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Neuroimaging
Original research
Hemodynamic assessment for intracranial atherosclerosis from angiographic images: a clinical validation study
  1. Pengfei Yang1,
  2. Shu Wan2,
  3. Jun Wang3,
  4. Yumeng Hu4,
  5. Ning Ma5,
  6. Xiaohui Wang3,
  7. Yongwei Zhang1,
  8. Lei Zhang1,
  9. Xuan Zhu1,
  10. Fang Shen1,
  11. Qian Zheng1,
  12. Ming Wang2,
  13. Xiaochang Leng4,
  14. Jens Fiehler6,
  15. Adnan H Siddiqui7,
  16. Zhongrong Miao5,
  17. Jianping Xiang4,
  18. Jianmin Liu1
  1. 1 Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
  2. 2 Brain Center, Zhejiang Hospital, Hangzhou, China
  3. 3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
  4. 4 ArteryFlow Technology Co., Ltd, Hangzhou, China
  5. 5 Interventional Neuroradiology Center, Beijing Tiantan Hospital, Beijing, China
  6. 6 Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  7. 7 Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Jianmin Liu, Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China; chstroke{at}163.com; Dr Jianping Xiang, ArteryFlow Technology Co., Ltd., Hangzhou 310051, China; jianping.xiang{at}arteryflow.com; Dr Zhongrong Miao, Interventional Neuroradiology Center, Beijing Tiantan Hospital, Beijing 100070, China; zhongrongm{at}163.com

Abstract

Background Intracranial atherosclerotic stenosis (ICAS) is one of the leading causes of ischemic stroke. Conventional anatomical analysis by CT angiography, MRI, or digital subtraction angiography can provide valuable information on the anatomical changes of stenosis; however, they are not sufficient to accurately evaluate the hemodynamic severity of ICAS. The goal of this study was to assess the diagnostic performance of the pressure ratio across intracranial stenoses (termed as fractional flow (FF)) derived from cerebral angiography for the diagnosis of hemodynamically significant ICAS defined by pressure wire-derived FF.

Methods This retrospective study represents a feasible and reliable method for calculating the FF from cerebral angiography (AccuFFicas). Patients (n=121) who had undergone wire-based measurement of FF and cerebral angiography were recruited. The accuracy of the computed pressure ratio was evaluated using wire-based FF as the reference standard.

Results The mean value of wire-based FF was 0.78±0.19, while the computed AccuFFicas had an average value of 0.79±0.18. Good correlation (Pearson’s correlation coefficient r=0.92, P<0.001) between AccuFFicas and FF was observed. Bland–Altman analysis showed that the mean difference between AccuFFicas and FF was −0.01±0.07, indicating good agreement. The area under the curve (AUC) of AccuFFicas in predicting FF≤0.70, FF≤0.75, and FF≤0.80 was 0.984, 0.986, and 0.962, respectively.

Conclusion Angiography-based FF computed from cerebral angiographic images could be an effective computational tool for evaluating the hemodynamic significance of ICAS.

  • angiography
  • atherosclerosis
  • stenosis
  • stroke
  • technology

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/jnis-2023-020073

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • PY, SW, JW, YH and NM are joint first authors.

    • Twitter @Fie0815

    • Contributors Conception and design: JX, JL. Project administration: PY, SW, JW. Data acquisition: all authors. Data analysis and interpretation: YH, NM, XW, YZ, LZ. Drafting the manuscript: YH. Revising the manuscript critically for important intellectual content: PY, LZ, JX. Supervision: JL, JX, ZM. Guarantor: JL. Final approval of the manuscript: all authors.

    • Funding Hangzhou Leading Innovation and Entrepreneurship Team Project (No. TD2022007); Medical Health Science and Technology Project of Health Commission of Zhejiang Province (No. WKJ-ZJ-2014); Shuguang Project of Shanghai Educational Development Foundation (No. 22SG37); Key Research and Development Project of Zhejiang Provincial Department of Science and Technology (No. 2021C03105); Research Project of Bureau of Healthcare, National Health Commission of the PRC (No. 2022YB14).

    • Competing interests YH is an employee of ArteryFlow Technology Co., Ltd. XL is a co-founder of ArteryFlow Technology Co., Ltd. JX is the founder and CEO of ArteryFlow Technology Co., Ltd.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.