Abstract
Background
The influence of computed tomography (CT) reconstruction algorithms on the performance
of machine-learning-based CT-derived fractional flow reserve (CT-FFRML) has not been investigated. CT-FFRML values and processing time of two reconstruction algorithms were compared using an
on-site workstation.
Methods
CT-FFRML was computed on 40 coronary CT angiography (CCTA) datasets that were reconstructed
with both iterative reconstruction in image space (IRIS) and filtered back-projection
(FBP) algorithms. CT-FFRML was computed on a per-vessel and per-segment basis as well as distal to lesions with
≥50% stenosis on CCTA. Processing times were recorded. Significant flow-limiting stenosis
was defined as invasive FFR and CT-FFRML values ≤ 0.80. Pearson's correlation, Wilcoxon, and McNemar statistical testing were
used for data analysis.
Results
Per-vessel analysis of IRIS and FBP reconstructions demonstrated significantly different
CT-FFRML values (p ≤ 0.05). Correlation of CT-FFRML values between algorithms was high for the left main (r = 0.74), left anterior descending
(r = 0.76), and right coronary (r = 0.70) arteries. Proximal and middle segments showed
a high correlation of CT-FFRML values (r = 0.73 and r = 0.67, p ≤ 0.001, respectively), despite having significantly different averages (p ≤ 0.05). No difference in diagnostic accuracy was observed (both 81.8%, p = 1.000). Of the 40 patients, 10 had invasive FFR results. Per-lesion correlation
with invasive FFR values was moderate for IRIS (r = 0.53, p = 0.117) and FBP (r = 0.49, p = 0.142). Processing time was significantly shorter using IRIS (15.9 vs. 19.8 min,
p ≤ 0.05).
Conclusion
CT reconstruction algorithms influence CT-FFRML analysis, potentially affecting patient management. Additionally, iterative reconstruction
improves CT-FFRML post-processing speed.
Keywords
Abbreviations:
BMI (Body mass index), CAD (Coronary artery disease), CCTA (Coronary CT angiography), CT-FFR (CT-derived fractional flow reserve), CT-FFRML (Machine-learning-based coronary CT-derived fractional flow reserve), CX (Left circumflex artery), FBP (Filtered back-projection), FFR (Fractional flow reserve), ICA (Invasive catheter angiography), IRIS (Iterative reconstruction in image space), LAD (Left anterior descending artery), LM (Left main artery), RCA (Right coronary artery), SD (Standard deviation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 25, 2018
Accepted:
October 24,
2018
Received in revised form:
October 19,
2018
Received:
June 20,
2018
Identification
Copyright
Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography
