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Herten VRLM, Hampe N, Takx RAP, Franssen KJ, Wang Y, Sucha D, Henriques JP, Leiner T, Planken RN, Isgum I. Automatic Coronary Artery Plaque Quantification and CAD-RADS Prediction Using Mesh Priors. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1272-1283. [PMID: 37862273 DOI: 10.1109/tmi.2023.3326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Coronary artery disease (CAD) remains the leading cause of death worldwide. Patients with suspected CAD undergo coronary CT angiography (CCTA) to evaluate the risk of cardiovascular events and determine the treatment. Clinical analysis of coronary arteries in CCTA comprises the identification of atherosclerotic plaque, as well as the grading of any coronary artery stenosis typically obtained through the CAD-Reporting and Data System (CAD-RADS). This requires analysis of the coronary lumen and plaque. While voxel-wise segmentation is a commonly used approach in various segmentation tasks, it does not guarantee topologically plausible shapes. To address this, in this work, we propose to directly infer surface meshes for coronary artery lumen and plaque based on a centerline prior and use it in the downstream task of CAD-RADS scoring. The method is developed and evaluated using a total of 2407 CCTA scans. Our method achieved lesion-wise volume intraclass correlation coefficients of 0.98, 0.79, and 0.85 for calcified, non-calcified, and total plaque volume respectively. Patient-level CAD-RADS categorization was evaluated on a representative hold-out test set of 300 scans, for which the achieved linearly weighted kappa ( κ ) was 0.75. CAD-RADS categorization on the set of 658 scans from another hospital and scanner led to a κ of 0.71. The results demonstrate that direct inference of coronary artery meshes for lumen and plaque is feasible, and allows for the automated prediction of routinely performed CAD-RADS categorization.
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Weichsel L, Giesen A, André F, Renker M, Baumann S, Breitbart P, Beer M, Maurovitch-Horvat P, Szilveszter B, Vattay B, Buss SJ, Marwan M, Giannopoulos AA, Kelle S, Frey N, Korosoglou G. Comparison of Two Contemporary Quantitative Atherosclerotic Plaque Assessment Tools for Coronary Computed Tomography Angiography: Single-Center Analysis and Multi-Center Patient Cohort Validation. Diagnostics (Basel) 2024; 14:154. [PMID: 38248031 PMCID: PMC10814854 DOI: 10.3390/diagnostics14020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) provides non-invasive quantitative assessments of plaque burden and composition. The quantitative assessment of plaque components requires the use of analysis software that provides reproducible semi-automated plaque detection and analysis. However, commercially available plaque analysis software can vary widely in the degree of automation, resulting in differences in terms of reproducibility and time spent. AIM To compare the reproducibility and time spent of two CCTA analysis software tools using different algorithms for the quantitative assessment of coronary plaque volumes and composition in two independent patient cohorts. METHODS The study population included 100 patients from two different cohorts: 50 patients from a single-center (Siemens Healthineers, SOMATOM Force (DSCT)) and another 50 patients from a multi-center study (5 different > 64 slice CT scanner types). Quantitative measurements of total calcified and non-calcified plaque volume of the right coronary artery (RCA), left anterior descending (LAD), and left circumflex coronary artery (LCX) were performed on a total of 300 coronaries by two independent readers, using two different CCTA analysis software tools (Tool #1: Siemens Healthineers, syngo.via Frontier CT Coronary Plaque Analysis and Tool #2: Siemens Healthineers, successor CT Coronary Plaque Analysis prototype). In addition, the total time spent for the analysis was recorded with both programs. RESULTS The patients in cohorts 1 and 2 were 62.8 ± 10.2 and 70.9 ± 11.7 years old, respectively, 10 (20.0%) and 35 (70.0%) were female and 34 (68.0%) and 20 (40.0%), respectively, had hyperlipidemia. In Cohort #1, the inter- and intra-observer variabilities for the assessment of plaque volumes per patient for Tool #1 versus Tool #2 were 22.8%, 22.0%, and 26.0% versus 2.3%, 3.9%, and 2.5% and 19.7%, 21.4%, and 22.1% versus 0.2%, 0.1%, and 0.3%, respectively, for total, noncalcified, and calcified lesions (p < 0.001 for all between Tools #1 and 2 both for inter- and intra-observer). The inter- and intra-observer variabilities using Tool #2 remained low at 2.9%, 2.7%, and 3.0% and 3.8%, 3.7%, and 4.0%, respectively, for total, non-calcified, and calcified lesions in Cohort #2. For each dataset, the median processing time was higher for Tool #1 versus Tool #2 (459.5 s IQR = 348.0-627.0 versus 208.5 s; IQR = 198.0-216.0) (p < 0.001). CONCLUSION The plaque analysis Tool #2 (CT-guided PCI) encompassing a higher degree of automated support required less manual editing, was more time-efficient, and showed a higher intra- and inter-observer reproducibility for the quantitative assessment of plaque volumes both in a representative single-center and in a multi-center validation cohort.
