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Authors and Affiliations

  1. Departement de Radiologie, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033, Caen, Normandie, France

    Michèle Hamon & Damien Geindreau

  2. Université de Caen, UFR de Médecine, Caen, Normandie, France

    Michèle Hamon, Damien Geindreau, Lydia Guittet & Martial Hamon

  3. Departement d’Information Médicale, Centre Hospitalier Universitaire de Caen, Caen, Normandie, France

    Lydia Guittet

  4. Departement de Cardiologie, Centre Hospitalier Universitaire Regional de Lille, Lille, Hauts de France, France

    Christophe Bauters

  5. INSERM U1167, Université de Lille, UFR de Médecine, Lille, Hauts de France, France

    Christophe Bauters

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  1. Michèle Hamon
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Correspondence to Michèle Hamon.

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Hamon, M., Geindreau, D., Guittet, L. et al. Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis. Eur Radiol 29, 3044–3061 (2019). https://doi.org/10.1007/s00330-018-5919-8

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