Quantitative coronary plaque analysis predicts high-risk plaque morphology on coronary computed tomography angiography: results from the ROMICAT II trial

  • Ting Liu
  • Pál Maurovich-Horvat
  • Thomas Mayrhofer
  • Stefan B. Puchner
  • Michael T. Lu
  • Khristine Ghemigian
  • Pieter H. Kitslaar
  • Alexander Broersen
  • Amit Pursnani
  • Udo Hoffmann
  • Maros Ferencik
Original Paper


Semi-automated software can provide quantitative assessment of atherosclerotic plaques on coronary CT angiography (CTA). The relationship between established qualitative high-risk plaque features and quantitative plaque measurements has not been studied. We analyzed the association between quantitative plaque measurements and qualitative high-risk plaque features on coronary CTA. We included 260 patients with plaque who underwent coronary CTA in the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) II trial. Quantitative plaque assessment and qualitative plaque characterization were performed on a per coronary segment basis. Quantitative coronary plaque measurements included plaque volume, plaque burden, remodeling index, and diameter stenosis. In qualitative analysis, high-risk plaque was present if positive remodeling, low CT attenuation plaque, napkin-ring sign or spotty calcium were detected. Univariable and multivariable logistic regression analyses were performed to assess the association between quantitative and qualitative high-risk plaque assessment. Among 888 segments with coronary plaque, high-risk plaque was present in 391 (44.0%) segments by qualitative analysis. In quantitative analysis, segments with high-risk plaque had higher total plaque volume, low CT attenuation plaque volume, plaque burden and remodeling index. Quantitatively assessed low CT attenuation plaque volume (odds ratio 1.12 per 1 mm3, 95% CI 1.04–1.21), positive remodeling (odds ratio 1.25 per 0.1, 95% CI 1.10–1.41) and plaque burden (odds ratio 1.53 per 0.1, 95% CI 1.08–2.16) were associated with high-risk plaque. Quantitative coronary plaque characteristics (low CT attenuation plaque volume, positive remodeling and plaque burden) measured by semi-automated software correlated with qualitative assessment of high-risk plaque features.


Coronary CT angiography High-risk coronary plaque Coronary atherosclerosis Quantitative assessment 



This work was supported by Grants from the National Heart, Lung, and Blood Institute (U01HL092040 and U01HL092022). Dr. Ferencik received support from the American Heart Association (13FTF16450001). Dr. Hoffmann received research Grant support from NIH (U01HL092040, U01HL092022), Siemens Medical Solutions and Heart Flow Inc. and consultant/advisory board support from Heart Flow Inc. Pieter Kitslaar is an employee of Medis medical imaging systems B.V.

Compliance with ethical standards

Conflict of interest

Dr. Hoffman receives grant support from Siemens Medical Solutions and Heart Flow Inc. and consultant/advisory board support from Heart Flow Inc. Pieter Kitslaar is an employee of Medis medical imaging systems B.V. Other authors declares that he/she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Ting Liu
    • 1
    • 2
  • Pál Maurovich-Horvat
    • 2
    • 3
  • Thomas Mayrhofer
    • 2
    • 4
  • Stefan B. Puchner
    • 2
    • 5
  • Michael T. Lu
    • 2
  • Khristine Ghemigian
    • 2
  • Pieter H. Kitslaar
    • 6
    • 7
  • Alexander Broersen
    • 6
  • Amit Pursnani
    • 2
  • Udo Hoffmann
    • 2
  • Maros Ferencik
    • 2
    • 8
  1. 1.Department of RadiologyFirst Affiliated Hospital of China Medical UniversityShenyangChina
  2. 2.Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  3. 3.MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
  4. 4.School of Business StudiesStralsund University of Applied SciencesStralsundGermany
  5. 5.Department of Biomedical Imaging and Image-Guided TherapyMedical University ViennaViennaAustria
  6. 6.Department of Radiology, Division of Image ProcessingLeiden University Medical CenterLeidenThe Netherlands
  7. 7.Medis Medical Imaging Systems B.VLeidenThe Netherlands
  8. 8.Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandUSA

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