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Affiliation(s)
- Loris Weichsel
- GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, 69469 Weinheim, Germany; (L.W.); (A.G.)
- Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany
| | - Alexander Giesen
- GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, 69469 Weinheim, Germany; (L.W.); (A.G.)
- Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, 69120 Heidelberg, Germany; (F.A.); (N.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Matthias Renker
- Department of Cardiology, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany;
- DZHK (German Centre for Cardiovascular Research), Partner Site Rhein Main, 61231 Bad Nauheim, Germany
| | - Stefan Baumann
- Department of Cardiology, District Hospital Bergstraße, 64646 Heppenheim, Germany;
- First Department of Medicine-Cardiology, University Medical Center Mannheim, 68167 Mannheim, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79189 Bad Krozingen, Germany;
| | - Meinrad Beer
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany;
| | - Pal Maurovitch-Horvat
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.M.-H.); (B.S.); (B.V.)
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.M.-H.); (B.S.); (B.V.)
| | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.M.-H.); (B.S.); (B.V.)
| | | | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany;
| | - Andreas A. Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Sebastian Kelle
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charité-University Medicine Berlin, 10117 Berlin, Germany;
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, 69120 Heidelberg, Germany; (F.A.); (N.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Grigorios Korosoglou
- GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, 69469 Weinheim, Germany; (L.W.); (A.G.)
- Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany
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Quantitative plaque assessment by coronary computed tomography angiography: An up-to-date review. IMAGING 2021. [DOI: 10.1556/1647.2021.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Coronary computed tomography angiography has an emerging role in the diagnostic workup of coronary artery disease. Due to its high sensitivity and negative predictive value, coronary computed tomography angiography can rule out obstructive coronary artery diseases and substitute invasive coronary angiography in many cases. In addition, coronary computed tomography angiography provides a unique information beyond stenosis grading as it can visualize atherosclerosis and quantify its extent. Qualitative and quantitative plaque assessment provides an incremental value in the prediction of future major adverse cardiac events. Moreover, determining adverse plaque features has a potential to identify advanced atherosclerosis and patients at increased risk of acute coronary syndrome. Nevertheless, challenges may emerge with the process of quantifying coronary plaques due to limited reproducibility, lack of automated, standardized and validated techniques. Therefore, reliable quantified data are scarce due to the various computed tomography scanners and software platforms and investigations with small sample sizes. Radiomics and machine learning-based image processing methods are relatively new in the field of cardiovascular plaque imaging. These techniques hold the promise to improve diagnostic performance, reproducibility and prognostic value of computed tomography based plaque assessment.
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Yang J, Dou G, Tesche C, De Cecco CN, Jacobs BE, Schoepf UJ, Chen Y. Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients. BMC Cardiovasc Disord 2019; 19:39. [PMID: 30744612 PMCID: PMC6371483 DOI: 10.1186/s12872-019-1016-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 02/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The heterogeneity of risk in patients with diabetes mellitus (DM) is acknowledged in new guidelines promulgating different treatment recommendations for diabetics at low cardiac risk. We performed a retrospective longitudinal follow-up study to evaluate coronary plaque progression and its impact on cardiac events in asymptomatic diabetic patients. METHODS Data of 197 asymptomatic patients (63.1 ± 17 years, 60% males) with DM and suspected coronary artery disease (CAD) who underwent clinically indicated dual-source cardiac computed tomography (CT) were retrospectively analyzed. Patients with DM received standard of care treatment. Patients were classified into two groups based on CT coronary artery calcium scores (CACS): A, CACS> 10; B, CACS≤10. Progression of coronary plaque burden in both groups was evaluated and compared by baseline and follow-up coronary CT angiography (CCTA) using semi-automated plaque analysis and quantification software. Follow-up data were retrospectively gathered from medical records and endpoints of cardiac events were recorded via prospective phone-calls. The impacts of plaque composition and progression on cardiac events were specifically assessed. RESULTS Patients with CACS> 10 showed an increase in dense coronary calcium volume, while patients with CACS≤10 had a more pronounced increase in the volume of low-attenuation "lipid-rich" plaque components between CCTA acquisitions. The composite endpoint occurred in 20 patients (10.2%) after a median follow-up period of 41.8 months. Furthermore, at follow-up CCTA, the presence of CACS> 10 (adjusted odds ratio, 0.701; 95% CI, 0.612-0.836), increase of dense calcium volume (OR, 0.860 95% CI, 0.771-0.960), and lipid volume (OR, 1.013; 95% CI, 1.007-1.020) were all independent predictors of cardiac events. CONCLUSION Asymptomatic patients with DM experienced plaque progression as well as progression to "overt or silent CAD". The relative increase in plaque volume was associated with subsequent cardiac events, and the coronary calcification seemed to be inversely related to the outcome in asymptomatic diabetic patients.
