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01.01.2015 | Breast

Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

verfasst von: Stefan B. Puchner, Maros Ferencik, Pal Maurovich-Horvat, Masataka Nakano, Fumiyuki Otsuka, Hans-Ulrich Kauczor, Renu Virmani, Udo Hoffmann, Christopher L. Schlett

Erschienen in: European Radiology | Ausgabe 1/2015

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Abstract

Objectives

To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.

Methods and materials

CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.

Results

Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm²: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.

Conclusion

Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

Key Points

• A low attenuation plaque area is associated with the presence of lipid-core plaque

• MBIR leads to higher diagnostic accuracy for detecting lipid-core plaque

• The benefit of MBIR is mainly due to increased sensitivity at high specificities

• Semiautomated CCTA assessment can detect vulnerable plaques non-invasively

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Titel: Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology
verfasst von: Stefan B. Puchner
Maros Ferencik
Pal Maurovich-Horvat
Masataka Nakano
Fumiyuki Otsuka
Hans-Ulrich Kauczor
Renu Virmani
Udo Hoffmann
Christopher L. Schlett
Publikationsdatum: 01.01.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 1/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3404-6

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Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology