ArticleJapanese journal of radiology2026
Fractal analysis of dynamic stress myocardial CT perfusion decouples diagnostic accuracy for obstructive coronary artery disease from remote flow.
Article in Japanese journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Fractional Flow Reserve Measurement Using Dynamic CT Perfusion Imaging in Patients with Heavy Coronary Calcification and Stent.Diagnostics (Basel, Switzerland) · 2026Article
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17 authors.
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Abstract
purposeIn patients with reduced remote flow, dynamic stress CT perfusion imaging (CTP) has limited utility for detecting obstructive coronary artery disease (CAD). We compared fractal analysis, a descriptor of macro- and microvascular ischemia patterns, with relative myocardial blood flow (MBF) for detecting obstructive CAD stratified by remote flow. MATERIALS AND
methodsThis secondary analysis of the prospective multi-center AMPLIFiED trial included patients who underwent invasive coronary angiography (ICA) with fractional flow reserve (FFR) and dynamic stress CTP. Obstructive CAD was defined invasively (stenosis ≥ 90% or FFR < 0.8). We assessed diagnostic accuracy of fractal analysis and relative MBF in patient groups subdivided into high, intermediate, and low remote flow.
resultsIn 148 patients (30% female; 416 vessels), obstructive CAD was present in 71/148 patients (48%), while signs of microvascular ischemia were found in 26/148 patients (prevalence in high, intermediate, low remote flow: 9%, 37%, 70%). Fractal analysis outperformed relative MBF in detecting obstructive CAD (patient-based sensitivity and specificity: 94% and 92% versus 80% and 64%, p < 0.005). In vessel-based subgroup analysis, both methods performed comparably in high remote flow (area under the receiver-operating curve [AUC]: 0.94 versus 0.88, p = 0.45), while fractal analysis outperformed relative MBF in intermediate and low remote flow (AUC: 0.93 versus 0.77, p = 0.004; 0.92 versus 0.6, p < 0.001).
conclusionFractal analysis eliminates reliance on remote flow for CTP imaging, which improves diagnostic accuracy for obstructive CAD particularly in patients with reduced remote flow or microvascular ischemia.
trial registrationThis study reports about data from the prospective, multi-center AMPLIFiED trial (UMIN000016353).
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