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Diagnostic Accuracy of a Novel On-site Virtual Fractional Flow Reserve Parallel Computing System
박형복,장영걸,Reza Arsanjani,Minh Tuan Nguyen,이상은,전병환,정성희,홍영택,하성민,김세근,이상욱,장혁재 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.2
Purpose: To evaluate the diagnostic accuracy of a novel on-site virtual fractional flow reserve (vFFR) derived from coronary computedtomography angiography (CTA). Materials and Methods: We analyzed 100 vessels from 57 patients who had undergone CTA followed by invasive FFR during coronaryangiography. Coronary lumen segmentation and three-dimensional reconstruction were conducted using a completelyautomated algorithm, and parallel computing based vFFR prediction was performed. Lesion-specific ischemia based on FFR wasdefined as significant at ≤0.8, as well as ≤0.75, and obstructive CTA stenosis was defined that ≥50%. The diagnostic performanceof vFFR was compared to invasive FFR at both ≤0.8 and ≤0.75. Results: The average computation time was 12 minutes per patient. The correlation coefficient (r) between vFFR and invasive FFRwas 0.75 [95% confidence interval (CI) 0.65 to 0.83], and Bland-Altman analysis showed a mean bias of 0.005 (95% CI -0.011 to0.021) with 95% limits of agreement of -0.16 to 0.17 between vFFR and FFR. The accuracy, sensitivity, specificity, positive predictivevalue, and negative predictive value were 78.0%, 87.1%, 72.5%, 58.7%, and 92.6%, respectively, using the FFR cutoff of 0.80. They were 87.0%, 95.0%, 80.0%, 54.3%, and 98.5%, respectively, with the FFR cutoff of 0.75. The area under the receiver-operatingcharacteristics curve of vFFR versus obstructive CTA stenosis was 0.88 versus 0.61 for the FFR cutoff of 0.80, respectively; it was0.94 versus 0.62 for the FFR cutoff of 0.75. Conclusion: Our novel, fully automated, on-site vFFR technology showed excellent diagnostic performance for the detection oflesion-specific ischemia.
하성민,정성희,박형복,신상훈,Reza Arsanjani,홍영택,이병권,장영걸,전병환,박세일,심학준,장혁재 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.3
Purpose: To compare image quality in selective intracoronary contrast-injected computed tomography angiography (SelectiveCTA) with that in conventional intravenous contrast-injected CTA (IV-CTA). Materials and Methods: Six pigs (35 to 40 kg) underwent both IV-CTA using an intravenous injection (60 mL) and Selective-CTA using an intracoronary injection (20 mL) through a guide-wire during/after percutaneous coronary intervention. Images of the common coronary artery were acquired. Scans were performed using a combined machine comprising an invasive coronary angiography suite and a 320-channel multi-slice CT scanner. Quantitative image quality parameters of CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), mean lumen diameter (MLD), and mean lumen area (MLA) were measured and compared. Qualitative analysis was performed using intraclass correlation coefficient (ICC), which was calculated for analysis of interobserver agreement. Results: Quantitative image quality, determined by assessing the uniformity of CT attenuation (399.06 vs. 330.21, p<0.001), image noise (24.93 vs. 18.43, p<0.001), SNR (16.43 vs. 18.52, p=0.005), and CNR (11.56 vs. 13.46, p=0.002), differed significantly between IV-CTA and Selective-CTA. MLD and MLA showed no significant difference overall (2.38 vs. 2.44, p=0.068, 4.72 vs. 4.95, p=0.078). The density of contrast agent was significantly lower for selective-CTA (13.13 mg/mL) than for IV-CTA (400 mg/mL). Agreement between observers was acceptable (ICC=0.79±0.08). Conclusion: Our feasibility study in swine showed that compared to IV-CTA, Selective-CTA provides better image quality and requires less iodine contrast medium
Park, Hyung-Bok,Lee, Byoung Kwon,Shin, Sanghoon,Heo, Ran,Arsanjani, Reza,Kitslaar, Pieter H,Broersen, Alexander,Dijkstra, Jouke,Ahn, Sung Gyun,Min, James K,Chang, Hyuk-Jae,Hong, Myeong-Ki,Jang, Yangso Springer International 2015 EUROPEAN RADIOLOGY Vol.25 No.10
<P>To evaluate the diagnostic performance of automated coronary atherosclerotic plaque quantification (QCT) by different users (expert/non-expert/automatic).</P>
Hong, Youngtaek,Shin, Sanghoon,Park, Hyung-Bok,Lee, Byoung Kwon,Arsanjani, Reza,Hartaigh, Brí,ain ó,Ha, Seongmin,Jang, Yeonggul,Jeon, Byunghwan,Jung, Sunghee,Park, Se-Il,Sung, Ji Min,Shim, J.B. Lippincott 2015 Vol. No.
OBJECTIVE: Selective catheter-directed intracoronary contrast injected coronary computed tomography angiography (selective CCTA) has recently been introduced for on-site evaluation of coronary artery disease during coronary artery catheterization. In this study, we aimed to develop a feasible protocol for selective CCTA using ultralow-dose contrast medium as compared with conventional intravenous CCTA (IV CCTA). MATERIALS AND METHODS: A novel combined system incorporating coronary angiography and a 320-detector row computed tomographic scanner was used to study 4 swine (35–40 kg) under animal institutional review board approval. A selective CCTA scan was simultaneously performed with an injection of 13.13 mgI/mL of modulated contrast medium at multiple different injection rates including 2, 3, and 4 mL/s and different total injection volumes of either 20 or 30 mL. Intravenous CCTA was performed with 60 mL of contrast medium, followed by 30 mL of saline chaser at 5 mL/s. Coronary mean and peak intensity, transluminal attenuation gradient, as well as 3-dimensional maximum intensity projections were obtained. RESULTS: Attenuation values (mean ± standard error, in Hounsfield units [HUs]) of selective CCTA for the left anterior descending (LAD) and right coronary artery (RCA) using the various combinations of injection rates and total injection volumes were as follows: 20 mL at 2 mL/s (LAD, 270.3 ± 20.4 HU; RCA, 322.6 ± 7.4 HU), 20 mL at 3 mL/s (LAD, 262.9 ± 20.4 HU; RCA, 264.7 ± 7.4 HU), 30 mL at 3 mL/s (LAD, 276.8 ± 20.4 HU; RCA, 274.0 ± 7.4 HU), 20 mL at 4 mL/s (LAD, 268.0 ± 20.4 HU; RCA, 277.7 ± 7.4 HU), and 30 mL at 4 mL/s (LAD, 251.3 ± 20.4 HU; RCA, 334.7 ± 7.4 HU). The representative protocol of the selective CCTA studies produced results within the optimal enhancement range (approximately 250-350 HU) for all segments, and comparison of transluminal attenuation gradient data with selective CCTA and IV CCTA studies demonstrated that the former method was more homogenous (−1.5245 and −1.7558 for LAD as well as 0.0459 and 0.0799 for RCA, respectively). Notably, the volume of iodine contrast medium used for selective CCTA was reported to be 1.09% (0.2 g) of IV CCTA (24 g). CONCLUSIONS: The current findings demonstrate the feasibility of selective CCTA using ultralow-dose intracoronary contrast injection. This technique may provide additional means of coronary evaluation in patients who may require strategic planning before a procedure using a combined modality system.