Coronary CT angiography-based FFR with ultrahigh-resolution photon-counting detector CT: Intra-individual comparison to energy-integrating detector CT

Vecsey-Nagy, Milan and Tremamunno, Giuseppe and Schoepf, U. Joseph and Gnasso, Chiara and Zsarnóczay, Emese and Fink, Nicola and Kravchenko, Dmitrij and Taha Hagar, Muhammad and Halfmann, Moritz C. and Jokkel, Zsófia and O’Doherty, Jim and Szilveszter, Bálint and Maurovich-Horvat, Pál and Spruill Suranyi, Pal and Varga-Szemes, Akos and Emrich, Tilman (2024) Coronary CT angiography-based FFR with ultrahigh-resolution photon-counting detector CT: Intra-individual comparison to energy-integrating detector CT. EUROPEAN JOURNAL OF RADIOLOGY, 181. p. 111797. ISSN 0720-048X

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Abstract

Purpose: To evaluate the feasibility of CT angiography-derived fractional flow reserve (CT-FFR) calculations on ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT series and to intra-individually compare the results with energy-integrating (EID)-CT measurements. Method: Prospective patients with calcified plaques detected on EID-CT between April 1st, 2023 and January 31st, 2024 were recruited for a UHR CCTA on PCD-CT within 30 days. PCD-CT was performed using the same or a lower CT dose index and an equivalent volume of contrast media. An on-site machine learning algorithm was used to obtain CT-FFR values on a per-vessel and per-patient basis. For all analyses, CT-FFR values ≤ 0.80 were deemed to be hemodynamically significant. Results: A total of 34 patients (age: 67.3 ± 6.6 years, 7 women [20.6 %]) were included. Excellent inter-scanner agreement was noted for CT-FFR values in the per-vessel (ICC: 0.93 [0.90–0.95]) and per-patient (ICC: 0.94 [0.88–0.97]) analysis. PCD-CT-derived CT-FFR values proved to be higher compared to EID-CT values on both vessel (0.58 ± 0.23 vs. 0.55 ± 0.23, p < 0.001) and patient levels (0.73 ± 0.23 vs. 0.70 ± 0.22, p < 0.001). Two patients (5.9 %) with hemodynamically significant lesions on EID-CT were reclassified as non-significant on PCDCT. All remaining participants were classified into the same category with both scanner systems. Conclusions: While UHR CT-FFR values demonstrate excellent agreement with EID-CT measurements, PCD-CT produces higher CT-FFR values that could contribute to a reclassification of hemodynamic significance.

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