Harmonizing multimodality imaging results using Bayesian analysis: the case of CT coronary angiography and CT-derived fractional flow reserve

The chest pain guidelines revisited: cherry picking from the frequentist tree

“…are still issues of what to do with discordant results 7 and it does appear longer lesion length and small vessel lumen decrease the accuracy 8 . Figure 3 shows two examples of discordant results with CCTA in patients who went on to subsequent invasive analysis.…”

“…The possibility of discordant results-a negative CCTA and a positive CTFFR or a positive CCTA and a negative CTFFR-occurs in up to 1/3 of cases. 7 Since neither test is perfect, it may be hard to reconcile the results. At this point, it is overly optimistic and misleading to promote CTFFR as a tool in patients with acute chest pain and it will impact the cost analysis for patients with stable chest pain.…”

The Application of Conditional Probability to Harmonize Nuclear Cardiology Test Results

“…An alternative approach is to maintain the clinical risk assessment formally and incorporate one of the tests into the pre-test probability with it when evaluating the second test, particularly when they are acquired in sequence ( Figure 1 ). In this manner, the post-test probability of the first test becomes the pre-test probability of the second test ( 11 ).…”

“…It uses the CRS combined with the exercise ECG post-test P. The CRS is still present, but it is now a function of the exercise ECG result. This approach has shown to improve the performance of computed tomography (CT) coronary angiography ( 11 ).…”

“…It is evident that the utilization of conditional probability (through Bayes' Theorem) allows the synthesis of multiple pieces of information, all of which are clinically relevant, into a single final probability for an individual patient. Using the example of coronary computed angiography and CT coronary flow reserve measures, this methodology was more accurate in identifying patients with significant CAD than either technique alone ( 11 ). This needs to be confirmed for PET using angiographic 3V/LMT disease as the end-point.…”