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A novel method for non-invasive plaque morphology analysis by coronary computed tomography angiography

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Abstract

Coronary computed tomography angiography (CCTA) plaque morphology based on conventional Hounsfield units relies on absolute CT numbers is influenced by imaging and anatomical variables. The project describes and tests a novel alternative method, termed the “labeling method”, which uses relative CT numbers and 3-dimensional plaque structure. Using virtual histology intravascular ultrasound (VH-IVUS) as the reference standard, this study compares the labeling method to a conventional CT-number based method to determine coronary plaque morphology. Thirty-seven high-risk, non-calcified atherosclerotic coronary lesions were prospectively evaluated in 33 consecutive patients who underwent CCTA followed by VH-IVUS (mean interval 8.6 ± 13.3 days). CCTA-derived vessel and minimum lumen areas were compared to VH-IVUS measures. Fibrotic and necrotic core areas were calculated by both the labeling method to the CT-number based method; both were tested for agreement with reference standard VH-IVUS. Inter- and intra-observer correlations were assessed. CCTA significantly underestimated minimum lumen area when compared to VH-IVUS (mean difference −1.4 ± 0.9 mm2, p < 0.0001). Necrotic core and fibrous areas quantified using the labeling method demonstrated superior correlation with VH-IVUS compared to those quantified using the CT-number based method, Pearson’s r = 0.75 versus 0.42 and r = 0.80 and 0.59, respectively. Compared to VH-IVUS, limits of agreement for the labeling method-derived necrotic core (−2.0 to 2.5 mm2) and fibrous areas (0.6–8.0 mm2) were more narrow than those determined using the CT-number based method (−3.7 to 7.3 and −4.0 to 8.9 mm2, respectively). Inter- and intraobserver correlations were excellent for all CCTA derived measures (r = 0.85–0.98). A novel CCTA-based labeling method offers an alternative to conventional CT-number based analyses for plaque morphology. The labeling method demonstrates superior correlation to VH-IVUS for measures of fibrotic and necrotic core areas within non-calcified coronary atherosclerotic plaques.

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Conflict of interest

Dr. Rybicki has a research agreement with Toshiba Medical Systems Corporation that is unrelated to this project. Ms. Fujisawa is an employee of Toshiba Medical Systems Corporation. All data was entirely under the control of the corresponding author. The role of Ms. Fujisawa included the phantom study and technical support for the CT data analyses. No other relationship with industry exists.

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Authors and Affiliations

  1. Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan

    Shinichiro Fujimoto, Eriko Matsunaga, Katsumi Miyauchi & Hiroyuki Daida

  2. Department of Cardiology, Takase Clinic, Takasaki, Japan

    Shinichiro Fujimoto, Takeshi Kondo & Kazuhisa Takamura

  3. Cardiovascular Center, Toranomon Hospital, Tokyo, Japan

    Takahide Kodama

  4. Application Research Group, Clinical Application Research Development Center, Toshiba Medical Systems Corporation, Otawara, Japan

    Yasuko Fujisawa

  5. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    John Groarke, Kanako K. Kumamaru & Frank J. Rybicki

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  1. Shinichiro Fujimoto
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  2. Takeshi Kondo
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  3. Takahide Kodama
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  4. Yasuko Fujisawa
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  7. Kazuhisa Takamura
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  8. Eriko Matsunaga
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  9. Katsumi Miyauchi
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  10. Hiroyuki Daida
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  11. Frank J. Rybicki
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Correspondence to Shinichiro Fujimoto.

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Fujimoto, S., Kondo, T., Kodama, T. et al. A novel method for non-invasive plaque morphology analysis by coronary computed tomography angiography. Int J Cardiovasc Imaging 30, 1373–1382 (2014). https://doi.org/10.1007/s10554-014-0461-5

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