Automatic coronary blood flow computation: validation in quantitative flow ratio from coronary angiography.
Automatic coronary blood flow computation: validation in quantitative flow ratio from coronary angiography.
复制标题
自动冠状动脉血流量计算：冠状动脉造影定量流量比的验证。
DOI：
10.1007/s10554-018-1506-y
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Shengxian Tu
中科院分区：
文献类型：
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作者：
Yimin Zhang;Su Zhang;Jelmer Westra;Daixin Ding;Qiuyang Zhao;Junqing Yang;Zhongwei Sun;Jiayue Huang;Jun Pu;Bo Xu;Shengxian Tu
评估一种自动计算冠状动脉造影定量血流比（QFR）的新方法。QFR是一种不使用压力导丝和诱导充血评估冠状动脉狭窄功能意义的新方法。患者特异性冠状动脉血流是通过帧计数方法半自动估计的，这在QFR分析的工作流程中是主观的且不方便。从冠状动脉造影图像中自动勾画出血管结构。随后，从每个图像帧上描绘的管腔中提取询问血管的中心线，并使用中心线长度的变化来计算流速，这为QFR（QFRauto）的计算提供了患者特异性流量。从中心线长度的增加中导出的参数用于自动量化造影剂流的稳定性。从用于三维血管造影重建的两个血管造影图像运行中，使用稳定性更好的一个来计算QFRauto。在FAVOR II中国研究入组的所有患者中评估QFR自动，并与基于帧数（QFR计数）的商业化QFR计算方法进行比较，使用基于压力导丝的血流储备分数（FFR）作为参考标准。在具有成对FFR数据的328条血管中，成功计算了325条（99%）血管的QFR自动，造影剂流填充的稳定性可接受。通过所提出的方法计算的流速与帧计数方法具有弱到中等的相关性（r = 0.37，p < 0.001），平均差异为-0.02 ± 0.07 m/s（p < 0.001）。QFR自身与QFR计数具有良好的相关性（r = 0.96，p < 0.001）和一致性（平均差异：-0.01 ± 0.04，p < 0.001）。QFR自动和FFR之间也观察到良好的相关性（r = 0.83，p < 0.001）和一致性（平均差：0.01 ± 0.06，p = 0.016）。使用FFR ≤ 0.80定义冠状动脉狭窄的功能意义，QFR自动的总体诊断准确率为93.2%（95% CI 90.5-96.0%）。受试者工作特征曲线下面积在QFR计数和QFR自动之间没有显著差异（差异：0.00; 95% CI-0.01至0.01; p = 0.529）。QFR自动检测的灵敏度、特异性、阳性似然比和阴性似然比分别为92.4%（95% CI 86.0-96.5%）、93.7%（95% CI 89.5-96.6%）、14.7（95% CI 8.7-25.0）和0.1（95% CI 0.0-0.2）。基于冠状动脉造影自动计算患者特定冠状动脉血流速度是可行的。基于这种新方法的QFR评估在确定冠状动脉狭窄的功能意义方面具有良好的诊断准确性。
To assess a novel approach for automatic flow velocity computation in deriving quantitative flow ratio (QFR) from coronary angiography. QFR is a novel approach for assessment of functional significance of coronary artery stenosis without using pressure wire and induced hyperemia. Patient-specific coronary flow is estimated semi-automatically by frame count method, which is subjective and inconvenient in the workflow of QFR analysis. The vascular structures were automatically delineated from coronary angiogram. Subsequently, the centerline of the interrogated vessel was extracted from the delineated lumen on each image frame and the change in the length of centerline was used to compute the flow velocity, which provided patient-specific flow for computation of QFR (QFRauto). A parameter derived from the increase in centerline length was used to automatically quantify the stability of contrast flow. From the two angiographic image runs used for three-dimensional angiographic reconstruction, the one with better stability was used to compute QFRauto. QFRautowas assessed in all patients enrolled in the FAVOR II China study, and compared with the commercialized QFR computational method based on frame count (QFRcount), using pressure wire-based fractional flow reserve (FFR) as the reference standard. Out of 328 vessels with paired FFR data, QFRautowas successfully computed on 325 (99%) vessels with acceptable stability in filling of contrast flow. The flow velocity computed by the proposed approach had a weak to moderate correlation with the frame count method (r = 0.37, p < 0.001), with mean differences of − 0.02 ± 0.07 m/s (p < 0.001). QFRautohad good correlation (r = 0.96, p < 0.001) and agreement (mean difference: − 0.01 ± 0.04, p < 0.001) with QFRcount. Good correlation (r = 0.83, p < 0.001) and agreement (mean difference: 0.01 ± 0.06, p = 0.016) were also observed between QFRautoand FFR. Using FFR ≤ 0.80 to define functional significance of coronary stenosis, the overall diagnostic accuracy for QFRautowas 93.2% (95% CI 90.5–96.0%). The area under the receiver-operating characteristic curve did not differ significantly between QFRcountand QFRauto(difference: 0.00; 95% CI − 0.01 to 0.01; p = 0.529). Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for QFRautowere 92.4% (95% CI 86.0–96.5%), 93.7% (95% CI 89.5–96.6%), 14.7 (95% CI 8.7–25.0), and 0.1 (95% CI 0.0–0.2), respectively. Automatic computation of patient-specific coronary flow velocity based on coronary angiography is feasible. Assessment of QFR based on this novel approach had good diagnostic accuracy in determining the functional significance of coronary stenosis.