Author + information
- Received May 21, 2010
- Revision received October 5, 2010
- Accepted October 20, 2010
- Published online February 1, 2011.
- Szilard Voros, MD⁎ (, )
- Sarah Rinehart, MD,
- Zhen Qian, PhD,
- Gustavo Vazquez, MD,
- Hunt Anderson, MD,
- Laura Murrieta, CCRC,
- Charles Wilmer, MD,
- Harold Carlson, MD,
- Kenneth Taylor, MD,
- William Ballard, MD,
- Dimitri Karmpaliotis, MD,
- Anna Kalynych, MD and
- Charles Brown III, MD
- ↵⁎Reprint requests and correspondence:
Dr. Szilard Voros, Piedmont Heart Institute, 1968 Peachtree Road, North West, Atlanta, Georgia 30309
Objectives This study sought to determine the accuracy of 3-dimensional, quantitative measurements of coronary plaque by computed tomography angiography (CTA) against intravascular ultrasound with radiofrequency backscatter analysis (IVUS/VH).
Background Quantitative, 3-dimensional coronary CTA plaque measurements have not been validated against IVUS/VH.
Methods Sixty patients in a prospective study underwent coronary X-ray angiography, IVUS/VH, and coronary CTA. Plaque geometry and composition was quantified after spatial coregistration on segmental and slice-by-slice bases. Correlation, mean difference, and limits of agreement were determined.
Results There was significant correlation for all pre-specified parameters by segmental and slice-by-slice analyses (r = 0.41 to 0.84; all p < 0.001). On a segmental basis, CTA underestimated minimal lumen diameter by 21% and overestimated diameter stenosis by 39%. Minimal lumen area was overestimated on CTA by 27% but area stenosis was only underestimated by 5%. Mean difference in noncalcified plaque volume and percent and calcified plaque volume and percent were 38%, −22%, 104%, and 64%. On a slice-by-slice basis, lumen, vessel, noncalcified-, and calcified-plaque areas were overestimated on CTA by 22%, 19%, 44%, and 88%. There was significant correlation for percentage of atheroma volume (0.52 vs. 0.54; r = 0.51; p < 0.001). Compositional analysis suggested that high-density noncalcified plaque on CTA best correlated with fibrous tissue and low-density noncalcified plaque correlated with necrotic core plus fibrofatty tissue by IVUS/VH.
Conclusions This is the first validation that standardized, 3-dimensional, quantitative measurements of coronary plaque correlate with IVUS/VH. Mean differences are small, whereas limits of agreement are wide. Low-density noncalcified plaque correlates with necrotic core plus fibrofatty tissue on IVUS/VH.
This study was supported in part by grants from Abbott Vascular, Volcano Inc., Vital Images, and Siemens Medical Solutions. Furthermore, these grants were awarded to Dr. Voros. All other authors have reported that they have no relationships to disclose. John W. Hirshfeld, Jr., MD, served as Guest Editor for this paper.
- Received May 21, 2010.
- Revision received October 5, 2010.
- Accepted October 20, 2010.
- American College of Cardiology Foundation