TY - JOUR
T1 - How to assess non-calcified plaque in CT angiography
T2 - Delineation methods affect diagnostic accuracy of low-attenuation plaque by CT for lipid-core plaque in histology
AU - Schlett, Christopher L.
AU - Ferencik, Maros
AU - Celeng, Csilla
AU - Maurovich-Horvat, Pál
AU - Scheffel, Hans
AU - Stolzmann, Paul
AU - Do, Synho
AU - Kauczor, Hans Ulrich
AU - Alkadhi, Hatem
AU - Bamberg, Fabian
AU - Hoffmann, Udo
PY - 2013/11
Y1 - 2013/11
N2 - AimsTo 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 resultsFive 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).ConclusionLow-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.
AB - AimsTo 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 resultsFive 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).ConclusionLow-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.
KW - (Semi)-Automated plaque assessment
KW - Coronary computed tomographic angiography
KW - Low-attenuation plaque
KW - Plaque delineation techniques
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U2 - 10.1093/ehjci/jet030
DO - 10.1093/ehjci/jet030
M3 - Article
C2 - 23671211
AN - SCOPUS:84885909320
SN - 2047-2404
VL - 14
SP - 1099
EP - 1105
JO - European heart journal cardiovascular Imaging
JF - European heart journal cardiovascular Imaging
IS - 11
ER -