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Improved Evaluation of Lipid-Rich Plaque at Coronary CT Angiography: Head-to-Head Comparison with Intravascular US.

ABSTRACT: Purpose:To improve the evaluation of low-attenuation plaque (LAP) by using semiautomated software and to assess whether the use of a proposed automated function (LAP editor) that excludes voxels adjacent to the outer vessel wall improves the relationship between LAP and the presence and size of the lipid-rich component (LRC) verified at intravascular US. At coronary CT angiography, quantification of LAP can improve risk stratification. Plaque, defined as the area between the vessel and the lumen wall, is prone to partial volume effects from the surrounding pericoronary adipose tissue. Materials and Methods:The percentage of LAP (%LAP), defined as the percentage of noncalcified plaque with an attenuation value lower than 30 HU (LAP/total plaque volume) at greater than or equal to 0 mm (%LAP0), greater than or equal to 0.1 mm (%LAP0.1), greater than or equal to 0.3 mm (%LAP0.3), greater than or equal to 0.5 mm (%LAP0.5), and greater than or equal to 0.7 mm (%LAP0.7) inward from the vessel wall boundaries, were quantified in 155 plaques in 90 patients who underwent coronary CT angiography before intravascular US. At intravascular US, the LRC was identified by using echo attenuation, and its size was measured by using the attenuation score (summed score/analysis length) based on the attenuation arc (1 = < 90°, 2 = 90° to < 180°, 3 = 180° to < 270°, 4 = 270°-360°) for every 1 mm. Results:Use of LAP editing improved the ability for discriminating LRC (areas under receiver operating characteristic curve: 0.667 with %LAP0, 0.713 with %LAP0.1 [P < .001 for comparison with %LAP0]), 0.778 with %LAP0.3 [P < .001], 0.825 with %LAP0.5 [P < .001], 0.802 with %LAP0.7 [P = .002]). %LAP0.5 had the strongest correlation (r = 0.612, P < .001) with LRC size, whereas %LAP0 resulted in the weakest correlation (r = 0.307; P < .001). Conclusion:Evaluation of LAP at coronary CT angiography can be significantly improved by excluding voxels that are adjacent to the vessel wall boundaries by 0.5 mm.Supplemental material is available for this article.© RSNA, 2019.

SUBMITTER: Matsumoto H

PROVIDER: S-EPMC6939749 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Improved Evaluation of Lipid-Rich Plaque at Coronary CT Angiography: Head-to-Head Comparison with Intravascular US.

Matsumoto Hidenari H Watanabe Satoshi S Kyo Eisho E Tsuji Takafumi T Ando Yosuke Y Eisenberg Evann E Otaki Yuka Y Manabe Osamu O Cadet Sebastien S Slomka Piotr J PJ Tamarappoo Balaji K BK Berman Daniel S DS Dey Damini D

Radiology. Cardiothoracic imaging 20191219 5

<h4>Purpose</h4>To improve the evaluation of low-attenuation plaque (LAP) by using semiautomated software and to assess whether the use of a proposed automated function (LAP editor) that excludes voxels adjacent to the outer vessel wall improves the relationship between LAP and the presence and size of the lipid-rich component (LRC) verified at intravascular US. At coronary CT angiography, quantification of LAP can improve risk stratification. <i>Plaque,</i> defined as the area between the vesse ...[more]

PMID: 32076671

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Project description: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.

