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26.04.2019 | Cardiac

Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound

verfasst von: Hidenari Matsumoto, Satoshi Watanabe, Eisho Kyo, Takafumi Tsuji, Yosuke Ando, Yuka Otaki, Sebastien Cadet, Heidi Gransar, Daniel S. Berman, Piotr Slomka, Balaji K. Tamarappoo, Damini Dey

Erschienen in: European Radiology | Ausgabe 11/2019

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Abstract

Objectives

We sought to evaluate the accuracy of standardized total plaque volume (TPV) measurement and low-density non-calcified plaque (LDNCP) assessment from coronary CT angiography (CTA) in comparison with intravascular ultrasound (IVUS).

Methods

We analyzed 118 plaques without extensive calcifications from 77 consecutive patients who underwent CTA prior to IVUS. CTA TPV was measured with semi-automated software comparing both scan-specific (automatically derived from scan) and fixed attenuation thresholds. From CTA, %LDNCP was calculated voxels below multiple LDNCP thresholds (30, 45, 60, 75, and 90 Hounsfield units [HU]) within the plaque. On IVUS, the lipid-rich component was identified by echo attenuation, and its size was measured using attenuation score (summed score ∕ analysis length) based on attenuation arc (1 = < 90°; 2 = 90–180°; 3 = 180–270°; 4 = 270–360°) every 1 mm.

Results

TPV was highly correlated between CTA using scan-specific thresholds and IVUS (r = 0.943, p < 0.001), with no significant difference (2.6 mm³, p = 0.270). These relationships persisted for calcification patterns (maximal IVUS calcium arc of 0°, < 90°, or ≥ 90°). The fixed thresholds underestimated TPV (− 22.0 mm³, p < 0.001) and had an inferior correlation with IVUS (p < 0.001) compared with scan-specific thresholds. A 45-HU cutoff yielded the best diagnostic performance for identification of lipid-rich component, with an area under the curve of 0.878 vs. 0.840 for < 30 HU (p = 0.023), and corresponding %LDNCP resulted in the strongest correlation with the lipid-rich component size (r = 0.691, p < 0.001).

Conclusions

Standardized noninvasive plaque quantification from CTA using scan-specific thresholds correlates highly with IVUS. Use of a < 45-HU threshold for LDNCP quantification improves lipid-rich plaque assessment from CTA.

Key Points

• Standardized scan-specific threshold-based plaque quantification from coronary CT angiography provides an accurate total plaque volume measurement compared with intravascular ultrasound.

• Attenuation histogram-based low-density non-calcified plaque quantification can improve lipid-rich plaque assessment from coronary CT angiography.

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Titel: Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound
verfasst von: Hidenari Matsumoto
Satoshi Watanabe
Eisho Kyo
Takafumi Tsuji
Yosuke Ando
Yuka Otaki
Sebastien Cadet
Heidi Gransar
Daniel S. Berman
Piotr Slomka
Balaji K. Tamarappoo
Damini Dey
Publikationsdatum: 26.04.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 11/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06219-3

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Standardized volumetric plaque quantification and characterization from coronary CT angiography: a head-to-head comparison with invasive intravascular ultrasound