Coronary Artery Stenoses: Accuracy of 64–Detector Row CT Angiography in Segments with Mild, Moderate, or Severe Calcification—A Subanalysis of the CORE-64 Trial

Abstract

Purpose:To evaluate the infl uence of cross-sectional arc calcifi cation on the diagnostic accuracy of computed tomography (CT) angiography compared with conventional coronary angiography for the detection of obstructive coronary artery disease (CAD). Materials and Methods:Institutional Review Board approval and written informed consent were obtained from all centers and participants for this HIPAA-compliant study. Overall, 4511 segments from 371 symptomatic patients (279 men, 92 women; median age, 61 years [interquartile range, 53-67 years]) with clinical suspicion of CAD from the CORE-64 multicenter study were included in the analysis. Two independent blinded observers evaluated the percentage of diameter stenosis and the circumferential extent of calcium (arc calcium). The accuracy of quantitative multidetector CT angiography to depict substantial ( Ն 50%) stenoses was assessed by using quantitative coronary angiography (QCA). Cross-sectional arc calcium was rated on a segment level as follows: noncalcifi ed or mild ( , 90°), moderate (90°-180°), or severe ( . 180°) calcifi cation. Univariable and multivariable logistic regression, receiver operation characteristic curve, and clustering methods were used for statistical analyses. Results:A total of 1099 segments had mild calcifi cation, 503 had moderate calcifi cation, 338 had severe calcifi cation, and 2571 segments were noncalcifi ed. Calcifi ed segments were highly associated ( P , .001) with disagreement between CTA and QCA in multivariable analysis after controlling for sex, age, heart rate, and image quality. The prevalence of CAD was 5.4% in noncalcifi ed segments, 15.0% in mildly calcifi ed segments, 27.0% in moderately calcifi ed segments, and 43.0% in severely calcifi ed segments. A signifi cant difference was found in area under the receiver operating characteristic curves (noncalcifi ed: 0.86, mildly calcifi ed: 0.85, moderately calcifi ed: 0.82, severely calcifi ed: 0.81; P , .05). Conclusion:In a symptomatic patient population, segment-based coronary artery calcifi cation signifi cantly decreased agreement between multidetector CT angiography and QCA to detect a coronary stenosis of at least 50%.

Diagnostic Value of Coronary CT Angiography With Use of Left Coronary Bifurcation Angle in Coronary Artery Disease

“…Low diagnostic specificity and PPV of CCTA in calcified plaques is mainly due to high false positive rates caused by blooming artifacts which result from heavy calcification in the coronary arteries. [11][12][13][14][15] This is a widely known limitation of CCTA. Some recent studies have addressed this issue by showing the improved diagnostic performance of CCTA with use of bifurcation angle measurement when compared to the conventional approach based on coronary lumen stenosis.…”

“…[6][7][8][9][10] It is well known that high calcification or high calcium score in the coronary arteries results in false positive results, thus leading to low specificity and positive predictive value (PPV). [11][12][13][14][15] This limitation has been addressed to some extent with use of image processing methods as reported in some studies. [16][17][18] Another approach to improve diagnostic value of CCTA in the diagnosis of calcified plaques is to use left coronary bifurcation angle as opposed to the conventional method of measuring coronary lumen stenosis.…”

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

“…Количественные измерения при перфузионной МРТ сердца демонстрируют хоро-шую корреляцию с измерениями ФРК [138]. Исполь-зование высокомощных магнитов при 3,0 Т, хотя они пациента посегментная оценка кальциноза оказывает более сильное влияние на диагностическую точность, чем общее содержание кальция [159], причем влия-ние кальция на точность КТА коронарных артерий менее выражено при меньших значениях ЧСС и при использовании современных КТ-систем [160,161]. В случае, если индекс коронарного кальция не опре-делялся и кальциноз наблюдается только по заверше-нии КТ-ангиографического сканирования, может быть благоразумным воздержаться от количествен-ной оценки стеноза в областях распространенного кальциноза и признать результаты исследования "неясными" (рис.…”

The comparison of multislice computed tomography coronary angiography and invasive coronary angiography for the detection of coronary artery pathologies

“…When the calcification is severe, there can be an exaggerated appearance once the contrast fills the lumen. In the analysis of the study named CorE-64, Vavere et al (22) demonstrated that the diagnostic quality decreased in cases with multiple coronary artery calcifications. In our study, especially in distal segments and in cases identified to have severe calcifications, MSCT identified different rates of obstruction compared to CCA.…”