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Affiliation(s)
- Junjie Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China.,Master Program of Medical Science and Clinical Investigation, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Guanhua Dou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Department of Cardiology and Intensive Care Medicine, Heart Center Munich- Bogenhausen, Munich, Germany
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Jacobs
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China.
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de Knegt MC, Haugen M, Linde JJ, Kühl JT, Nordestgaard BG, Køber LV, Hove JD, Kofoed KF. Reproducibility of quantitative coronary computed tomography angiography in asymptomatic individuals and patients with acute chest pain. PLoS One 2018; 13:e0207980. [PMID: 30550593 PMCID: PMC6294364 DOI: 10.1371/journal.pone.0207980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/11/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose Quantitative computed tomography (QCT) provides important prognostic information of coronary atherosclerosis. We investigated intraobserver and interobserver QCT reproducibility in asymptomatic individuals, patients with acute chest pain without acute coronary syndrome (ACS), and patients with acute chest pain and ACS. Methods Fifty patients from each cohort, scanned between 01/02/2010-14/11/2013 and matched according to age and gender, were retrospectively assessed for inclusion. Patients with no coronary artery disease, previous coronary artery bypass graft surgery, and poor image quality were excluded. Coronary atherosclerosis was measured semi-automatically by 2 readers. Reproducibility of minimal lumen area (MLA), minimal lumen diameter (MLD), area stenosis, diameter stenosis, vessel remodeling, plaque eccentricity, plaque burden, and plaque volumes was assessed using concordance correlation coefficient (CCC), Bland-Altman, coefficient of variation, and Cohen’s kappa. Results A total of 84 patients (63 matched) were included. Intraobserver and interobserver reproducibility estimates were acceptable for MLA (CCC = 0.94 and CCC = 0.91, respectively), MLD (CCC = 0.92 and CCC = 0.86, respectively), plaque burden (CCC = 0.86 and CCC = 0.80, respectively), and plaque volume (CCC = 0.97 and CCC = 0.95, respectively). QCT detected area and diameter stenosis ≥50%, positive remodeling, and eccentric plaque with moderate-good intraobserver and interobserver reproducibility (kappa: 0.64–0.66, 0.69–0.76, 0.46–0.48, and 0.41–0.62, respectively). Reproducibility of plaque composition decreased with decreasing plaque density (intraobserver and interobserver CCC for dense calcium (>0.99; 0.98), fibrotic (0.96; 0.93), fibro-fatty (0.95; 0.91), and necrotic core tissue (0.89; 0.84). Reproducibility generally decreased with worsening clinical risk profile. Conclusions Semi-automated QCT of coronary plaque morphology is reproducible, albeit with some decline in reproducibility with worsening patient risk profile.
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Affiliation(s)
- Martina C. de Knegt
- Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Morten Haugen
- Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J. Linde
- Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars V. Køber
- Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens D. Hove
- Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F. Kofoed
- Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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You S, Sun JS, Park SY, Baek Y, Kang DK. Relationship between indexed epicardial fat volume and coronary plaque volume assessed by cardiac multidetector CT. Medicine (Baltimore) 2016; 95:e4164. [PMID: 27399137 PMCID: PMC5058866 DOI: 10.1097/md.0000000000004164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We explored whether baseline indexed epicardial fat volume (EFVi) and serial changes in EFVi were associated with increase in coronary plaque volume as assessed by multidetector computed tomography.We retrospectively reviewed 87 patients with coronary artery plaque, identified during either baseline or follow-up cardiac computed tomography (CT) examinations. Each plaque volume was measured in volumetric units using a semiautomatic software tool. EFVi was quantified by calculating the total volume of epicardial tissue of CT density -190 to -30 HU, indexed to the body surface area. Clinical cardiovascular risk factors were extracted by medical record review at the time of the cardiac CT examinations. The relationship between EFVi and coronary plaque volume was explored by regression analysis.Although the EFVi did not change significantly from baseline to the time of the follow-up CT (65.7 ± 21.8 vs 66.0 ± 21.8 cm/m, P = 0.620), the plaque volumes were increased significantly on the follow-up CT scans. The annual change in EFVi was not accompanied by a parallel change in coronary plaque volume (P = 0.096-0.500). On univariate analysis, smoking, hypercholesterolemia, 10-year coronary heart disease risk, obesity, and baseline EFVi predicted rapid increases in lipid-rich and fibrous plaque volumes. On multivariate analysis, baseline EFVi (odds ratio = 1.029, P = 0.016) was an independent predictor of a rapid increase in lipid-rich plaque volume.EFVi was shown to be an independent predictor of a rapid increase in lipid-rich plaque volume. However, changes in EFVi were not associated with parallel changes in coronary plaque volume.
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Affiliation(s)
| | | | | | | | - Doo Kyoung Kang
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
- Correspondence: Doo Kyoung Kang, Department of Radiology, Ajou University School of Medicine, San 5, Woncheon-dong, Yongtong-gu, Suwon, 442-749, South Korea (e-mail: )
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Li D, Budoff MJ. Genetics paired with CT angiography in the setting of atherosclerosis. Clin Imaging 2016; 40:917-25. [PMID: 27183141 DOI: 10.1016/j.clinimag.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 03/14/2016] [Accepted: 04/21/2016] [Indexed: 12/31/2022]
Abstract
Coronary artery disease (CAD) continues to be the leading cause of morbidity and mortality globally. Although the etiological mechanisms for CAD have not been fully elucidated, however, most would agree that atherosclerotic plaques progressively narrow the coronary arteries are the earliest manifestations and the principal cause of CAD. The emergence of revolutionary imaging technologies such as cardiac CT angiography, noninvasive computed fractional flow reserve and intravascular ultrasound provided the possibility of detecting and monitoring phenotypes associated with subclinical atherosclerosis. Meanwhile, with the widespread use of high-throughput genotyping pipeline such as next-generation sequencing, combined with big data-driven solutions in bioinformatics, translating the emerging genetic technologies into clinical practice and, therefore, provide valuable insight into the CAD study. In this review, we briefly describe the latest noninvasive cardiac imaging techniques for atherosclerosis-related phenotypes' detection, mainly focusing on the coronary artery calcification, plaque burden and stenosis. Furthermore, we highlight the state-of-the-art genotyping techniques and its application in the field of CAD translational study. Finally, we discuss the clinical relevance of genetics paired with noninvasive imaging in the setting of coronary artery atherosclerosis.
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Affiliation(s)
- Dong Li
- Los Angeles Biomedical Research Institute.
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Celeng C, Takx RAP, Ferencik M, Maurovich-Horvat P. Non-invasive and invasive imaging of vulnerable coronary plaque. Trends Cardiovasc Med 2016; 26:538-47. [PMID: 27079893 DOI: 10.1016/j.tcm.2016.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/28/2016] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
Vulnerable plaque is characterized by a large necrotic core and an overlying thin fibrous cap. Non-invasive imaging modalities such as computed tomography angiography (CTA) and magnetic resonance imaging (MRI) allow for the assessment of morphological plaque characteristics, while positron emission tomography (PET) enables the detection of metabolic activity within the atherosclerotic lesions. Invasive imaging modalities such as intravascular ultrasound (IVUS), optical-coherence tomography (OCT), and intravascular MRI (IV-MRI) display plaques at a high spatial resolution. Near-infrared spectroscopy (NIRS) allows for the detection of chemical components of atherosclerotic plaques. In this review, we describe state-of-the-art non-invasive and invasive imaging modalities and stress the combination of their advantages to identify vulnerable plaque features.
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Affiliation(s)
- Csilla Celeng
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Richard A P Takx
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol 2014; 11:390-402. [PMID: 24755916 DOI: 10.1038/nrcardio.2014.60] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Most acute coronary syndromes are caused by sudden luminal thrombosis due to atherosclerotic plaque rupture or erosion. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary heart disease. Coronary lesions prone to rupture have a distinct morphology compared with stable plaques, and provide a unique opportunity for noninvasive imaging to identify vulnerable plaques before they lead to clinical events. The submillimeter spatial resolution and excellent image quality of modern computed tomography (CT) scanners allow coronary atherosclerotic lesions to be detected, characterized, and quantified. Large plaque volume, low CT attenuation, napkin-ring sign, positive remodelling, and spotty calcification are all associated with a high risk of acute cardiovascular events in patients. Computation fluid dynamics allow the calculation of lesion-specific endothelial shear stress and fractional flow reserve, which add functional information to plaque assessment using CT. The combination of morphologic and functional characteristics of coronary plaques might enable noninvasive detection of vulnerable plaques in the future.
