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Reproducibility of artificial intelligence–enabled plaque measurements between systolic and diastolic phases from coronary computed tomography angiography

  • Cardiac
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Abstract

Objectives

Current coronary CT angiography (CTA) guidelines suggest both end-systolic and mid-diastolic phases of the cardiac cycle can be used for CTA image acquisition. However, whether differences in the phase of the cardiac cycle influence coronary plaque measurements is not known. We aim to explore the potential impact of cardiac phases on quantitative plaque assessment.

Methods

We enrolled 39 consecutive patients (23 male, age 66.2 ± 11.5 years) who underwent CTA with dual-source CT with visually evident coronary atherosclerosis and with good image quality. End-systolic and mid- to late-diastolic phase images were reconstructed from the same CTA scan. Quantitative plaque and stenosis were analyzed in both systolic and diastolic images using artificial intelligence (AI)–enabled plaque analysis software (Autoplaque).

Results

Overall, 186 lesions from 39 patients were analyzed. There were excellent agreement and correlation between systolic and diastolic images for all plaque volume measurements (Lin’s concordance coefficient ranging from 0.97 to 0.99; R ranging from 0.96 to 0.98). There were no substantial intrascan differences per patient between systolic and diastolic phases (p > 0.05 for all) for total (1017.1 ± 712.9 mm3 vs. 1014.7 ± 696.2 mm3), non-calcified (861.5 ± 553.7 mm3 vs. 856.5 ± 528.7 mm3), calcified (155.7 ± 229.3 mm3 vs. 158.2 ± 232.4 mm3), and low-density non-calcified plaque volume (151.4 ± 106.1 mm3 vs. 151.5 ± 101.5 mm3) and diameter stenosis (42.5 ± 18.4% vs 41.3 ± 15.1%).

Conclusion

Excellent agreement and no substantial differences were observed in AI-enabled quantitative plaque measurements on CTA in systolic and diastolic images. Following further validation, standardized plaque measurements can be performed from CTA in systolic or diastolic cardiac phase.

Clinical relevance statement

Quantitative plaque assessment using artificial intelligence–enabled plaque analysis software can provide standardized plaque quantification, regardless of cardiac phase.

Key Points

• The impact of different cardiac phases on coronary plaque measurements is unknown.

• Plaque analysis using artificial intelligence–enabled software on systolic and diastolic CT angiography images shows excellent agreement.

• Quantitative coronary artery plaque assessment can be performed regardless of cardiac phase.

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Abbreviations

AI:

Artificial intelligence

BMI:

Body mass index

CAD:

Coronary artery disease

CAD-RADS:

Coronary artery disease-reporting and data system

CP:

Calcified plaque

CT:

Computed tomography

CTA:

Computed tomography angiography

DL:

Deep learning

ECG:

Electrocardiogram

HU:

Hounsfield units

LD-NCP:

Low-density non-calcified plaque

NCP:

Non-calcified plaque

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Funding

This work was supported by NIH grants 1R01HL148787-01A1 and 1R01HL151266, and diversity supplement 3R01HL148787-03S1, and in part by the Dr Miriam and Sheldon G. Adelson Medical Research Foundation.

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Author notes

  1. Guadalupe Flores Tomasino and Donghee Han contributed equally.

Authors and Affiliations

  1. Departments of Imaging and Medicine, and the, Cedars-Sinai Medical Center , Smidt Heart Institute, Los Angeles, CA, USA

    Guadalupe Flores Tomasino, Donghee Han, Raymond Pimentel, William Paz, Juni Liang & Daniel S. Berman

  2. Minneapolis Heart Institute, Minneapolis, MN, USA

    Victor Y Cheng

  3. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Piotr Slomka

  4. Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, 116 N Robertson Blvd, Los Angeles, CA, 90048, USA

    Damini Dey

Authors
  1. Guadalupe Flores Tomasino
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  2. Donghee Han
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  3. Raymond Pimentel
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  4. William Paz
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  5. Juni Liang
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  6. Victor Y Cheng
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Corresponding author

Correspondence to Damini Dey.

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Guarantor

The scientific guarantor of this publication is Dr Damini Dey.

Conflict of interest

Piotr Slomka, Daniel Berman, and Damini Dey: Outside this study, these authors received software royalties from Cedars-Sinai Medical Center and have a patent. The remaining co-authors have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

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

Ethical approval

The study was approved by Cedars-Sinai Medical Center Institutional Review Board.

Study subjects or cohorts overlap

No overlap.

Methodology

• retrospective

• observational

• performed at one institution

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Flores Tomasino, G., Han, D., Pimentel, R. et al. Reproducibility of artificial intelligence–enabled plaque measurements between systolic and diastolic phases from coronary computed tomography angiography. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10688-6

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  • DOI: https://doi.org/10.1007/s00330-024-10688-6

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