Total coronary atherosclerotic plaque burden assessment by CT angiography for detecting obstructive coronary artery disease associated with myocardial perfusion abnormalities

被引：27

作者：

Kishi, Satoru ^{[1
]}

Magalhaes, Tiago A. ^{[2
]}

Cerci, Rodrigo J. ^{[1
]}

Matheson, Matthew B. ^{[3
]}

Vavere, Andrea ^{[1
]}

Tanami, Yutaka ^{[4
]}

Kitslaar, Pieter H. ^{[5
]}

George, Richard T. ^{[1
]}

Brinker, Jeffrey ^{[1
]}

Miller, Julie M. ^{[1
]}

Clouse, Melvin E. ^{[6
]}

Lemos, Pedro A. ^{[7
]}

Niinuma, Hiroyuki ^{[8
]}

Reiber, Johan H. C. ^{[5
]}

Rochitte, Carlos E. ^{[7
]}

Rybicki, Frank J. ^{[9
,10
]}

Di Carli, Marcelo F. ^{[11
]}

Cox, Christopher ^{[3
]}

Lima, Joao A. C. ^{[1
]}

Arbab-Zadeh, Armin ^{[1
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Dept Med, Div Cardiol, Baltimore, MD 21205 USA

[2] Catholic Univ Parana PUC PR, Div Cardiol, Dept Med, Curitiba, Parana, Brazil

[3] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA

[4] Keio Univ, Dept Radiol, Tokyo, Japan

[5] Leiden Univ, Med Ctr Medis Med Imaging Syst, Dept Radiol, Div Image Proc, Leiden, Netherlands

[6] Harvard Univ, Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[7] Univ Sao Paulo, Sch Med, Heart Inst InCor, Sao Paulo, Brazil

[8] St Lukes Int Hosp, Div Cardiol, Tokyo, Japan

[9] Univ Ottawa, Ottawa Hosp, Res Inst, Ottawa, ON K1H 8M5, Canada

[10] Univ Ottawa, Fac Med, Dept Radiol, Ottawa, ON K1H 8M5, Canada

[11] Harvard Univ, Brigham & Womens Hosp, Dept Radiol, Boston, MA 02115 USA

来源：

JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY | 2016年 / 10卷 / 02期

关键词：

Coronary artery disease; Coronary heart disease; CT angiography; Myocardial perfusion; Atherosclerotic plaque; COMPUTED-TOMOGRAPHY ANGIOGRAPHY; FRACTIONAL FLOW RESERVE; INTRAVASCULAR ULTRASOUND; AUTOMATED QUANTIFICATION; DIAGNOSTIC PERFORMANCE; CORE320; MULTICENTER; ALGORITHM; LESIONS; DESIGN;

D O I：

10.1016/j.jcct.2016.01.005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Total atherosclerotic plaque burden assessment by CT angiography (CTA) is a promising tool for diagnosis and prognosis of coronary artery disease (CAD) but its validation is restricted to small clinical studies. We tested the feasibility of semi-automatically derived coronary atheroma burden assessment for identifying patients with hemodynamically significant CAD in a large cohort of patients with heterogenous characteristics. Methods: This study focused on the CTA component of the CORE320 study population. A semi-automated contour detection algorithm quantified total coronary atheroma volume defined as the difference between vessel and lumen volume. Percent atheroma volume (PAV = [total atheroma volume/total vessel volume] x 100) was the primary metric for assessment (n = 374). The area under the receiver operating characteristic curve (AUC) determined the diagnostic accuracy for identifying patients with hemodynamically significant CAD defined as >= 50% stenosis by quantitative coronary angiography and associated myocardial perfusion abnormality by SPECT. Results: Of 374 patients, 139 (37%) had hemodynamically significant CAD. The AUC for PAV was 0.78 (95% confidence interval [CI] 0.73-0.83) compared with 0.84 [0.79-0.88] by standard expert CTA interpretation (p = 0.02). Accuracy for both CTA (0.91 [0.87, 0.96]) and PAV (0.86 [0.81-0.91]) increased after excluding patients with history of CAD (p < 0.01 for both). Bland-Altman analysis revealed good agreement between two observers (bias of 280.2 mm(3) [161.8, 398.7]). Conclusions: A semi-automatically derived index of total coronary atheroma volume yields good accuracy for identifying patients with hemodynamically significant CAD, though marginally inferior to CTA expert reading. These results convey promise for rapid, reliable evaluation of clinically relevant CAD. (C) 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

引用

页码：121 / 127

页数：7

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