Abstract
Background
Advances in coronary computed tomography angiography (CCTA) reconstruction algorithms
are expected to enhance the accuracy of CCTA plaque quantification. We aim to evaluate
different CCTA reconstruction approaches in assessing vessel characteristics in coronary
atheroma using intravascular ultrasound (IVUS) as the reference standard.
Methods
Matched cross-sections (n = 7241) from 50 vessels in 15 participants with chronic
coronary syndrome who prospectively underwent CCTA and 3-vessel near-infrared spectroscopy-IVUS
were included. Twelve CCTA datasets per patient were reconstructed using two different
kernels, two slice thicknesses (0.75 mm and 0.50 mm) and three different strengths
of advanced model-based iterative reconstruction (IR) algorithms. Lumen and vessel
wall borders were manually annotated in every IVUS and CCTA cross-section which were
co-registered using dedicated software. Image quality was sub-optimal in the reconstructions
with a sharper kernel, so these were excluded. Intraclass correlation coefficient
(ICC) and repeatability coefficient (RC) were used to compare the estimations of the
6 CT reconstruction approaches with those derived by IVUS.
Results
Segment-level analysis showed good agreement between CCTA and IVUS for assessing atheroma
volume with approach 0.50/5 (slice thickness 0.50 mm and highest strength 5 ADMIRE
IR) being the best (total atheroma volume ICC: 0.91, RC: 0.67, p < 0.001 and percentage
atheroma volume ICC: 0.64, RC: 14.06, p < 0.001). At lesion-level, there was no
difference between the CCTA reconstructions for detecting plaques (accuracy range:
0.64–0.67; p = 0.23); however, approach 0.50/5 was superior in assessing IVUS-derived
lesion characteristics associated with plaque vulnerability (minimum lumen area ICC:
0.64, RC: 1.31, p < 0.001 and plaque burden ICC: 0.45, RC: 32.0, p < 0.001).
Conclusion
CCTA reconstruction with thinner slice thickness, smooth kernel and highest strength
advanced IR enabled more accurate quantification of the lumen and plaque at a segment-,
and lesion-level analysis in coronary atheroma when validated against intravascular
ultrasound. Clinicaltrials.gov (NCT03556644)
Keywords
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Article info
Publication history
Published online: September 21, 2022
Accepted:
September 17,
2022
Received in revised form:
September 3,
2022
Received:
April 11,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography.
