Quantitative Assessment of Coronary Plaques by Coronary CT Angiography: High Inter-Reader and Intra-Reader Agreement is Achieved but Inter-Scanner Variability should not be Ignored
DOI:
https://doi.org/10.17140/HROJ-4-e007Keywords:
Coronary artery disease; Coronary CT angiography, Coronary plaque, Volume measurement, VariabilityAbstract
This editorial discusses a recent paper published in the December issue of Radiology 2016
on the quantitative assessment of coronary plaques by coronary computed tomography (CT)
angiography. Three main findings are discussed in the editorial: First, coronary CT angiography
is an accurate imaging modality for analysis of plaque volume as well as monitoring volume
change, with excellent inter- and intra-reader agreement with use of the state-of-the-art CT
scanners. Second, the reliability of coronary CT angiography is noticed for low scan variability
when plaque volume assessment is performed with the same vendor, but with high variability
of nearly 30% when assessment is conducted with different vendors at baseline and follow-up
scans. Finally, a large sample size is required to assess non-calcified plaques, in particular with
use of different vendors.
References
Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008; 52(21): 1724-1732. doi: 10.1016/j.jacc.2008.07.031
Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008; 359(22): 2324-2336. doi: 10.1056/NEJMoa0806576
Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: A prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008; 52(25): 2135-2144. doi: 10.1016/j.jacc.2008.08.058
Sun Z, Choo GH, Ng KH. Coronary CT angiography: Current status and continuing challenges. Br J Radiol. 2012; 85(1013): 495-510. doi: 10.1259/bjr/15296170
Xu L, Yang L, Fan Z, Yu W, Lv B, Zhang Z. Diagnostic performance of 320-detector CT coronary angiography in patients atrial fibrillation. Eur Radiol. 2011; 21(5): 936-943. doi: 10.1007/s00330-010-1987-0
Flohr TG, De Cecco CN, Schmidt B, Wang R, Schoepf UJ, Meinel FG. Computed tomographic assessment of coronary artery disease: state-of-the-art imaging techniques. Radiol Clin N Am. 2015; 53(2): 271-285. doi: 10.1016/j.rcl.2014.11.011
Saremi F, Achenbach S. Coronary plaque characterization using CT. AJR Am J Roentegenol. 2015; 204(3): W249-W260. doi: 10.2214/AJR.14.13760
Henzler T, Porubsky S, Kayed H, et al. Attenuation-based characterization of coronary atheroscleroticplaque: Comparison of dual source anddual energy CT with single-source CT and histopathology. Eur J Radiol. 2011; 80(1): 54-59. doi: 10.1016/j. ejrad.2010.07.024
Marwan M, Taher MA, El Meniawy K, et al. Invivo CT detection of lipid-rich coronary artery atherosclerotic plaques using quantitative histogram analysis: A head to head comparison with IVUS. Atherosclerosis. 2011; 215(1): 110-115. doi: 10.1016/j. atherosclerosis.2010.12.006
Pundziute G, Schuijf JD, Jukema JW, et al. Head-to-head comparison of coronary plaque evaluation between multislices computed tomography and intravascular ultrasound radiofrequency data analysis. JACC Cardiovasc Interv. 2008; 1(2): 176-182. doi: 10.1016/j.jcin.2008.01.007
Lin F, Shaw LJ, Berman DS, et al. Multidetector computed tomography coronary artery plaque predictors of stress-induced myocardial ischemia by SPECT. Atherosclerosis. 2008; 197(2): 700-709. doi: 10.1016/j.atherosclerosis.2007.07.002
Pundziute G, Schuijf JD, Jukema JW, et al. Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007; 49(1): 62-70. doi: 10.1016/j.jacc.2006.07.070
Van Werkhoven JM, Schuijf JD, Gaemperli O, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009; 53(7): 623-632. doi: 10.1016/j.jacc.2008.10.043
Sun Z, Al Moudi M, Cao Y. CT angiography in the diagnosis of cardiovascular disease: A transformation in cardiovascular CT practice. Quant Imaging Med Surg. 2014; 4(5): 376-396. doi: 10.3978/j.issn.2223-4292.2014.10.02
Jia H, Abtahian F, Aguirre AD, et al. In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol. 2013; 62(19): 1748-1758. doi: 10.1016/j. jacc.2013.05.071
Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. 2014; 11(7): 390-402. doi: 10.1038/nrcardio.2014.60
Nadjiri J, Hausleiter J, Jahnichen C, et al. Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow-up. J Cardiovasc Comput Tomogr. 2016; 10(2): 97-104. doi: 10.1016/j.jcct.2016.01.007
Sun Z, Xu L. Coronary CT angiography in the quantitative assessment of coronary plaques. Biomed Res Int. 2014; 2014: 346380. doi: 10.1155/2014/346380
Pflederer M, Marwan T, Schepis T, et al. Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography. Atherosclerosis. 2010; 211(2): 437-444. doi: 10.1016/j.atherosclerosis.2010.02.001
