On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice.

PURPOSE: Technical feasibility of CT-based calculation of fractional flow reserve (cFFR) using a 128-row computed tomography scanner in an everyday routine setting. Post-processing and everyday practicability should be analyzed on the scanner on-site in connection with clinical parameters. MATERIALS AND METHODS: This single-center retrospective analysis included 230 patients (74 female; mean age 63.8 years) with CCTA within 21 months between 01/2018 and 09/2019 without non-pathological examinations. cFFR values were obtained using a deep learning-based non-commercial research prototype (cFFR Version3.5.0; Siemens Healthineers GmbH, Erlangen). cFFR values were evaluated at two points: at the maximum point of the stenosis and 1.0 cm distal to the stenosis. Comparison with invasive coronary angiography in 57/230 patients (24.7 %) was performed. CT parameters and quality were evaluated. Further subgroup classification concerning criteria of technical postprocessing was performed: no changes necessary, minor corrections necessary, major corrections necessary, and no evaluation was possible. The required time from starting the software to the final result was evaluated. RESULTS: A total of 116/448 (25.9 %) mild, 223/448 (49.8 %) moderate, and 109/448 (24.3 %) obstructive stenoses was found. The mean cFFR at the maximum point of the stenosis was 0.92 ±â€Š0.09 and significantly higher than the cFRR value of 0.89 ±â€Š0.13 distal to the stenosis (p < 0.001*). The mean degree of stenosis was 44.02 ±â€Š26.99 % (range: 1-99 %) with an area of 5.39 ±â€Š3.30 mm2. In a total of 45 patients (19.1 %), a relevant reduction in cFFR below 0.80 was determined. Overall, in 57/230 patients (24.8 %), catheter angiography was performed. No significant difference in the degree of maximal stenosis (CAD-RADS 0-2/3/4) was detected between the classification of CCTA and ICA (p = 0.171). The mean post-processing time varied significantly with 8.34 ±â€Š4.66 min. in single-vessel CAD vs. 12.91 ±â€Š3.92 min. in two-vessel CAD vs. 21.80 ± 5.94 min. in three-vessel CAD (each p < 0.001). CONCLUSION: Noninvasive onsite quantification of cFFR is feasible with minimal observer interaction in a routine real-world setting on a 128-row scanner. Deep learning-based algorithms allow a robust and semi-automatic on-site determination of cFFR based on data from standard CT scanners. KEY POINTS: · Non-invasive on-site quantification of cFFR is feasible with minimal observer interaction.. · Deep-learning based algorithms allow robust and semi-automatic on-site determination of cFFR.. · The mean follow-up time varied significantly with the extent of vascular CAD..

Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. / Strukturierte Befundung in der Schnittbilddiagnostik des Herzens: Befundvorlagen für die Herz-MRT bezüglich Ischämie- und Vitalitätsdiagnostik sowie für die Herz-CT bezüglich Koronardiagnostik und Planung vor TAVI.

BACKGROUND: Structured reporting allows a high grade of standardization and thus a safe and unequivocal report communication. In the past years, the radiological societies have started several initiatives to base radiological reports on structured reporting rather than free text reporting. METHODS: Upon invitation of the working group for Cardiovascular Imaging of the German Society of Radiology, in 2018 an interdisciplinary group of Radiologists, Cardiologists, Pediatric Cardiologists and Cardiothoracic surgeons -all experts on the field of cardiovascular MR and CT imaging- met for interdisciplinary consensus meetings at the University Hospital Cologne. The aim of these meetings was to develop and consent templates for structured reporting in cardiac MR and CT of various cardiovascular diseases. RESULTS: Two templates for structured reporting of CMR in ischemia imaging and vitality imaging and two templates for structured reporting of CT imaging for planning Transcatheter Aortic Valve Implantation (TAVI; pre-TAVI-CT) and coronary CT were discussed, consented and transferred to a HTML 5/IHR MRRT compatible format. The templates were made available for free use on the website www.befundung.drg.de. CONCLUSION: This paper suggests consented templates in German language for the structured reporting of cross-sectional CMR imaging of ischemia and vitality as well as reporting of CT imaging pre-TAVI and coronary CT. The implementation of these templates is aimed at providing a constant level of high reporting quality and increasing the efficiency of report generation as well as a clinically based communication of imaging results. KEY POINTS: · Structured reporting offers a constant level of high reporting quality and increases the efficiency of report generation as well as a clinically based communication of imaging results.. · For the first time templates in German language for the structured reporting of CMR imaging of ischemia and vitality and CT imaging pre-TAVI and coronary CT are reported.. · These templates will be made available on the website www.befundung.drg.de and can be commented via strukturierte-befundung@drg.de.. ZITIERWEISE: · Soschynski M, Bunck AC, Beer M et al. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. Fortschr Röntgenstr 2023; 195: 293 - 296.