Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study

TY - JOUR

T1 - Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study

AU - Ostovaneh, Mohammad R

AU - Vavere, Andrea L

AU - Mehra, Vishal C

AU - Kofoed, Klaus F.

AU - Matheson, Matthew B

AU - Arbab-Zadeh, Armin

AU - Fujisawa, Yasuko

AU - Schuijf, Joanne D

AU - Rochitte, Carlos E

AU - Scholte, Arthur J

AU - Kitagawa, Kakuya

AU - Dewey, Marc

AU - Cox, Christopher

AU - DiCarli, Marcelo F

AU - George, Richard T

AU - Lima, Joao A C

PY - 2018/5/1

Y1 - 2018/5/1

N2 - AIMS: To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging.METHODS: The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC).RESULTS: Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all).CONCLUSION: Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD.

AB - AIMS: To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging.METHODS: The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC).RESULTS: Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all).CONCLUSION: Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD.

KW - Aged

KW - Aged, 80 and over

KW - Area Under Curve

KW - Asia

KW - Automation

KW - Computed Tomography Angiography/methods

KW - Coronary Angiography/methods

KW - Coronary Artery Disease/diagnostic imaging

KW - Coronary Circulation

KW - Coronary Vessels/diagnostic imaging

KW - Europe

KW - Female

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multidetector Computed Tomography/methods

KW - Myocardial Perfusion Imaging/methods

KW - North America

KW - Observer Variation

KW - Predictive Value of Tests

KW - Prospective Studies

KW - ROC Curve

KW - Radiographic Image Interpretation, Computer-Assisted/methods

KW - Reference Standards

KW - Reproducibility of Results

KW - Severity of Illness Index

KW - South America

KW - Tomography, Emission-Computed, Single-Photon

U2 - 10.1016/j.jcct.2018.03.010

DO - 10.1016/j.jcct.2018.03.010

M3 - Journal article

C2 - 29730016

SN - 1934-5925

VL - 12

SP - 212

EP - 219

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

IS - 3

ER -