European Radiology

, Volume 28, Issue 4, pp 1356–1364 | Cite as

Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events

  • Junghoon Kim
  • Hyon Joo Kwag
  • Seung Min Yoo
  • Jin Young Yoo
  • In-Ho Chae
  • Dong-Ju Choi
  • Min-Jae Park
  • Mani Vembar
  • Eun Ju ChunEmail author



To evaluate the clinical significance of discrepant lesions between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) in a longitudinal study.


In 220 patients with suspected coronary artery disease (CAD) who underwent both 256-row CCTA and ICA, the obstructive CAD (≥ 50% stenosis) on CCTA was compared with that on ICA as the reference standard. We analysed the causes of the discrepancy between CCTA and ICA. During a 40-month follow-up period, major adverse cardiac events (MACE) were assessed.


Discordance between CCTA and ICA was observed in 121 of the 3166 coronary artery segments (3.8%). Common causes were calcification (45.9%) and positive remodelling (PR) (29.6%) in 83 false positive lesions, and noise (40.0%) and motion artefact (37.8%) in 38 false negative lesions. MACE occurred in seven lesions among the discrepant lesions; six among the 29 PR lesions (20.7%) and one among the 53 calcified lesions (1.9%). With respect to the prediction power of MACE in an intermediate stenosis, the CCTA-related value including PR was higher than the ICA-related value.


PR was a frequent cause of MACE among the false positive lesions on CCTA. Therefore, the presence of PR on CCTA may suggest clinical significance, although it can be missed by ICA.

Key Points

• Compared to ICA, PR in CCTA may be cause of false positive lesion.

• CCTA-related value including PR shows higher prediction power of MACE than ICA-related value.

• PR reflects atherosclerotic burden that can be related to cardiac events.

• PR in CCTA should be observed carefully, even if it is false positive.


Coronary artery disease Computed tomography angiography Atherosclerotic plaque Coronary stenosis Acute coronary syndrome 


Compliance with ethical standards


The scientific guarantor of this publication is Kyung Won Lee, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


This study has received funding from the Seoul National University Bundang Hospital (SNUBH) (research grant no. 02-2015-044) and by the National Research Foundation (NRF) grant funded by the Korea government (MEST) (NRF-2015R1D1A1A01059717).

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional review board approval was obtained.

Informed consent

Written informed consent was waived by the institutional review board.


