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Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

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Abstract

Objectives

To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.

Methods and materials

CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.

Results

Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm2: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.

Conclusion

Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

Key Points

• A low attenuation plaque area is associated with the presence of lipid-core plaque

• MBIR leads to higher diagnostic accuracy for detecting lipid-core plaque

• The benefit of MBIR is mainly due to increased sensitivity at high specificities

• Semiautomated CCTA assessment can detect vulnerable plaques non-invasively

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Abbreviations

ASIR:

adaptive statistical iterative reconstruction

CCTA:

coronary computed tomographic angiography

FBP:

filtered back projection reconstruction

MBIR:

model-based iterative reconstruction

LCP:

lipid-core plaque

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Acknowledgements

The scientific guarantor of this publication is Prof. Dr. Udo Hoffmann, Division Head of Cardiac and Vascular Imaging, Massachusetts General Hospital/Harvard Medical School, Boston, MA. The authors of this manuscript declare relationships with the following companies: This work was supported by an unrestricted grant from GE Healthcare, Milwaukee WI. The authors had access to pre-commercial image reconstruction algorithms as developed by GE Healthcare. Commercially available software for the (semi-)automated plaque assessment was provided free of charge by Vital Images, Minnetonka, MN. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported as part of the MGH Multi-Modality Coronary Plaque Imaging Database [Maurovich-Horvat P, Schlett CL, Alkadhi H, et al. Differentiation of early from advanced coronary atherosclerotic lesions: systematic comparison of CT, intravascular US, and optical frequency domain imaging with histopathologic examination in ex vivo human hearts. Radiology. 2012 Nov;265(2):393-401]. Methodology: prospective, experimental (ex vivo), performed at one institution.

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Authors and Affiliations

  1. Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Stefan B. Puchner, Maros Ferencik, Pal Maurovich-Horvat, Udo Hoffmann & Christopher L. Schlett

  2. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria

    Stefan B. Puchner

  3. Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Maros Ferencik

  4. MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary

    Pal Maurovich-Horvat

  5. CV Path Institute Inc., Gaithersburg, MD, USA

    Masataka Nakano, Fumiyuki Otsuka & Renu Virmani

  6. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany

    Hans-Ulrich Kauczor & Christopher L. Schlett

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  1. Stefan B. Puchner
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Correspondence to Christopher L. Schlett.

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Puchner, S.B., Ferencik, M., Maurovich-Horvat, P. et al. Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology. Eur Radiol 25, 15–23 (2015). https://doi.org/10.1007/s00330-014-3404-6

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