第二代追踪冻结技术提高CT冠状动脉血流储备分数计算准确度的诊断研究

The diagnostic study of second-generation motion correction algorithm in improving the accuracy of CT-derived fractional flow reserve calculations

目的比较未纠正运动伪影的标准图像(STD)、第一代追踪冻结(SSF1)技术和第二代全心运动校正(SSF2)技术纠正运动伪影后的冠状动脉CT血管成像(CCTA)图像, 分别用于CT冠状动脉血流储备分数(CT-FFR)计算的诊断效能。方法回顾性收集2020年1月至2022年12月于上海交通大学医学院附属第一人民医院同时行CCTA、有创性冠状动脉造影(ICA)和FFR检查的患者。最终纳入121例患者(134处病变)。分别使用标准迭代重建、迭代联合SSF1和SSF2技术对患者的CCTA图像进行重建。将所有图像分为STD组、SSF1组和SSF2组, 使用Likert量表对CCTA图像质量进行评分, 采用Kruskal-Wallis检验和Mann-WhitneyU检验比较各组间差异。使用Spearman相关系数和Bland-Altman图评估CT-FFR与FFR之间的相关性和一致性。使用受试者操作特性(ROC)曲线分析CCTA诊断阻塞性狭窄及CT-FFR评估缺血性病变的效能, 计算曲线下面积(AUC), 并使用DeLong检验比较组间差异。结果 SSF2组的图像质量评分(中位数3.7分)显著高于STD组和SSF1组(中位数均为3.0分)。SSF2组CT-FFR与FFR的相关性(r=0.652, P<0.001)和一致性(平均差=0.03)最好。ROC分析结果显示, 在病变水平上, SSF2组CT-FFR诊断缺血性病变的效能显著高于SSF1组(AUC分别为0.88、0.76, P=0.003), 而STD组和SSF1组差异无统计学意义(P=0.125)。SSF2组的特异度和阴性预测值最高, 分别为92.72%和87.50%。在患者水平上, SSF2组也具有最高的诊断效能。结论 SSF2技术改善了CCTA图像质量, 进而显著提高狭窄程度评估和CT-FFR模拟计算的诊断准确度。

Objective To investigate the diagnostic performance of CT-derived fractional flow reserve(CT-FFR)derived from standard images(STD),images processed by first-generation(SSF1)and second-generation(SSF2)whole-heart motion correction algorithm,respectively.Methods Patients who underwent both coronary CT angiography(CCTA)and invasive coronary angiography(ICA)with FFR examination within 3 months in Shanghai General Hospital,Shanghai Jiao Tong Univerisity School of Medicine from January 2020 to December 2022 were screened in this retrospective study.Totally of 121 patients(134 lesions)were finally included in the study.CCTA images were reconstructed using iterative reconstruction,iterative reconstruction plus SSF1 and SSF2 algorithms.All images were divided into three groups:STD group,SSF1 group,and SSF2 group.The image quality of the CCTA images was assessed using the Likert scale,and differences between the two groups were compared using the Mann-Whitney U and Kruskal-Wallis test.The correlation and consistency between CT-FFR and FFR were evaluated using Spearman correlation coefficient and Bland-Altman plots.The diagnostic performance of CCTA and CT-FFR from three groups was compared by receiver operating characteristic(ROC)curves.The area under the curve(AUC)was compared using the DeLong test.Results Compared to the STD group and SSF1 group,the SSF2 group showed the best performance in image quality score(median=3.7).Best correlation(r=0.652,P<0.001)and consistency(mean difference=0.03)between CT-FFR and FFR were observed in SSF2 group.ROC analysis results revealed that,at the per-lesion level,in the diagnosis of ischemic lesions,the diagnostic performance of CT-FFR in the SSF2 group was significantly better than that of the SSF1 group(AUC=0.88 vs.0.76,P=0.003),while no significant difference was observed between STD group and SSF1 group(P=0.125).At the per-patient level,the SSF2 group also demonstrated the highest diagnostic performance.Conclusion The SSF2 algorithm significantly improved CCTA image quality and enhanced its diagnostic performance for evaluating stenosis severity and CT-FFR calculations.