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Affiliation(s)
- Pál Maurovich-Horvat
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary
| | - Maros Ferencik
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA
| | - Szilard Voros
- Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794 USA
| | - Béla Merkely
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA
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Accuracy of coronary computed tomography angiography vs intravascular ultrasound for evaluation of vessel area. J Cardiovasc Comput Tomogr 2014; 8:141-8. [DOI: 10.1016/j.jcct.2013.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/12/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
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Reproducibility of noncalcified coronary artery plaque burden quantification from coronary CT angiography across different image analysis platforms. AJR Am J Roentgenol 2014; 202:W43-9. [PMID: 24370164 DOI: 10.2214/ajr.13.11225] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the reproducibility of noncalcified coronary artery plaque burden quantification from coronary CT angiography (CTA) across different commercial analysis platforms. MATERIALS AND METHODS For this study, 47 patients (36 men, 11 women; mean age ± SD, 62 ± 13 years) with noncalcified plaques on coronary CTA were included. Automated quantification of noncalcified coronary artery plaque volume was performed on identical datasets using three commercially available image analysis software platforms (software platforms 1-3). Identical tissue attenuation ranges between 0 and 50 HU for low-attenuation plaques and 50-130 HU for medium-attenuation plaques were consistently applied. Log volume data were compared with the Pearson correlation coefficient and Bland-Altman analysis. RESULTS Differences in plaque volume measurements on intraplatform repeat measurements were statistically insignificant (p = 0.923). At the low-attenuation threshold, software platform 3 had significantly higher log volumes (p < 0.001) than both software platforms 1 and 2 and software platform 1 had significantly higher log volumes than software platform 2 (p < 0.001). The results at the medium-attenuation level were identical except that the log volumes for software platforms 1 and 2 were not significantly different (p > 0.05) in the left anterior descending artery and left circumflex artery. The Pearson correlation coefficient was found to be 0.677 (p < 0.001; 95% CI, 0.608-0.735) between software platforms 1 and 2, 0.672 (p < 0.001; 95% CI, 0.603-0.732) between software platforms 1 and 3, and 0.550 (p < 0.001; 95% CI, 0.463-0.627) between software platforms 2 and 3. CONCLUSION Currently available noncalcified plaque quantification software provides good intraplatform reproducibility but poor interplatform reproducibility. Serial or comparative assessments require evaluation using the same software. Industry standards should be developed to enable reproducible assessments across manufacturers.
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The effect of iterative image reconstruction algorithms on the feasibility of automated plaque assessment in coronary CT angiography. Int J Cardiovasc Imaging 2013; 29:1879-88. [DOI: 10.1007/s10554-013-0281-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/21/2013] [Indexed: 01/31/2023]
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Quantitative analysis of coronary plaque composition by dual-source CT in patients with acute non-ST-elevation myocardial infarction compared to patients with stable coronary artery disease correlated with virtual histology intravascular ultrasound. Acad Radiol 2013; 20:995-1003. [PMID: 23830605 DOI: 10.1016/j.acra.2013.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES To quantitatively assess coronary atherosclerotic plaque composition in patients with acute non-ST elevation myocardial infarction (NSTEMI) and patients with stable coronary artery disease (CAD) by coronary computed tomography angiography (cCTA) correlated with virtual histology intravascular ultrasound (VH-IVUS). MATERIALS AND METHODS Sixty patients (35 with NSTEMI) were included. Corresponding plaques were assessed by dual-source cCTA and VH-IVUS regarding volumes and percentages of fatty, fibrous, and calcified component; overall plaque burden; and maximal percent area stenosis. Possible differences between patient groups were investigated. Concordance between cCTA and VH-IVUS measurements was validated by Bland-Altman analysis. RESULTS Forty corresponding plaques (22 of patients with NSTEMI) were finally analyzed by cCTA and VH-IVUS. cCTA plaque analysis revealed no significant differences between plaques of patients with NSTEMI and stable CAD regarding absolute and relative amounts of any plaque component (fatty: 20 mm³/13% versus 17 mm³/14%; fibrous: 81 mm³/63% versus 80 mm³/53%; calcified: 16 mm³/14% versus 26 mm³/26%; all P > .05) or overall plaque burden (153 mm³ versus 165 mm³; P > .05), nor did VH-IVUS plaque analysis. VH-IVUS measured a higher area stenosis in patients with NSTEMI compared to patients with stable CAD (76% versus 68%, P = .01; in cCTA 69% versus 65%, P = .2). Volumes of fatty component were measured systematically lower in cCTA, whereas calcified and fibrous volumes were higher. No significant bias was observed comparing volumes of overall noncalcified component and overall plaque burden. CONCLUSION Plaques of patients with acute NSTEMI and of patients with stable CAD cannot be differentiated by quantification of plaque components. cCTA and VH-IVUS differ in plaque component analysis.
