Interscan reproducibility of quantitative coronary plaque volume and composition from CT coronary angiography using an automated method

Schuhbaeck, Annika; Dey, Damini; Otaki, Yuka; Slomka, Piotr J.; Král, B; Achenbach, Stephan; Berman, Daniel S.; Fishman, Elliot K.; Lai, Shenghan; Li, Hong

doi:10.1007/s00330-014-3253-3

Cited by 54 publications

(23 citation statements)

References 42 publications

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“…Voxels with attenuation <130 HU were assigned to the noncalcified volume of the plaque. This volumetric plaque measurement technique has excellent intraobserver, interobserver, and interscan reproducibility 23, 25–29 .…”

Section: Methodsmentioning

confidence: 99%

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

et al. 2015

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Background No studies have yet assessed the ability of statin treatment to reduce arterial inflammation and achieve regression of coronary atherosclerosis in HIV-infected patients, a population with elevated risk of myocardial infarction. Methods In a randomized, double-blind, placebo-controlled trial, 40 HIV-infected participants with subclinical coronary atherosclerosis, evidence of arterial inflammation in the aorta by fluorodeoxyglucose positron emission tomography (FDG-PET) and low density lipoprotein(LDL)-cholesterol <3·37mmol/L(130mg/dL) were randomized to one year of treatment with atorvastatin (n=19) or placebo (n=21). Randomization was carried out by the MGH Clinical Research Pharmacy using a permuted-block algorithm, stratified by gender with a fixed block size of four, with 1:1 allocation to atorvastatin or identical matching placebo. Study codes were available only to the MGH Research Pharmacy and not to study investigators or participants. The prespecified primary endpoint was arterial inflammation, as assessed by FDG-PET of the aorta. Additional prespecified endpoints included coronary atherosclerotic plaque as assessed by coronary computed tomography angiography. We quantitatively assessed non-calcified and calcified plaque and high risk plaque features. Analysis was performed using intention-to-treat principle, using all available data, without imputation for missing data. Findings Thirty seven out of forty (92·5%) subjects completed the study, with equivalent discontinuation rates in both groups. Baseline parameters were similar between groups. After 12 months, change in FDG-PET uptake of the most diseased segment of the aorta was not different between atorvastatin and placebo, but technically adequate results comparing longitudinal changes in identical regions could only be assessed in a subset of patients (atorvastatin Δ −0·03 [95% CI: −0·17, 0·12] vs. placebo Δ −0·06 [−0·25, 0·13], p=0·77, n=21). Change in plaque could be assessed in all subjects completing the study. Atorvastatin reduced noncalcified coronary plaque volume compared to placebo (−19·4%(IQR: −39·2%, 9·3%) vs. +20·4%(−7·1%, 94·4%), p=0·009, n=37). In addition, the number of high risk plaques was significantly reduced by atorvastatin compared to placebo (change in number of low attenuation plaques −0·2[95% CI: −0·6, 0·2] vs. 0·4[0·0, 0·7], p=0·03, n=37 and change in number of positively remodeled plaques −0·2[95% CI −0·4, 0·1] vs. 0·4[−0·1, 0·8], p=0·04, n=37). Direct LDL-cholesterol (−1·00[95% CI −1·38, 0·61] vs. 0·30[0·04, 0·55] mmol/L, p<0·0001) and lipoprotein-associated phospholipase A2 (−52·2[95% CI −70·4, −34·0] vs. −13·3[−32·8, 6·2] ng/mL, p=0·005, n=37) significantly decreased with atorvastatin compared to placebo. Statin therapy was well-tolerated, with low incidence of clinical adverse events. Interpretation Compared to placebo, statin therapy reduces noncalcified plaque volume and high risk plaque features in HIV-infected patients with subclinical coronary atherosclerosis. Significant effects of statin therapy...

