Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients
Abstract Background Fractional flow reserve with computed tomography (FFR-CT) is influenced by calcified plaque artifacts, which can reduce its accuracy in predicting myocardial ischemia. Subtraction techniques can mitigate these artifacts, thereby enhancing diagnostic precision. However, the potent...
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BMC
2025-08-01
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| Series: | BMC Medical Imaging |
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| Online Access: | https://doi.org/10.1186/s12880-025-01874-z |
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| author | Tingting Zhu Yanhui Li Yujin Wang Hanxiong Guan Qian Li Defu Li |
| author_facet | Tingting Zhu Yanhui Li Yujin Wang Hanxiong Guan Qian Li Defu Li |
| author_sort | Tingting Zhu |
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| description | Abstract Background Fractional flow reserve with computed tomography (FFR-CT) is influenced by calcified plaque artifacts, which can reduce its accuracy in predicting myocardial ischemia. Subtraction techniques can mitigate these artifacts, thereby enhancing diagnostic precision. However, the potential of subtraction FFR-CT and the pericoronary fat attenuation index (FAI) to improve the prediction of revascularization in patients with coronary artery disease (CAD) remains unclear. We aimed to evaluate the diagnostic performance of FFR-CT and pericoronary FAI in identifying the need for revascularization in patients with CAD. Methods We retrospectively analyzed coronary computed tomography angiography (CCTA) data from 76 patients with CAD (142 branches) using both conventional and subtraction CCTA images. The diagnostic performance of FFR-CT and FAI in identifying revascularization needs was assessed using receiver operating characteristic curves. Results Among the 76 patients, 54 underwent revascularization. Patients who underwent revascularization had higher pericoronary FAI and lower FFR-CT values. Subtraction FFR-CT values were higher than those obtained using conventional methods. Models 4 (subtraction CCTA), 5 (Model 4 + subtraction FFR-CT), and 6 (Model 5 + subtraction FAI) showed significantly better diagnostic efficacy for revascularization needs than compared to the Models 1 (conventional CCTA), 2 (Model 1 + conventional FFR-CT), and 3 (Model 2 + conventional FAI) (all p < 0.05). In the subtraction models, Model 6 and 5 were significantly more effective than Models 4 (all p < 0.05). Additionally, when clinical variables (male, age, body mass index, hypertension, dyslipidemia, diabetes mellitus, and smoking) were incorporated into Models 3 and 6, the resulting Models 7 and 8 performed significantly better than Model 3 (all p < 0.05). Conclusion Subtraction techniques have significantly improved the efficacy of CCTA with FFR-CT in assessing the need for revascularization in patients with CAD. By integrating clinical variables, CCTA, FFR-CT, and pericoronary FAI, individualized therapeutic decisions for CAD patients can be further optimized. |
| format | Article |
| id | doaj-art-0be56d8f5ed14ecebaf989cac2fe0eda |
| institution | Kabale University |
| issn | 1471-2342 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Imaging |
| spelling | doaj-art-0be56d8f5ed14ecebaf989cac2fe0eda2025-08-24T11:57:43ZengBMCBMC Medical Imaging1471-23422025-08-0125111110.1186/s12880-025-01874-zSubtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patientsTingting Zhu0Yanhui Li1Yujin Wang2Hanxiong Guan3Qian Li4Defu Li5Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background Fractional flow reserve with computed tomography (FFR-CT) is influenced by calcified plaque artifacts, which can reduce its accuracy in predicting myocardial ischemia. Subtraction techniques can mitigate these artifacts, thereby enhancing diagnostic precision. However, the potential of subtraction FFR-CT and the pericoronary fat attenuation index (FAI) to improve the prediction of revascularization in patients with coronary artery disease (CAD) remains unclear. We aimed to evaluate the diagnostic performance of FFR-CT and pericoronary FAI in identifying the need for revascularization in patients with CAD. Methods We retrospectively analyzed coronary computed tomography angiography (CCTA) data from 76 patients with CAD (142 branches) using both conventional and subtraction CCTA images. The diagnostic performance of FFR-CT and FAI in identifying revascularization needs was assessed using receiver operating characteristic curves. Results Among the 76 patients, 54 underwent revascularization. Patients who underwent revascularization had higher pericoronary FAI and lower FFR-CT values. Subtraction FFR-CT values were higher than those obtained using conventional methods. Models 4 (subtraction CCTA), 5 (Model 4 + subtraction FFR-CT), and 6 (Model 5 + subtraction FAI) showed significantly better diagnostic efficacy for revascularization needs than compared to the Models 1 (conventional CCTA), 2 (Model 1 + conventional FFR-CT), and 3 (Model 2 + conventional FAI) (all p < 0.05). In the subtraction models, Model 6 and 5 were significantly more effective than Models 4 (all p < 0.05). Additionally, when clinical variables (male, age, body mass index, hypertension, dyslipidemia, diabetes mellitus, and smoking) were incorporated into Models 3 and 6, the resulting Models 7 and 8 performed significantly better than Model 3 (all p < 0.05). Conclusion Subtraction techniques have significantly improved the efficacy of CCTA with FFR-CT in assessing the need for revascularization in patients with CAD. By integrating clinical variables, CCTA, FFR-CT, and pericoronary FAI, individualized therapeutic decisions for CAD patients can be further optimized.https://doi.org/10.1186/s12880-025-01874-zCoronary computed tomography angiographyCoronary artery diseaseFat attenuation indexFractional flow reserveSubtraction |
| spellingShingle | Tingting Zhu Yanhui Li Yujin Wang Hanxiong Guan Qian Li Defu Li Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients BMC Medical Imaging Coronary computed tomography angiography Coronary artery disease Fat attenuation index Fractional flow reserve Subtraction |
| title | Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients |
| title_full | Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients |
| title_fullStr | Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients |
| title_full_unstemmed | Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients |
| title_short | Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients |
| title_sort | subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients |
| topic | Coronary computed tomography angiography Coronary artery disease Fat attenuation index Fractional flow reserve Subtraction |
| url | https://doi.org/10.1186/s12880-025-01874-z |
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