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Atherosclerotic plaque burden in cocaine users with acute chest pain: Analysis by coronary computed tomography angiography. Atherosclerosis 2013; 229:443-8. [DOI: 10.1016/j.atherosclerosis.2013.05.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/19/2013] [Accepted: 05/30/2013] [Indexed: 11/22/2022]
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Schlett CL, Ferencik M, Celeng C, Maurovich-Horvat P, Scheffel H, Stolzmann P, Do S, Kauczor HU, Alkadhi H, Bamberg F, Hoffmann U. How to assess non-calcified plaque in CT angiography: delineation methods affect diagnostic accuracy of low-attenuation plaque by CT for lipid-core plaque in histology. Eur Heart J Cardiovasc Imaging 2013; 14:1099-105. [PMID: 23671211 DOI: 10.1093/ehjci/jet030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To compare the accuracy of two plaque delineation methods for coronary computed tomographic angiography (CTA) to identify lipid-core plaque (LCP) using histology as the reference standard. METHODS AND RESULTS Five ex vivo hearts were analysed by CTA and histology. LCP was defined by histology as fibroatheroma with core diameter/circumference >200 μm/>60° and cap thickness <450 μm. In CTA, plaque was manually delineated either as the difference between the inner and outer vessel walls (Method A) or as a direct tracing of plaque (Method B). Low-attenuation plaque was defined as an area with <90 Hounsfield units. Of 446 co-registered cross-sections, 55 (12%) contained LCP. In CTA, low-attenuation plaque area was larger as assessed with Method A compared with Method B (difference: 120 ± 60%). Although low-attenuation plaque was associated with the presence of LCP, the delineation Method B yielded higher diagnostic accuracy than Method A [area under the curve (AUC): 0.831 vs. 0.780, respectively, P = 0.005]. After excluding 'normal' cross-sections by CTA (n = 117), AUC for detecting LCP became similar between both methods (0.767 vs. 0.729, P = 0.07, respectively). CONCLUSION Low-attenuation plaque in CTA is a diagnostic tool for LCP but prone to error if plaque is defined as the area between the inner and outer vessel walls and normal cross-sections are included in the assessment.
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Affiliation(s)
- Christopher L Schlett
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Yang E, Vargas JD, Bluemke DA. Understanding the genetics of coronary artery disease through the lens of noninvasive imaging. Expert Rev Cardiovasc Ther 2012; 10:27-36. [PMID: 22149524 PMCID: PMC3482161 DOI: 10.1586/erc.11.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary artery disease is a common condition with a known heritable component that has spurred interest in genetic research for decades, resulting in a handful of candidate genes and an appreciation for the complexity of its genetic contributions. Recent advances in sequencing technologies have resulted in large-scale association studies, possibly adding to our current understanding of the genetics of coronary artery disease. Sifting through the statistical noise, however, requires the selection of effective phenotypic markers. New imaging technologies have improved our ability to detect subclinical atherosclerosis in a safe and reproducible manner in large numbers of patients. In this article, we propose that advances in imaging technology have generated improved phenotypic markers for genetic association studies of coronary artery disease.
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Affiliation(s)
| | - Jose D Vargas
- Radiology and Imaging Sciences, National Institutes of Health
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Dr, Rm 10/1C355, Bethesda, MD, 20892
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Xu Y, Liang G, Hu G, Yang Y, Geng J, Saha PK. Quantification of coronary arterial stenoses in CTA using fuzzy distance transform. Comput Med Imaging Graph 2012; 36:11-24. [DOI: 10.1016/j.compmedimag.2011.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 03/15/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
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19
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Voros S, Rinehart S, Qian Z, Joshi P, Vazquez G, Fischer C, Belur P, Hulten E, Villines TC. Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging 2011; 4:537-48. [PMID: 21565743 DOI: 10.1016/j.jcmg.2011.03.006] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/14/2011] [Accepted: 03/21/2011] [Indexed: 02/07/2023]
Abstract
Coronary computed tomography angiography (CTA) allows coronary artery visualization and the detection of coronary stenoses. In addition; it has been suggested as a novel, noninvasive modality for coronary atherosclerotic plaque detection, characterization, and quantification. Emerging data show that coronary CTA-based semiquantitative plaque characterization and quantification are sufficiently reproducible for clinical purposes, and fully quantitative approaches may be appropriate for use in clinical trials. Furthermore, several lines of investigation have validated plaque imaging by coronary CTA against other imaging modalities such as intravascular ultrasound/"virtual histology" and optical coherence tomography, and there are emerging data using biochemical modalities such as near-infrared spectroscopy. Finally, clinical validation in patients with acute coronary syndrome and in the outpatient setting has shown incremental value of CTA-based plaque characterization for the prediction of major cardiovascular events. With recent developments in image acquisition and reconstruction technologies, coronary CTA can be performed with relatively low radiation exposure. With further technological innovation and clinical research, coronary CTA may become an important tool in the quest to identify vulnerable plaques and the at-risk patient.
