Author + information
- Received January 17, 2018
- Revision received July 8, 2018
- Accepted July 12, 2018
- Published online July 1, 2019.
- Csilla Celeng, MD, PhDa,∗ (, )
- Tim Leiner, MD, PhDa,
- Pál Maurovich-Horvat, MD, PhD, MPHb,
- Béla Merkely, MD, PhDb,
- Pim de Jong, MD, PhDa,
- Jan W. Dankbaar, MD, PhDa,
- Hendrik W. van Es, MD, PhDc,
- Brian B. Ghoshhajra, MD, MBAd,
- Udo Hoffmann, MD, MPHd and
- Richard A.P. Takx, MD, PhD, MSca,c,d
- aDepartment of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- bMTA-SE Cardiovascular Imaging Research Group Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- cDepartment of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- dCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Csilla Celeng, Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Objectives This meta-analysis determined the diagnostic performance of coronary computed tomography (CT) angiography (CTA), CT myocardial perfusion (CTP), fractional flow reserve CT (FFRCT), the transluminal attenuation gradient (TAG), and their combined use with CTA versus FFR as a reference standard for detection of hemodynamically significant coronary artery disease (CAD).
Background CTA provides excellent anatomic, albeit limited functional information for the evaluation of CAD. Recently, various functional CT techniques emerged to assess the hemodynamic consequences of CAD.
Methods This meta-analysis was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Web of Science were searched from inception until September 7, 2017. Bayesian random effects analysis was used to compute pooled sensitivity, specificity, and the summary receiver-operating characteristic curve of the index tests and compare them with the FFR as a reference standard. Analyses were performed on vessel and patient levels. Because CTA has excellent sensitivity, specificity was considered most relevant. Individual FFRCT values were collected.
Results Overall, 54 articles and 5,330 patients were included. At vessel level, pooled specificity of CTP (0.86; 95% confidence interval [CI]: 0.76 to 0.93), FFRCT (0.78; 95% CI: 0.72 to 0.83) and TAG (0.77; 95% CI: 0.61 to 0.89) were substantially higher than that of CTA (0.61; 95% CI: 0.54 to 0.68). The addition of FFRCT, CTP, and TAG to CTA resulted in high to excellent specificities (0.80 to 0.92). The summary receiver-operating characteristic curve at vessel level yielded superior diagnostic accuracy for CTP, FFRCT, and combined CTA and CTP, compared with CTA. A subanalysis of on-site versus off-site FFRCT revealed no substantial differences between the sensitivity (0.84 vs. 0.85) and specificity (0.80 vs. 0.73) of the 2 techniques. In a second subanalysis, dynamic CTP showed higher sensitivity (0.85 vs. 0.72), but had a lower specificity (0.81 vs. 0.90) than static CTP.
Conclusions CTP and FFRCT demonstrated a substantial improvement in the identification of hemodynamically significant CAD compared with CTA; therefore, their integration to clinical workflow before revascularization is recommended.
- coronary artery disease
- computed tomography
- fractional flow reserve
- myocardial perfusion imaging
Dr. Celeng has received grant support from the European Association of Cardiovascular Imaging. Dr. Ghoshhajra has been a consultant for Siemens Healthcare and Medtronic. Dr. Hoffman has received research grants from KOWA, MedImmune, Pfizer, Siemens, and HeartFlow, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 17, 2018.
- Revision received July 8, 2018.
- Accepted July 12, 2018.
- 2019 American College of Cardiology Foundation
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