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Section: Methodsmentioning

confidence: 99%

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

et al. 2015

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“…The end-expiration position of the CCTA allowed excellent alignment with PET data when the patient remained in the same position. Coronary regions were first extracted from the CCTA by vessel tracking based on Bayesian maximal paths (9), as implemented and validated in our Autoplaq CCTA processing software (10)(11)(12). This algorithm requires as input only proximal and distal points for every coronary artery and automatically finds the vessel centerline.…”

Section: Motion Correctionmentioning

confidence: 99%

Motion Correction of ¹⁸F-NaF PET for Imaging Coronary Atherosclerotic Plaques

et al. 2015

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Ruptured coronary atherosclerotic plaques commonly cause acute myocardial infarction. It has recently been shown that active microcalcification in the coronary arteries, one of the features that characterizes vulnerable plaques at risk of rupture, can be imaged using 18 F-NaF PET. We aimed to determine whether a motion correction technique applied to gated 18 F-NaF PET images could enhance image quality and improve uptake estimates. Methods: Seventeen patients with myocardial infarction (n 5 7) or stable angina (n 5 10) underwent 18 F-NaF PET and prospective coronary CT angiography. PET data were reconstructed in 4 different ways: the first was 1 gated bin (end-diastolic phase with 25% of the counts), the second was 4 gated bins (consecutive 25% segments), the third was 10 gated bins (consecutive 10% segments), and the fourth was ungated. Subsequently, with data from either 4 or 10 bins, gated PET images were registered using a local, nonlinear motion correction method guided by the extracted coronary arteries from CT angiography. Global noise levels and target-to-background ratios (TBR) defined on manually delineated coronary plaque lesions were compared to assess image quality and uptake estimates. Results: Compared with the reference standard of using only 1 bin of PET data, motion correction using 10 bins of PET data reduced image noise by 46% (P , 0.0001). TBR in positive lesions for 10-bin motion-corrected data was 11% higher than for 1-bin data (1.98 [interquartile range, 1.70-2.37] vs. 1.78 [1.58-2.16], P 5 0.0027) and 33% higher than for ungated data (1.98 [1.70-2.37] vs. 1.49 [1.39-1.88], P , 0.0001). Conclusion: Motion correction of gated 18 F-NaF PET/coronary CT angiography is feasible, reduces image noise, and increases TBR. This improvement may allow more reliable identification of vulnerable coronary artery plaques using 18 F-NaF PET.

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“…A key issue is high reproducibility (test – retest) which needs to be firmly established. A study conducted in 30 patients on different CT scanners showed reasonable inters can reproducibility (repeatability coefficient 109 mm 2 for plaque volume measurement and below 10% for plaque composition) using a semi-automatic quantitative software 98 .…”

Section: Coronary Ct Angiography Assessment Of Plaque Burden and Progmentioning

confidence: 99%

“…For example, in a randomized trial with CT evaluation as a secondary endpoint in a subgroup 28 of 88 patients had to be excluded due to insufficient image quality in one of the exams 30 . The reproducibility study by Schuhbaeck et al noted suboptimal image quality as the most important reason for diverging measurements 98 . Finally, image analysis methods need further optimization.…”

Section: Coronary Ct Angiography Assessment Of Plaque Burden and Progmentioning

confidence: 99%

Noninvasive Imaging of Atherosclerotic Plaque Progression

Sandfort

Lima

Bluemke

2015

Circ: Cardiovascular Imaging

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The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high risk patients. For low to moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression, and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary CT angiography (CCTA) to evaluate the extent and subtypes of coronary plaque. CT technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on CT angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of CCTA compared to competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low to moderate cardiovascular risk.

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Interscan reproducibility of quantitative coronary plaque volume and composition from CT coronary angiography using an automated method

Abstract: Reproducibility of coronary atherosclerotic plaque volume in coronary CTA is high. Using automated software facilitates quantitative measurements. Serial studies to determine progression or regression of coronary plaque are possible.

Cited by 54 publications

References 42 publications

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Motion Correction of ¹⁸F-NaF PET for Imaging Coronary Atherosclerotic Plaques

Noninvasive Imaging of Atherosclerotic Plaque Progression

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Interscan reproducibility of quantitative coronary plaque volume and composition from CT coronary angiography using an automated method

Abstract: Reproducibility of coronary atherosclerotic plaque volume in coronary CTA is high. Using automated software facilitates quantitative measurements. Serial studies to determine progression or regression of coronary plaque are possible.

Cited by 54 publications

References 42 publications

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Motion Correction of 18F-NaF PET for Imaging Coronary Atherosclerotic Plaques

Noninvasive Imaging of Atherosclerotic Plaque Progression

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Motion Correction of ¹⁸F-NaF PET for Imaging Coronary Atherosclerotic Plaques