ArticleThe international journal of cardiovascular imaging2026
Improved diagnostic performance of CT-derived FFR using 70-keV monoenergetic spectral CT in coronary artery disease.
Article in The international journal of cardiovascular imaging, 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
To compare the diagnostic performance of coronary CT-derived fractional flow reserve (CT-FFR) calculated from conventional polychromatic CT images with 70-keV monoenergetic reconstructions derived from spectral CT data. This retrospective study enrolled patients who underwent spectral coronary CT angiography followed by invasive FFR measurements. The CT-FFR values were computed from conventional polychromatic and 70-keV monoenergetic images. Image quality was assessed using the contrast-to-noise ratio (CNR). Comparison of the CT-FFR with invasive FFR provided mean absolute error (MAE), Pearson's correlation, Bland-Altman analysis, and receiver operating characteristic (ROC) curve analysis. Hemodynamically significant stenosis was defined as an invasive FFR < 0.80. Thirty-two patients (21 men, 11 women; mean age, 68.5 ± 8.4 years) with 47 coronary artery lesions were included in this study. The 70-keV images demonstrated significantly higher CNR than conventional images (36.4 ± 15.2 vs. 25.3 ± 7.4; p < 0.01). CT-FFR derived from 70-keV images yielded lower MAE (0.07 ± 0.05 vs. 0.12 ± 0.08; p < 0.01) and showed stronger correlation with invasive FFR (R = 0.769 vs. R = 0.439). Bland-Altman analysis revealed narrower limits of agreement for the 70-keV CT-FFR. In 17 lesions with hemodynamically significant stenosis, the area under the ROC curve of 70-keV CT-FFR was significantly higher than that of conventional CT-FFR (0.929 vs. 0.807; p = 0.01). CT-FFR derived from 70-keV monoenergetic spectral CT images demonstrated promising agreement with invasive FFR and may offer exploratory insight into improving functional assessment of coronary stenosis.
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