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- Title
Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound.
- Authors
Matsumoto, Hidenari; Watanabe, Satoshi; Kyo, Eisho; Tsuji, Takafumi; Ando, Yosuke; Otaki, Yuka; Cadet, Sebastien; Gransar, Heidi; Berman, Daniel S.; Slomka, Piotr; Tamarappoo, Balaji K.; Dey, Damini
- Abstract
<bold>Objectives: </bold>We sought to evaluate the accuracy of standardized total plaque volume (TPV) measurement and low-density non-calcified plaque (LDNCP) assessment from coronary CT angiography (CTA) in comparison with intravascular ultrasound (IVUS).<bold>Methods: </bold>We analyzed 118 plaques without extensive calcifications from 77 consecutive patients who underwent CTA prior to IVUS. CTA TPV was measured with semi-automated software comparing both scan-specific (automatically derived from scan) and fixed attenuation thresholds. From CTA, %LDNCP was calculated voxels below multiple LDNCP thresholds (30, 45, 60, 75, and 90 Hounsfield units [HU]) within the plaque. On IVUS, the lipid-rich component was identified by echo attenuation, and its size was measured using attenuation score (summed score ∕ analysis length) based on attenuation arc (1 = < 90°; 2 = 90-180°; 3 = 180-270°; 4 = 270-360°) every 1 mm.<bold>Results: </bold>TPV was highly correlated between CTA using scan-specific thresholds and IVUS (r = 0.943, p < 0.001), with no significant difference (2.6 mm3, p = 0.270). These relationships persisted for calcification patterns (maximal IVUS calcium arc of 0°, < 90°, or ≥ 90°). The fixed thresholds underestimated TPV (- 22.0 mm3, p < 0.001) and had an inferior correlation with IVUS (p < 0.001) compared with scan-specific thresholds. A 45-HU cutoff yielded the best diagnostic performance for identification of lipid-rich component, with an area under the curve of 0.878 vs. 0.840 for < 30 HU (p = 0.023), and corresponding %LDNCP resulted in the strongest correlation with the lipid-rich component size (r = 0.691, p < 0.001).<bold>Conclusions: </bold>Standardized noninvasive plaque quantification from CTA using scan-specific thresholds correlates highly with IVUS. Use of a < 45-HU threshold for LDNCP quantification improves lipid-rich plaque assessment from CTA.<bold>Key Points: </bold>• Standardized scan-specific threshold-based plaque quantification from coronary CT angiography provides an accurate total plaque volume measurement compared with intravascular ultrasound. • Attenuation histogram-based low-density non-calcified plaque quantification can improve lipid-rich plaque assessment from coronary CT angiography.
- Subjects
INTRAVASCULAR ultrasonography; CORONARY angiography; OPERATIVE ultrasonography; VOLUME measurements; CALCIFICATION; ALGORITHMS; ATHEROSCLEROSIS; COMPARATIVE studies; CORONARY arteries; CORONARY disease; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH evaluation; RESEARCH funding; ULTRASONIC imaging; EVALUATION research
- Publication
European Radiology, 2019, Vol 29, Issue 11, p6129
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-019-06219-3