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Nance JW, Bamberg F, Schoepf UJ, Kang DK, Barraza JM, Abro JA, Bastarrika G, Headden GF, Costello P, Thilo C. Coronary Atherosclerosis in African American and White Patients with Acute Chest Pain: Characterization with Coronary CT Angiography. Radiology 2011; 260:373-80. [DOI: 10.1148/radiol.11110158] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maurovich-Horvat P, Kallianos K, Engel LC, Szymonifka J, Fox CS, Hoffmann U, Truong QA. Influence of pericoronary adipose tissue on local coronary atherosclerosis as assessed by a novel MDCT volumetric method. Atherosclerosis 2011; 219:151-7. [PMID: 21782176 DOI: 10.1016/j.atherosclerosis.2011.06.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/22/2011] [Accepted: 06/27/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Pericoronary adipose tissue (PCAT) may create a pro-inflammatory state, contributing to the development of coronary artery disease (CAD). We sought to evaluate the feasibility of a novel volumetric PCAT quantification method using a novel threshold based computed tomography approach. In addition we determined the relation between PCAT volumes and CAD. METHODS In 51 patients (49.5±5.1 years, 64.8% male) who underwent 64-slice MDCT, we measured threshold-based PCAT volumes using distance and anatomic-based methods. Using the most reproducible method, we performed the proximal 40-mm distance measurement in three groups as stratified by coronary plaque and high-sensitivity C-reactive protein (hs-CRP) levels: Group 1 (presence of coronary plaque, hs-CRP >2.0 mg/L); an intermediate group (Group 2, no plaque, hs-CRP >2.0 mg/L); and Group 3 (no plaque, hs-CRP<1.0 mg/L). We compared PCAT volumes to the presence of coronary plaque on a patient (n=51) and vessel (n=153) basis. On a subsegment basis (n=1224), we compared PCAT volume to the presence of plaque as well as plaque morphology. RESULTS Distance-based PCAT volume measurements yielded excellent reproducibility with intra-observer intraclass correlation (ICC) of 0.997 and inter-observer ICC of 0.951. On a both a per-patient and per-vessel analysis, adjusted PCAT volume was greater in patients with plaque (Group 1) than without plaque (Groups 2 and 3, p<0.001). No difference in PCAT volume was seen between high and low hs-CRP groups without plaque (p=0.51). Adjusted PCAT volumes were higher in subsegments with plaque as compared without (p<0.001). Additionally, adjusted PCAT volume was greatest in subsegments with mixed plaque followed by non-calcified plaque, calcified plaque, and the lowest volume in segments with no plaque (p<0.001). CONCLUSION In this proof-of-concept study, threshold based PCAT volume assessment is feasible and highly reproducible. PCAT volume is increased in patients and vessels with coronary plaques. Surrounding vessel subsegments with coronary plaque, particularly mixed plaques, have greatest PCAT volume and highlight the effect of local PCAT in the development of coronary atherosclerosis.
