ArticleQuantitative imaging in medicine and surgery2026
Efficacy of coronary computed tomography angiography and its fractional flow reserve in predicting myocardial ischemia in patients with obstructive coronary artery disease with positron emission tomography myocardial perfusion imaging as a reference standard.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide. Accurate assessment of myocardial ischemia is essential for guiding clinical management. This study aimed to evaluate and compare the diagnostic efficacy of coronary computed tomography angiography (CCTA) for the visual coronary analysis (VCA) of stenosis, quantitative coronary analysis (QCA), and computed tomography-derived fractional flow reserve (CT-FFR) for predicting myocardial ischemia in patients with obstructive CAD, with positron emission tomography (PET) myocardial perfusion imaging (MPI) serving a reference standard for myocardial ischemia. Methods: Data on suspected or confirmed obstructive CAD cases with PET-MPI and concurrent CCTA were retrospectively collected. The maximum stenosis of each vessel was determined visually and measured quantitatively, and CT-FFR was derived from CCTA. Semiquantitative parameters, including summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS), were obtained from PET-MPI and then used as the reference standard for the diagnosis of myocardial ischemia. The diagnostic efficacy of CCTA for visual analysis of coronary artery stenosis, quantitative analysis, and CT-FFR for the diagnosis of myocardial ischemia and its differences were analyzed and compared via the area under the curve (AUC). Results: A total of 86 cases with a mean age of 59.5±11.54 years were included. With the semiquantitative parameters of PET serving the reference standard for myocardial ischemia and stenosis ≥50% as the positive criterion for CCTA, the diagnostic efficacy for predicting myocardial ischemia was similar (P=0.878) between CT-FFR (AUC =0.780) and QCA (AUC =0.777), with both demonstrating superior performance to that of VCA of stenosis (AUC =0.701) (all P values <0.05); however, CT-FFR, as compared to QCA, had higher diagnostic specificity (90.7% Conclusions: The diagnostic efficacy of CT-FFR and quantitative analysis of coronary artery stenosis for predicting myocardial ischemia was similar and higher than that of visual analysis; however, the diagnostic specificity and accuracy of the former were higher. As the degree of stenosis increased, the diagnostic efficacy of visual analysis, quantitative analysis, and CT-FFR in predicting myocardial ischemia increased. However, CT-FFR had the highest diagnostic specificity and accuracy in predicting myocardial ischemia.
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