Clinical Feasibility of 3D Automated Coronary Atherosclerotic Plaque Quantification Algorithm on Coronary Computed Tomography Angiography: Comparison with Intravascular Ultrasound

Abstract

• Coronary CTA enables the assessment of coronary atherosclerotic plaque. • High-risk plaque characteristics and overall plaque burden can predict future cardiac events. • Coronary atherosclerotic plaque quantification is currently unfeasible in practice. • Quantitative computed tomography coronary plaque analysis software (QCT) enables feasible plaque quantification. • Fully automatic QCT analysis shows excellent performance.

Rationale and design of the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry: A comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary computed tomographic angiography study

“…44 More recent studies using QCA or IVUS-like parameters also validated the reliability and reproducibility of CCTA in quantitative assessment of coronary atherosclerotic plaque. 26,27,33,45 Still, there is limited data regarding plaque progression using CCTA. Although some papers have used serial CCTA findings to describe the progression or change in coronary plaques, 33,[45][46][47][48][49][50][51] research to date has been limited by a small study sample, relatively short time of interval between the scans, as well as focus on a specific subset of patients or lesions.…”

“…For quantitative atherosclerotic plaque analysis, a semi-automated method will be utilized which has been validated versus IVUS in previous studies 26 . First, a centerline originating from the ostium defined by the observer will be automatically drawn.…”

“…25 Further, more recent studies have used fully or semiautomated plaque assessment, thereby allowing higher accuracy and better reproducibility than manual technique. 21,26,27 In addition, the relatively high radiation dose, which was a prior limiting factor of serial CCTA examination, have significantly been reduced from 15 to 20 mSv to below 1 mSv in selected patients. 28 Hence, CCTA has emerged as an effective alternative to invasive IVUS in serial studies for assessment of interval change in morphological plaque characteristics and efficacy of treatment, especially in patients with flow-limiting lesions.…”

Therapeutic modulation of the natural history of coronary atherosclerosis: lessons learned from serial imaging studies

“…In addition to its noninvasiveness, coronary CTA carries the distinct advantage of being able to qualitatively and quantitatively assess overall plaque burden in the entire coronary vasculature, with recent data showing that widespread, multivessel, nonobstructive CAD confers similar risk of event rates to localized obstructive disease (28). Various semi-quantitative methods have been used to score the degree of plaque in coronary segments using coronary CTA (24), with the best results shown for semiautomatic expert-guided measurements, as determined by comparison against IVUS (29). Although coronary CTA provides excellent correlation of individual plaque measurements with IVUS (29), it is limited in detecting small noncalcified plaques (<1 mm) and may misclassify plaque subcomponents (30).…”

“…Various semi-quantitative methods have been used to score the degree of plaque in coronary segments using coronary CTA (24), with the best results shown for semiautomatic expert-guided measurements, as determined by comparison against IVUS (29). Although coronary CTA provides excellent correlation of individual plaque measurements with IVUS (29), it is limited in detecting small noncalcified plaques (<1 mm) and may misclassify plaque subcomponents (30). This is especially the case at the low radiation doses (≤1 mSv) which have become achievable with contemporary coronary CTA technology, and which otherwise would enable patients to more safely undergo repeat CCTA examinations.…”