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Subtraction improves the accuracy of coronary CT angiography for detecting obstructive disease in severely calcified segments

  • Cardiac
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A Correction to this article was published on 16 September 2021

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Abstract

Objective

To investigate the accuracy, diagnostic confidence, and interobserver agreement of subtraction coronary CT angiography (CCTA) versus invasive coronary angiography on 320-row CT in coronary segments with severe or non-severe calcification.

Materials/methods

Sixty-four patients (33 men, 66.6 ± 8.2 years) with suspected coronary artery disease (CAD) were prospectively enrolled from October 2019 to June 2020. The cross-sectional circumferential extent of calcification was used to classify calcified segments as non-severely ( < 180°) or severely calcified ( ≥ 180°). Three independent, blinded radiologists evaluated the severity of coronary stenosis. Interobserver agreement was evaluated using Fleiss’ kappa (κ). A multiple-reader multiple-case receiver operating characteristic (ROC) method was conducted, and diagnostic accuracy was measured using the mean areas under the ROC curves (AUCs), with ≥ 50% stenosis as a cut-off. Diagnostic confidence, diagnostic accuracy, and interobserver agreement were compared between CCTA with or without subtraction information in severely and non-severely calcified segments.

Results

In cases with severe calcification (51 patients, 146 segments), CCTA with subtraction information achieved better diagnostic accuracy (per-patient AUC: 0.73 vs 0.57, p = 0.03; per-segment AUC: 0.85 vs 0.62, p = 0.01), diagnostic confidence (3.7 vs 2.6, p < 0.001), and interobserver agreement (κ: 0.59 vs 0.30). Diagnostic accuracy (per-patient AUC: 0.81 vs 0.93, p = 0.30; per-patient AUC: 0.79 vs 0.82, p = 0.54) was not increased in cases with non-severe calcification (13 patients, 190 segments).

Conclusions

CCTA with subtraction information achieved better diagnostic accuracy in cases of severe calcification (circumferential extent ≥ 180°). However, for non-severe calcification (circumferential extent < 180°), the effect of calcium subtraction was unclear, as it did not improve diagnostic accuracy.

Key Points

• Subtraction coronary CT angiography achieves better diagnostic accuracy, higher diagnostic confidence, and increased interobserver agreement for severe calcification (circumferential extent ≥ 180°).

• Calcium subtraction does not improve the diagnostic accuracy of coronary CT angiography for calcification with a circumferential extent of < 180°.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

BMI:

Body mass index

CAD:

Coronary artery disease

CCTA:

Coronary computed tomographic angiography

FP:

False positive

HR:

Heart rate

ICA:

Invasive coronary angiography

MRMC:

Multiple-reader multiple-case

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Funding

This study has received funding from National Key Research and Development Program of China (grant 2019YFE0107800), National Natural Science Foundation of China (grants 81671650, 81971569) and Beijing Municipal Science and technology commission (grant Z201100005620009).

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Author notes

  1. Lixue Xu and Fang Li contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People’s Republic of China

    Lixue Xu, Fang Li, Kewei Wu, Zhaohui Zhong, Zhenchang Wang, Zhenghan Yang & Yi He

  2. Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95 YongAn Road, Beijing, 100050, People’s Republic of China

    Rongchong Huang

  3. Canon Medical Systems (China) CO., LTD., Building 205, Yard NO. A10, JiuXianQiao North Road, Beijing, 100015, People’s Republic of China

    Yinghao Xu

Authors
  1. Lixue Xu
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  3. Kewei Wu
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  9. Yi He
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Corresponding authors

Correspondence to Zhenghan Yang or Yi He.

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Guarantor

The scientific guarantor of this publication is Yi He.

Conflict of interest

One of the authors of this manuscript (Yinghao Xu) is an employee of Canon Medical Systems. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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The original online version of this article was revised: The funding information and the conflict of interest were incorrect.

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Xu, L., Li, F., Wu, K. et al. Subtraction improves the accuracy of coronary CT angiography for detecting obstructive disease in severely calcified segments. Eur Radiol 31, 6211–6219 (2021). https://doi.org/10.1007/s00330-021-08092-5

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  • DOI: https://doi.org/10.1007/s00330-021-08092-5

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