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

Reproducibility of coronary plaque detection and characterization using low radiation dose coronary computed tomographic angiography in patients with intermediate likelihood of coronary artery disease (ReSCAN study)

“…Although simplicity may facilitate the use of semi-quantitative plaque scores in clinical practice, reliability of such scores are intertwined with reproducibility. Based on the reported interobserver variability of the ''plaque severity'' and the ''segment stenosis'' scores [10], and the present findings, the clinical applicability of such scores as a surrogate measure of plaque burden warrants improvements in reproducibility. It may be speculated that the introduction of (semi)automatic plaque detection and quantification algorithms for coronary CTA [24] may improve reproducibility and thus reliability of plaque burden quantification.…”

“…The ''plaque severity'' score grades plaques according to size, whereas the ''segment stenosis'' score grades segments according to the degree of stenosis [3]. In a recent study, Pagali et al [10] evaluated the interobserver reproducibility of the ''plaque severity'' and ''segment stenosis'' scores in 229 patients. Although correlations between scores were excellent, mean differences between observers were significant for both scores with wide limits of agreement.…”

“…A simple semi-quantitative measure of plaque burden using the segment involvement score (SIS) provides prognostic information [2,3]. Hitherto, few studies have evaluated the interobserver [8][9][10][11] and in particular the interscan agreement [12,13] of plaque detection, characterization and semi-quantification. High-pitch spiral acquisition coronary CTA may permit assessment of interscan agreement of coronary plaque detection without excessive radiation exposure [14].…”

Right Answer, Wrong Question

“…[7][8][9] A recent study by several of the CONFIRM investigators disclosed pairwise standardized variations (SD/mean) of 113%, 158%, and 193% among 3 blinded observers reading 221 scans despite superficially impressive statistically significant correlation coefficients. 10 There is little doubt that anatomically severe disease is associated with more extreme clinical manifestations of ischemia than is anatomically mild disease. We are not told, however, if any of the patients in CONFIRM underwent historical evaluation, risk factor assessment, or stress testing by their physicians before being referred for anatomic verification.…”

The Prognostic Value of Coronary CT Angiography

“…Longerterm studies involving modern generation coronary CTA are needed. Furthermore, studies examining more detailed and, hopefully, standardized measures of CAD severity and plaque parameters, to include semiquantitative coronary arterial segment scores integrating disease severity and location, inclusion of additional clinical parameters (e.g., pre-CTA exercise capacity, LVEF), and plaque morphology, are of considerable interest to enhance assessment of prognosis in symptomatic patients undergoing coronary CTA [12][13][14].…”