European Radiology

, Volume 25, Issue 10, pp 3073–3083 | Cite as

Clinical Feasibility of 3D Automated Coronary Atherosclerotic Plaque Quantification Algorithm on Coronary Computed Tomography Angiography: Comparison with Intravascular Ultrasound

  • Hyung-Bok Park
  • Byoung Kwon Lee
  • Sanghoon Shin
  • Ran Heo
  • Reza Arsanjani
  • Pieter H. Kitslaar
  • Alexander Broersen
  • Jouke Dijkstra
  • Sung Gyun Ahn
  • James K. Min
  • Hyuk-Jae Chang
  • Myeong-Ki Hong
  • Yangsoo Jang
  • Namsik Chung



To evaluate the diagnostic performance of automated coronary atherosclerotic plaque quantification (QCT) by different users (expert/non-expert/automatic).


One hundred fifty coronary artery segments from 142 patients who underwent coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS) were analyzed. Minimal lumen area (MLA), maximal lumen area stenosis percentage (%AS), mean plaque burden percentage (%PB), and plaque volume were measured semi-automatically by expert, non-expert, and fully automatic QCT analyses, and then compared to IVUS.


Between IVUS and expert QCT analysis, the correlation coefficients (r) for the MLA, %AS, %PB, and plaque volume were excellent: 0.89 (p < 0.001), 0.84 (p < 0.001), 0.91 (p < 0.001), and 0.94 (p < 0.001), respectively. There were no significant differences in the mean parameters (all p values >0.05) except %AS (p = 0.01). The automatic QCT analysis showed comparable performance to non-expert QCT analysis, showing correlation coefficients (r) of the MLA (0.80 vs. 0.82), %AS (0.82 vs. 0.80), %PB (0.84 vs. 0.73), and plaque volume (0.84 vs. 0.79) when they were compared to IVUS, respectively.


Fully automatic QCT analysis showed clinical utility compared with IVUS, as well as a compelling performance when compared with semiautomatic analyses.

Key Points

Coronary CTA enables the assessment of coronary atherosclerotic plaque.

High-risk plaque characteristics and overall plaque burden can predict future cardiac events.

Coronary atherosclerotic plaque quantification is currently unfeasible in practice.

Quantitative computed tomography coronary plaque analysis software (QCT) enables feasible plaque quantification.

Fully automatic QCT analysis shows excellent performance.


Coronary atherosclerotic plaque Coronary computed tomography angiography Automatic quantification Plaque volume Intravascular ultrasound 



Coronary computed tomography angiography


Quantitative computed tomography


Invasive coronary angiography


Intravascular ultrasound


Coronary artery disease


Confidence interval


Minimal lumen area


Minimal lumen diameter


Maximal lumen diameter stenosis percentage


Maximal lumen area stenosis percentage


Mean plaque burden percentage



The scientific guarantor of this publication is Hyuk-Jae Chang. 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 research was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP) (No. 2012027176). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, multicenter study.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Hyung-Bok Park
    • 1
    • 2
  • Byoung Kwon Lee
    • 3
  • Sanghoon Shin
    • 1
    • 4
  • Ran Heo
    • 1
    • 5
  • Reza Arsanjani
    • 6
  • Pieter H. Kitslaar
    • 7
    • 8
  • Alexander Broersen
    • 7
  • Jouke Dijkstra
    • 7
  • Sung Gyun Ahn
    • 9
  • James K. Min
    • 10
  • Hyuk-Jae Chang
    • 1
    • 5
  • Myeong-Ki Hong
    • 5
  • Yangsoo Jang
    • 5
  • Namsik Chung
    • 1
    • 5
  1. 1.Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research CenterYonsei University Health SystemSeoulSouth Korea
  2. 2.Division of Cardiology, Cardiovascular CenterMyongji HospitalGoyangSouth Korea
  3. 3.Division of Cardiology, Gangnam Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  4. 4.Division of CardiologyNational Health Insurance Corporation Ilsan HospitalGoyangSouth Korea
  5. 5.Division of Cardiology, Severance Cardiovascular HospitalYonsei University Health SystemSeoulSouth Korea
  6. 6.Departments of Imaging and Medicine, Cedars-Sinai Heart InstituteCedars-Sinai Medical CenterLos AngelesUSA
  7. 7.Department of Radiology, Division of Image ProcessingLeiden University Medical CenterLeidenThe Netherlands
  8. 8.Medis medical Imaging Systems B.V.LeidenThe Netherlands
  9. 9.Division of CardiologyYonsei University Wonju Severance Christian HospitalWonjuSouth Korea
  10. 10.Institute for Cardiovascular Imaging, Weill-Cornell Medical CollegeNew York-Presbyterian HospitalNew YorkUSA

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