¹⁵O-water PET-detected myocardial ischaemia and CT-derived FFR: Predicting the functional significance of anatomical stenosis.
4 affiliations
- 1Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland.
- 2Heart Center, Oulu University Hospital, Oulu, Finland.
- 3Institute of Medicine, University of Eastern Finland, Kuopio, Finland.
- 4Heart Center, Kuopio University Hospital, Kuopio, Finland.
Abstract
Aims
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. While coronary computed tomography angiography (CCTA) provides anatomical assessment of coronary stenoses, its ability to determine their functional significance is limited. Computed tomography-derived fractional flow reserve (CT-FFR) has emerged as a non-invasive method for lesion-specific ischaemia assessment. This study evaluated the diagnostic performance of CT-FFR using ¹⁵O-water positron emission tomography (PET) myocardial perfusion imaging as the reference standard.Methods and results
We retrospectively reviewed 193 patients who underwent hybrid CCTA and ¹⁵O-water PET at Kuopio University Hospital between 2017 and 2022. Patients with low-to-moderate pretest probability of CAD in whom CAD could not be ruled out by CCTA were eligible. After exclusions, 165 patients were included. CT-FFR values were calculated using a research prototype algorithm and compared with PET-derived perfusion abnormalities. In the overall cohort, CT-FFR showed moderate diagnostic performance, with area under the curve (AUC) values of 0.672-0.740. In a subgroup of 83 patients with high-quality CCTA and stenosis >50%, diagnostic performance improved substantially (AUC 0.836). Using a CT-FFR threshold of 0.80, sensitivity and specificity were 85% and 87%, respectively.Conclusion
In an unselected clinical population referred for PET perfusion imaging after CCTA, CT-FFR did not significantly improve diagnostic performance compared with CCTA alone. However, in patients with high-quality CCTA and obstructive coronary stenoses, CT-FFR demonstrated good accuracy for identifying functionally significant disease, supporting its role as a complementary non-invasive diagnostic tool.
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BibTeX
@article{vornanen2026¹⁵owater,
title = {{¹⁵O-water PET-detected myocardial ischaemia and CT-derived FFR: Predicting the functional significance of anatomical stenosis.}},
author = {Vornanen J and Okkonen M and Ronkainen A-P and Laitinen Tm and Laitinen Tp and Hedman M},
journal = {Clinical physiology and functional imaging},
year = {2026},
month = oct,
doi = {10.1111/cpf.70106},
url = {https://europepmc.org/article/MED/42960544},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - ¹⁵O-water PET-detected myocardial ischaemia and CT-derived FFR: Predicting the functional significance of anatomical stenosis.
AU - Vornanen J
AU - Okkonen M
AU - Ronkainen A-P
AU - Laitinen Tm
AU - Laitinen Tp
AU - Hedman M
PY - 2026
DA - 2026/10/30
JO - Clinical physiology and functional imaging
DO - 10.1111/cpf.70106
UR - https://europepmc.org/article/MED/42960544
AB - Aims Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. While coronary computed tomography angiography (CCTA) provides anatomical assessment of coronary stenoses, its ability to determine their functional significance is limited. Computed tomography-derived fractional flow reserve (CT-FFR) has emerged as a non-invasive method for lesion-specific ischaemia assessment. This study evaluated the diagnostic performance of CT-FFR using ¹⁵O-water positron emission tomography (PET) myocardial perfusion imaging as the reference standard.Methods and results We retrospectively reviewed 193 patients who underwent hybrid CCTA and ¹⁵O-water PET at Kuopio University Hospital between 2017 and 2022. Patients with low-to-moderate pretest probability of CAD in whom CAD could not be ruled out by CCTA were eligible. After exclusions, 165 patients were included. CT-FFR values were calculated using a research prototype algorithm and compared with PET-derived perfusion abnormalities. In the overall cohort, CT-FFR showed moderate diagnostic performance, with area under the curve (AUC) values of 0.672-0.740. In a subgroup of 83 patients with high-quality CCTA and stenosis >50%, diagnostic performance improved substantially (AUC 0.836). Using a CT-FFR threshold of 0.80, sensitivity and specificity were 85% and 87%, respectively.Conclusion In an unselected clinical population referred for PET perfusion imaging after CCTA, CT-FFR did not significantly improve diagnostic performance compared with CCTA alone. However, in patients with high-quality CCTA and obstructive coronary stenoses, CT-FFR demonstrated good accuracy for identifying functionally significant disease, supporting its role as a complementary non-invasive diagnostic tool.
SN - 1475-0961
SN - 1475-097X
ER -