Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

Stefan B. Puchner, Maros Ferencik, Pal Maurovich-Horvat, Masataka Nakano, Fumiyuki Otsuka, Hans Ulrich Kauczor, Renu Virmani, Udo Hoffmann, Christopher L. Schlett

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Objectives: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.

Methods and materials: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.

Results: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm2: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.

Conclusion: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

Original languageEnglish (US)
Pages (from-to)15-23
Number of pages9
JournalEuropean Radiology
Issue number1
StatePublished - Jan 2015
Externally publishedYes


  • Coronary CT angiography
  • Diagnostic accuracy
  • Iterative reconstruction algorithm
  • Low attenuation plaque
  • Vulnerable plaque

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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