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Neuroimaging
Original research
Diagnostic accuracy of hemodynamic assessment of intracranial atherosclerotic stenosis from a single angiographic view: a validation study
  1. Jianping Xiang1,
  2. Lei Zhang2,
  3. Chenbin Rong1,
  4. Rong Zou1,
  5. Yumeng Hu1,
  6. Yongwei Zhang2,
  7. Ming Wang3,
  8. Jens Fiehler4,
  9. Adnan H Siddiqui5,
  10. Jun Wang6,
  11. Zhongrong Miao7,
  12. Pengfei Yang2,
  13. Shu Wan3,
  14. Jianmin Liu2
    1. 1ArteryFlow Technology Co Ltd, Hangzhou, China
    2. 2Neurovascular Center, Changhai Hospital, Naval Medical Uniervisty, Shanghai, China
    3. 3Brain Center, Zhejiang Hospital, Hangzhou, China
    4. 4Dept. of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
    5. 5Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
    6. 6Department of Neurology, Chinese PLA General Hospital, Beijing, China
    7. 7Interventional Neuroradiology Center, Beijing Tiantan Hospital, Beijing, China
    1. Correspondence to Dr. Jianmin Liu; chstroke{at}163.com; Dr. Shu Wan; wanshu{at}zju.edu.cn

    Abstract

    Background The aim of this study is to assess the feasibility of identifying the hemodynamic status of intracranial atherosclerotic stenosis (ICAS) using angio-based fractional flow (FF) calculated from a single angiographic view, with wire-based FF as the reference standard.

    Method The study retrospectively recruited 100 ICAS patients who underwent pressure wire measurement and digital subtraction angiography. The AccuICAD software was used to calculate angio-based FF, with the wire-measured value serving as the reference standard for evaluating the accuracy, consistency, and diagnostic performance of angio-based FF.

    Results The mean±SD value of wire-based FF was 0.77±0.18, while the mean value of angio-based FF was 0.77±0.19. A good correlation between angio-based FF and wire-based FF was evident (r=0.90, P<0.001), with good agreement (mean difference 0.00±0.08). The diagnostic accuracy of angio-based FF and percent diameter stenosis (DS%) were 93.23% versus 72.18%, 91.73% versus 72.93%, and 89.47% versus 78.95% for predicted wire-based FF thresholds of 0.70, 0.75, and 0.80, respectively. The area under the curve (AUC) values for angio-based FF and DS% were 0.975 versus 0.822, 0.970 versus 0.814, and 0.943 versus 0.826 at the respective thresholds, respectively.

    Conclusion The FF calculated from a single angiographic view can be considered an effective tool for functional assessment of cerebral arterial stenosis.

    • Angiography
    • Artery
    • Atherosclerosis
    • Blood Flow
    • Stenosis

    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request. Data includes anonymous patient baseline clinical and lesion characteristics, wire measurement results and AccuICAD analysis results. The request should be sent to Dr JX (jianping.xiang@arteryflow.com) from ArteryFlow Technology Co, Ltd. Reuse permission should be requested via email.

    https://doi.org/10.1136/jnis-2024-022114

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      Data availability statement

      Data are available upon reasonable request. Data are available upon reasonable request. Data includes anonymous patient baseline clinical and lesion characteristics, wire measurement results and AccuICAD analysis results. The request should be sent to Dr JX (jianping.xiang@arteryflow.com) from ArteryFlow Technology Co, Ltd. Reuse permission should be requested via email.

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      Footnotes

      • X @Fie0815

      • Contributors JX, SW, JF, AS, PY and JL contributed to the study conception and design. Material preparation and data collection were performed by LZ, YZ, MW, JW and ZM. Analysis was performed by CR. Software was performed by RZ and YH. The first draft of the manuscript was written by JX. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. JX is the guarantor.

      • Funding This study was funded by Zhejiang Provincial Key Research and Development Plan (No. 2024C03095), Hangzhou Leading Innovation and Entrepreneurship Team Project (No.TD2022007), Shuguang Project of Shanghai Educational Development Foundation (No. 22SG37), Key Research and Development Project of Zhejiang Provincial Department of Science and Technology (No. 2021C03105), Special Support Program for High Level Talents of Zhejiang Province (No. 2022R52038), Medical Health Science and Technology Project of Zhejiang Provincial Health Commision (No. WKJ-ZJ-2340), and Basic Public Welfare Project of the Natural Science Foundation of Zhejiang Province (No. LGF22H090017).

      • Competing interests JX, CR, RZ, and YH are employees of ArteryFlow Technology Co, Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest.

      • 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.