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Affiliation(s)
- Pál Maurovich-Horvat
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States
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Lee MS, Chun EJ, Kim KJ, Kim JA, Vembar M, Choi SI. Reproducibility in the assessment of noncalcified coronary plaque with 256-slice multi-detector CT and automated plaque analysis software. Int J Cardiovasc Imaging 2010; 26:237-44. [DOI: 10.1007/s10554-010-9710-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/15/2010] [Indexed: 10/19/2022]
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Pagali SR, Madaj P, Gupta M, Nair S, Hamirani YS, Min JK, Lin F, Budoff MJ. Interobserver variations of plaque severity score and segment stenosis score in coronary arteries using 64 slice multidetector computed tomography: a substudy of the ACCURACY trial. J Cardiovasc Comput Tomogr 2010; 4:312-8. [PMID: 20630819 DOI: 10.1016/j.jcct.2010.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 05/02/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Assessing the severity of coronary plaque for the risk stratification and management of coronary artery disease is important. Multidetector computed tomography has been shown to be a useful tool to measure coronary plaque; however, interreader variability is a concern. OBJECTIVE We measured interobserver variations of plaque severity score (PSS) and segment stenosis score (SSS) as measured by the total plaque severity score (TPS) and total segment stenosis score (TSS). METHODS Cardiac CT scans (n = 221) of the ACCURACY trial were interpreted by 3 different readers blinded to patient characteristics. PSS (mild, 1; moderate, 2; and severe, 3) and SSS (stenosis 1%-29%, 1; 30%-49%, 2; 50%-69%, 3; and ≥70%, 4) were calculated with the 15-segment American Heart Association model. TPS and TSS were determined by summing the segments for each interpreter. TPS and TSS were compared for correlation and variation among any 2 of the 3 readers. RESULTS A highly significant correlation was observed among any 2 of the 3 readers for both TPS and TSS. For TPS, the r = 0.91, 0.93, 0.94 (P < 0.001) for A vs B, B vs C, A vs C, respectively, and for TSS, r = 0.91, 0.92, 0.93 (P < 0.001) for A vs B, B vs C, A vs C, respectively. On Bland Altman plot, the mean difference between the scores of any 2 readers was 3.33 ± 3.93, 1.65 ± 2.88, and 1.68 ± 2.92 for TPS and 4.19 ± 4.73, 2.54 ± 4.02, and 1.65 ± 3.18 for TSS. CONCLUSION Semiquantitative measures of coronary plaque burden, including the TPS and TSS, can be determined with a high degree of interobserver agreement, suggesting their potential role as tools to aid in the assessment of coronary heart disease.
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Affiliation(s)
- Sandeep R Pagali
- Los Angeles Biomedical Research Institute, Harbor-UCLA, 1124 West Carson Street, Torrance, CA 90502, USA
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Bastarrika G, Lee YS, Huda W, Ruzsics B, Costello P, Schoepf UJ. CT of coronary artery disease. Radiology 2009; 253:317-38. [PMID: 19864526 DOI: 10.1148/radiol.2532081738] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Technical innovation is rapidly improving the clinical utility of cardiac computed tomography (CT) and will increasingly address current technical limitations, especially the association of this test with relatively high levels of radiation. Guidelines for appropriate indications are in place and are evolving, with an increasing evidence base to ensure the appropriate use of this modality. New technologies and new applications, such as myocardial perfusion imaging and dual-energy CT, are being explored and are widening the scope of coronary CT angiography from mere coronary artery assessment to the integrative analysis of cardiac morphology, function, perfusion, and viability. The scientific evaluation of coronary CT angiography has left the stage of feasibility testing and increasingly, evidence-based data are accumulating on outcomes, prognosis, and cost-effectiveness. In this review, these developments will be discussed in the context of current pivotal transitions in cardiovascular disease management and their potential influence on the current role and future fate of coronary CT angiography will be examined.
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Affiliation(s)
- Gorka Bastarrika
- Department of Radiology and Division of Cardiology, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29401, USA
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Maurovich-Horvat P, Ferencik M, Bamberg F, Hoffmann U. Methods of plaque quantification and characterization by cardiac computed tomography. J Cardiovasc Comput Tomogr 2009; 3 Suppl 2:S91-8. [PMID: 20129522 DOI: 10.1016/j.jcct.2009.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022]
Abstract
The pathologic evolution of coronary artery atherosclerosis occurs slowly over decades, which may provide an opportunity for diagnostic imaging to identify patients before clinical events evolve. Cardiac computed tomography (CT) is an emerging noninvasive imaging tool, which can visualize the entire coronary tree with submillimeter resolution. We reviewed the current status of cardiac CT to qualitatively and quantitatively determine coronary plaque dimensions and composition, and its potential to improve our understanding of the natural history of coronary artery disease as well as prevention of cardiovascular events.
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Affiliation(s)
- Pal Maurovich-Horvat
- Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
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Bekkers E, Roos J. Coronary CTA: stenosis classification and quantification, including automated measures. J Cardiovasc Comput Tomogr 2009; 3 Suppl 2:S109-15. [PMID: 20129518 DOI: 10.1016/j.jcct.2009.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/23/2009] [Indexed: 11/24/2022]
Abstract
The development of larger multidetector computed tomography (CT) systems has allowed increased accuracy in quantifying obstructive lesions involving the coronary arteries. This article reviews the accuracy of coronary CT angiography (CTA) in quantifying obstructive lesions, evaluating the extent of coronary artery disease, and classifying the composition of coronary plaques. In addition, several outcomes studies and some promising automated techniques for quantifying coronary CTA are reviewed.
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Affiliation(s)
- Erik Bekkers
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room S-072, Stanford, CA 94305-5105, USA.
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