Nakazato R, Shalev A, Doh JH, et al. Quantification and characterisation of coronary artery plaque volume and adverse plaque features by coronary computed tomographic angiography: A direct comparison to intravascular ultrasound. Eur Radiol. 2013; 23(8): 2109-2117. doi: 10.1007/s00330-013-2822-1
Papadopoulou SL, Neefjes LA, Schaap M, et al. Detection and quantification of coronary atherosclerotic plaque by 64-slice multidetector CT: A systematic head-to-head comparison with intravascular ultrasound. Atherosclerosis. 2011; 219(1): 163-170. doi: 10.1016/j.atherosclerosis.2011.07.005
Voros S, Rinehart S, Qian Z, et al. Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: Results from theALTANTA(Assessment of Tissue Characteristics, Lesion Morphology, and Hemodynamics by Angiography with Fractional Flow Reserve, Intravascular Ultrasound and Virtual Histology, and Noninvasive Computed Tomography in Atherosclerotic Plaques) I Study. JACCC ardiovasc Imaging. 2011; 4(2): 198-205. doi: 10.1016/j.jcin.2010.10.008
Symons R, Morris JZ, Wu CO, et al. Coronary CT angiography: Variability of CT scanners and readers in measurement of plaque volume. Radiology. 2016; 281(3): 737-748. doi: 10.1148/radiol.2016161670
Gauss S, Achenbach S, Pflederer T, Schuhback A, Daniel WG, Marwan M. Assessment of coronary artery remodelling by dualsource CT: A head-to-head comparison with intravascular ultrasound. Heart. 2011; 97: 991-997. doi: 10.1136/hrt.2011.223024
Takaoka H, Ishibashi I, Uehara M, Rubin GD, Komuro I, Funabashi N. Comparison of image characteristics of plaques in culprit coronary arteries by 64 slice CT and intravascular ultrasound in acute coronary syndromes. Int J Cardiol. 2012; 160(2): 119-126. doi: 10.1016/j.ijcard.2011.04.014
Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol.2007; 50(4): 319-326.
Motoyama S, Sarai M, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009; 54(1): 49-57. doi: 10.1016/j.jacc.2009.02.068
Vazquez-Figueroa JG, Rinehart S, Qian Z, et al. Prospective validation that vulnerable plaque associated with major adverse outcomes have large plaque volume, less dense calcium, and more non-calcified plaque by quantitative, three-dimensional measurements using intravascular ultrasound with radiofrequency backscatter analysis. Results from the ATLANTA I Study. J Cardiovasc Trans Res. 2013; 6(5): 762-771. doi: 10.1007/s12265-013-9473-0
Meng L, Cui L, Cheng Y, et al. Effect of heart rate and coronary calcification on the diagnostic accuracy of the dual-source CT coronary angiography in patients with suspected coronary artery disease. Korean J Radiol. 2009; 10(4): 347-354. doi: 10.3348/ kjr.2009.10.4.347
Sun Z, Lin C. Diagnostic value of 320-slice coronary CT angiography in coronary artery disease: A systematic review and meta-analysis. Curr Med Imaging Rev. 2014; 10(4): 272-280. Web site. http://www.ingentaconnect.com/content/ben/ cmir/2014/00000010/00000004/art00008. Accessed January 20, 2017.
Pelliccia F, Pasceri V, Evangelista A, et al. Diagnostic accuracy of 320-row computed tomography as compared with invasive coronary angiography in unselected, consecutive patients with suspected coronary artery disease. Int J Cardiovasc Imaging. 2013; 29(2): 443-452. doi: 10.1007/s10554-012-0095-4
Tomizawa N, Maeda E, Akahane M, Torigoe R, Kiryu S, Ohtomo K. Coronary CT angiography using the second-generation 320-detector row CT: Assessment of image qualityand radiation dose in various heart rates compared with the first-generation scanner. Int J Cardiovasc Imaging. 2013; 29(7): 1613-1618. doi: 10.1007/s10554-013-0238-2
Wong DTL, Soh SY, Ko BS, et al. Superior CTcoronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: A comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther. 2014; 4(4): 299-306. doi: 10.3978/j.issn.2223-3652.2014.08.05
Ghekiere O, Nchimi A, Djekic J, et al. Coronary computed tomography angiography: patient-related factors determining image quality using a second-generation 320-slice CT scanner. Int J Cardiol. 2016; 221: 970-976. doi: 10.1016/j.ijcard.2016.07.141
Meinel FG, Canstein C, Schoepf UJ, et al. Imaging quality and radiation dose of low tube voltage 3rd-generation dual-source coronary CT angiography in obese patients: A phantom study. Eur Radiol. 2014; 24: 1643-1650. doi: 10.1007/s00330-014-3194-x
Mangold S, Wichmann JL, Schoepf UJ, et al. Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automatic tube voltage selection: Clinical application in a non-obese and obese patient population. Eur Radiol. 2016; 1-11. doi: 10.1007/s00330-016-4601-2
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