European journal of radiology · 2026
Diagnostic performance of Angio-Based fractional flow for hemodynamic assessment in intracranial Atherosclerosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Yongsheng, Zhang Fengyi, Shao Guiwen, Liu Yuxiang, Liu Yongjian, Ge Peng, Wang Feng
Аннотация
OBJECTIVES: To evaluate the diagnostic performance of Angio-based fractional flow (Angio-FF), a computational fluid dynamics technique, for identifying hemodynamically significant intracranial atherosclerotic stenosis (ICAS) compared with the degree of stenosis (DS).
MATERIALS AND METHODS: This retrospective study included 348 patients with unilateral ICAS. Angio-FF was calculated using AccuFFicas V1.0 software. Diagnostic accuracy, sensitivity, specificity, and area under the ROC curve (AUC) were compared between Angio-FF and DS, stratified by stenosis severity, vascular territory, and Angio-FF gray zone.
RESULTS: Symptomatic lesions exhibited lower Angio-FF (median 0.46 vs. 0.83,P < 0.001) and higher DS (69.5 % vs. 62.5 %,P < 0.001). Angio-FF showed superior AUC (0.884 vs. 0.664,P < 0.001) than DS. Angio-FF, using a cutoff value of 0.69, demonstrated significantly higher sensitivity (81.4 % vs. 50.0 %), specificity (88.9 % vs. 68.9 %), accuracy (83.3 % vs. 54.9 %), positive predictive value (PPV) (95.5 % vs. 82.2 %), and negative predictive value (NPV) (62.5 % vs. 32.5 %) compared to DS (≥ 70 % stenosis) for identifying culprit lesions (P < 0.001). Diagnostic performance was significantly better in anterior circulation lesions than in posterior ones, with higher sensitivity (91.8 % vs. 60.9 %), accuracy (89.5 % vs. 73.1 %), and NPV (73.1 % vs. 55.3 %) (all P < 0.05), while specificity and PPV remained high in both regions. Within the Angio-FF gray zone (0.64-0.74), diagnostic performance was lower than outside the zone, with reduced sensitivity (67.4 % vs. 84.4 %), accuracy (72.4 % vs. 85.5 %), and NPV (42.3 % vs. 67.6 %) (all P < 0.05), yet it still outperformed DS, with a higher AUC (0.795 vs. 0.524, P = 0.003).
CONCLUSIONS: Angio-FF outperformed conventional DS assessment in identifying hemodynamically significant ICAS, with particularly high accuracy in lesions with < 70 % stenosis. Despite reduced performance within the gray zone, it remained more reliable than DS.
ABBREVIATIONS: ICAS, intracranial atherosclerotic stenosis; TIA, transient ischemic attack; DS, degree of stenosis; FF, fractional flow; Angio-FF, Angio-based fractional flow; CFD, computational fluid dynamics; DSA, digital subtraction angiography; AUC, area under the curve; ROC, receiver operating characteristic; PPV, positive predictive value; NPV, negative predictive value; DCA, decision curve analysis; MCA, middle cerebral artery; BA, basilar artery; VA, vertebral artery; IQR, interquartile range; MRA, magnetic resonance angiography; Pa, proximal arterial pressure; Pd, distal arterial pressure; TIMI, Thrombolysis In Myocardial Infarction.
MATERIALS AND METHODS: This retrospective study included 348 patients with unilateral ICAS. Angio-FF was calculated using AccuFFicas V1.0 software. Diagnostic accuracy, sensitivity, specificity, and area under the ROC curve (AUC) were compared between Angio-FF and DS, stratified by stenosis severity, vascular territory, and Angio-FF gray zone.
RESULTS: Symptomatic lesions exhibited lower Angio-FF (median 0.46 vs. 0.83,P < 0.001) and higher DS (69.5 % vs. 62.5 %,P < 0.001). Angio-FF showed superior AUC (0.884 vs. 0.664,P < 0.001) than DS. Angio-FF, using a cutoff value of 0.69, demonstrated significantly higher sensitivity (81.4 % vs. 50.0 %), specificity (88.9 % vs. 68.9 %), accuracy (83.3 % vs. 54.9 %), positive predictive value (PPV) (95.5 % vs. 82.2 %), and negative predictive value (NPV) (62.5 % vs. 32.5 %) compared to DS (≥ 70 % stenosis) for identifying culprit lesions (P < 0.001). Diagnostic performance was significantly better in anterior circulation lesions than in posterior ones, with higher sensitivity (91.8 % vs. 60.9 %), accuracy (89.5 % vs. 73.1 %), and NPV (73.1 % vs. 55.3 %) (all P < 0.05), while specificity and PPV remained high in both regions. Within the Angio-FF gray zone (0.64-0.74), diagnostic performance was lower than outside the zone, with reduced sensitivity (67.4 % vs. 84.4 %), accuracy (72.4 % vs. 85.5 %), and NPV (42.3 % vs. 67.6 %) (all P < 0.05), yet it still outperformed DS, with a higher AUC (0.795 vs. 0.524, P = 0.003).
CONCLUSIONS: Angio-FF outperformed conventional DS assessment in identifying hemodynamically significant ICAS, with particularly high accuracy in lesions with < 70 % stenosis. Despite reduced performance within the gray zone, it remained more reliable than DS.
ABBREVIATIONS: ICAS, intracranial atherosclerotic stenosis; TIA, transient ischemic attack; DS, degree of stenosis; FF, fractional flow; Angio-FF, Angio-based fractional flow; CFD, computational fluid dynamics; DSA, digital subtraction angiography; AUC, area under the curve; ROC, receiver operating characteristic; PPV, positive predictive value; NPV, negative predictive value; DCA, decision curve analysis; MCA, middle cerebral artery; BA, basilar artery; VA, vertebral artery; IQR, interquartile range; MRA, magnetic resonance angiography; Pa, proximal arterial pressure; Pd, distal arterial pressure; TIMI, Thrombolysis In Myocardial Infarction.