• retrospective

• diagnostic or prognostic study

• performed at one institution


  1. 1.
    Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R et al (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428CrossRefPubMedGoogle Scholar
  2. 2.
    Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C (2007) 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J 28:3042–3050CrossRefPubMedGoogle Scholar
  3. 3.
    Chao SP, Law WY, Kuo CJ et al (2010) The diagnostic accuracy of 256-row computed tomographic angiography compared with invasive coronary angiography in patients with suspected coronary artery disease. Eur Heart J 31:1916–1923CrossRefPubMedGoogle Scholar
  4. 4.
    de Graaf FR, Schuijf JD, van Velzen JE et al (2010) Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur Heart J 31:1908–1915CrossRefPubMedGoogle Scholar
  5. 5.
    Dewey M, Zimmermann E, Deissenrieder F et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875CrossRefPubMedGoogle Scholar
  6. 6.
    West AM, Beller GA (2010) 256- and 320-row coronary CTA: is more better? Eur Heart J 31:1823–1825CrossRefPubMedGoogle Scholar
  7. 7.
    Arbab-Zadeh A, Hoe J (2011) Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography: methods, caveats, and implications. JACC Cardiovasc Imaging 4:191–202CrossRefPubMedGoogle Scholar
  8. 8.
    Napp AE, Haase R, Laule M et al (2017) Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial. Eur Radiol 27:2957–2968CrossRefPubMedGoogle Scholar
  9. 9.
    Alfonso F, Macaya C, Goicolea J et al (1994) Intravascular ultrasound imaging of angiographically normal coronary segments in patients with coronary artery disease. Am Heart J 127:536–544CrossRefPubMedGoogle Scholar
  10. 10.
    Mintz GS, Painter JA, Pichard AD et al (1995) Atherosclerosis in angiographically “normal” coronary artery reference segments: an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol 25:1479–1485CrossRefPubMedGoogle Scholar
  11. 11.
    Mann JM, Davies MJ (1996) Vulnerable plaque. Relation of characteristics to degree of stenosis in human coronary arteries. Circulation 94:928–931CrossRefPubMedGoogle Scholar
  12. 12.
    Achenbach S (2013) Coronary arteries: coronary atherosclerosis disease. In: Abbara S, Kalva SP (eds) Problem solving in cardiovascular imaging. Saunders, Philadelphia, pp 616–631Google Scholar
  13. 13.
    Chun EJ, Lee W, Choi YH et al (2008) Effects of nitroglycerin on the diagnostic accuracy of electrocardiogram-gated coronary computed tomography angiography. J Comput Assist Tomogr 32:86–92CrossRefPubMedGoogle Scholar
  14. 14.
    Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40CrossRefPubMedGoogle Scholar
  15. 15.
    Heo R, Park HB, Lee BK et al (2016) Optimal boundary detection method and window settings for coronary atherosclerotic plaque volume analysis in coronary computed tomography angiography: comparison with intravascular ultrasound. Eur Radiol 26:3190–3198CrossRefPubMedGoogle Scholar
  16. 16.
    Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316:1371–1375CrossRefPubMedGoogle Scholar
  17. 17.
    Hoffmann U, Moselewski F, Nieman K et al (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47:1655–1662CrossRefPubMedGoogle Scholar
  18. 18.
    Barrett JF, Keat N (2004) Artifacts in CT: recognition and avoidance. Radiographics 24:1679–1691CrossRefPubMedGoogle Scholar
  19. 19.
    Fleischmann D, Boas FE (2011) Computed tomography—old ideas and new technology. Eur Radiol 21:510–517CrossRefPubMedGoogle Scholar
  20. 20.
    Sarwar A, Rieber J, Mooyaart EA et al (2008) Calcified plaque: measurement of area at thin-section flat-panel CT and 64-section multidetector CT and comparison with histopathologic findings 1. Radiology 249:301–306CrossRefPubMedGoogle Scholar
  21. 21.
    Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD (2012) Third universal definition of myocardial infarction. Circulation 126:2020–2035CrossRefPubMedGoogle Scholar
  22. 22.
    Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW et al (2007) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 28:1598–1660CrossRefGoogle Scholar
  23. 23.
    Petcherski O, Gaspar T, Halon DA et al (2013) Diagnostic accuracy of 256-row computed tomographic angiography for detection of obstructive coronary artery disease using invasive quantitative coronary angiography as reference standard. Am J Cardiol 111:510–515CrossRefPubMedGoogle Scholar
  24. 24.
    Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336CrossRefPubMedGoogle Scholar
  25. 25.
    Poon M (2006) Technology insight: cardiac CT angiography. Nat Clin Pract Cardiovasc Med 3:265–275CrossRefPubMedGoogle Scholar
  26. 26.
    Li S, Ni Q, Wu H et al (2013) Diagnostic accuracy of 320-slice computed tomography angiography for detection of coronary artery stenosis: meta-analysis. Int J Cardiol 168:2699–2705CrossRefPubMedGoogle Scholar
  27. 27.
    Motoyama S, Sarai M, Harigaya H et al (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57CrossRefPubMedGoogle Scholar
  28. 28.
    Pflederer T, Marwan M, Schepis T et al (2010) Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography. Atherosclerosis 211:437–444CrossRefPubMedGoogle Scholar
  29. 29.
    Narula J, Strauss HW (2007) The popcorn plaques. Nat Med 13:532–534CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologySeoul National University Bundang HospitalSungnamKorea
  2. 2.Department of RadiologyKangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulKorea
  3. 3.Department of RadiologyCHA University Bundang Medical CenterSungnamKorea
  4. 4.Department of RadiologyChungbuk National University HospitalCheongjuKorea
  5. 5.Department of Internal MedicineSeoul National University Bundang HospitalSungnamKorea
  6. 6.Clinical Science, Philips HealthcareSeoulKorea
  7. 7.CT Clinical Science, Philips HealthcareClevelandUSA
  8. 8.Division of Radiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnam-siKorea

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