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Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound

  • Cardiac
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Abstract

Objectives

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).

Methods

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.

Results

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).

Conclusions

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.

Key Points

• 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.

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Abbreviations

CTA:

Coronary CT angiography

HU:

Hounsfield units

IQR:

Interquartile range

IVUS:

Intravascular ultrasound

LDNCP:

Low-density non-calcified plaque

TPV:

Total plaque volume

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Funding

This work was funded by National Institute of Health/National Heart, Lung, and Blood Institute grant 1R01HL133616 (to Dr. Dey), and partially by a grant from the Miriam and Sheldon G. Adelson Medical Research Foundation.

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Author notes

  1. Hidenari Matsumoto and Satoshi Watanabe contributed equally to this work.

Authors and Affiliations

  1. Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA

    Hidenari Matsumoto, Yuka Otaki, Sebastien Cadet, Heidi Gransar, Daniel S. Berman, Piotr Slomka & Balaji K. Tamarappoo

  2. Department of Cardiology, Kusatsu Heart Center, Kusatsu, Shiga, Japan

    Satoshi Watanabe, Eisho Kyo, Takafumi Tsuji & Yosuke Ando

  3. The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Balaji K. Tamarappoo

  4. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Damini Dey

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  1. Hidenari Matsumoto
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Correspondence to Hidenari Matsumoto.

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Guarantor

The scientific guarantor of this publication is Damini Dey, PhD.

Conflict of interest

Damini Dey, Sebastien Cadet, Piotr J Slomka, and Daniel S Berman received software royalties from Cedars-Sinai Medical Center; Damini Dey, Piotr J Slomka, and Daniel S Berman have a patent.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• retrospective

• diagnostic study

• performed at one institution

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Matsumoto, H., Watanabe, S., Kyo, E. et al. Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound. Eur Radiol 29, 6129–6139 (2019). https://doi.org/10.1007/s00330-019-06219-3

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