Project description:PurposeTo determine the impact of low tube voltage coronary CT angiography on detection of subclinical atherosclerosis.Materials and methodsRetrospective sampling of an emergency department coronary CT angiography registry was performed. All patients in the registry underwent a noncontrast coronary artery calcium (CAC) scoring scan at 120 kV before coronary CT angiography. The study sample (n = 264) constituted patients with subclinical atherosclerosis (Coronary Artery Disease Reporting and Data System™ [CAD-RADS] 1 or 2) randomly mixed one-to-one with patients without atherosclerosis (CAD-RADS 0). The patients with coronary CT angiography performed at 70-90 kV were considered the low tube voltage group (n = 159) and patients with coronary CT angiography performed at 100-120 kV were considered the standard tube voltage group (n = 105). The number of coronary plaques and overall CAD-RADS classification (per patient) were evaluated twice: initially, by reading coronary CT angiography alone, and then, by coronary CT angiography in combination with a CAC scan. Considering the combined reading (CT angiography plus CAC scan) as the reference standard, the performance of coronary CT angiography alone was assessed for plaque detection and appropriate CAD-RADS (per patient) classification. The comparisons were made between the low tube voltage and standard tube voltage groups by using a Fisher exact test and χ2 test for proportions and a Mann-Whitney test and Kruskal-Wallis test for means.ResultsIn total, 455 plaques were identified in 118 patients (70 of 159 patients in the low tube voltage group; 48 of 105 in the standard tube voltage group). When reading coronary CT angiographic images alone, 97 of 455 (21%) plaques were missed that led to an incorrect CAD-RADS classification in 16 of 264 (6%) studies (interpreted as CAD-RADS 0 instead of CAD-RADS 1 or 2). Missed plaques were significantly more frequent in the low tube voltage group versus the standard tube voltage group (41% [85 of 206] vs 5% [12 of 249], respectively; P < .001). Incorrect CAD-RADS classification was also seen more commonly in the low tube voltage group (8.8% [14 of 159] vs 2% [two of 105]; P = .01), typically at low plaque burden (median CAC score, 1; range, 1-4). Calcified plaques that appeared isodense to luminal contrast material attenuation were seen more frequently in the low tube voltage group compared with the standard tube voltage group (20% [32 of 159] vs 7.6% [eight of 105], respectively; P = .005).ConclusionCoronary artery plaques may be missed at low tube voltage coronary CT angiographic examination performed without a concomitant CAC scan.© RSNA, 2019Supplemental material is available for this article.See also the commentary by Truong in this issue.

Project description:Purpose To assess the relationship between total, calcified, and noncalcified coronary plaque burdens throughout the entire coronary vasculature at coronary computed tomographic (CT) angiography in relationship to cardiovascular risk factors in asymptomatic individuals with low-to-moderate risk. Materials and Methods This HIPAA-compliant study had institutional review board approval, and written informed consent was obtained. Two hundred two subjects were recruited to an ongoing prospective study designed to evaluate the effect of HMG-CoA reductase inhibitors on atherosclerosis. Eligible subjects were asymptomatic individuals older than 55 years who were eligible for statin therapy. Coronary CT angiography was performed by using a 320-detector row scanner. Coronary wall thickness and plaque were evaluated in all epicardial coronary arteries greater than 2 mm in diameter. Images were analyzed by using dedicated software involving an adaptive lumen attenuation algorithm. Total plaque index (calcified plus noncalcified plaque) was defined as plaque volume divided by vessel length. Multivariable regression analysis was performed to determine the relationship between risk factors and plaque indexes. Results The mean age of the subjects was 65.5 years ± 6.9 (standard deviation) (36% women), and the median coronary artery calcium (CAC) score was 73 (interquartile range, 1-434). The total coronary plaque index was higher in men than in women (42.06 mm(2) ± 9.22 vs 34.33 mm(2) ± 8.35; P < .001). In multivariable analysis controlling for all risk factors, total plaque index remained higher in men than in women (by 5.01 mm(2); P = .03) and in those with higher simvastatin doses (by 0.44 mm(2)/10 mg simvastatin dose equivalent; P = .02). Noncalcified plaque index was positively correlated with systolic blood pressure (β = 0.80 mm(2)/10 mm Hg; P = .03), diabetes (β = 4.47 mm(2); P = .03), and low-density lipoprotein (LDL) cholesterol level (β = 0.04 mm(2)/mg/dL; P = .02); the association with LDL cholesterol level remained significant (P = .02) after additional adjustment for the CAC score. Conclusion LDL cholesterol level, systolic blood pressure, and diabetes were associated with noncalcified plaque burden at coronary CT angiography in asymptomatic individuals with low-to-moderate risk. (©) RSNA, 2015 Online supplemental material is available for this article.

Dataset Information

Improved Evaluation of Lipid-Rich Plaque at Coronary CT Angiography: Head-to-Head Comparison with Intravascular US.

Publications

Improved Evaluation of Lipid-Rich Plaque at Coronary CT Angiography: Head-to-Head Comparison with Intravascular US.

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