Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

Abstract

To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.

Magnetic Particle Imaging (MPI): Experimental Quantification of Vascular Stenosis Using Stationary Stenosis Phantoms

“…However, both CT and MRI have drawbacks, like (high) doses of ionizing radiation, nephrotoxic contrast agents, impaired visualization of stenosis in stents and highly calcified vessels for CT and limited spatial and temporal resolution, limited patient access and restrictions for certain implants and medical devices for MRI. Current research addresses these issues: in CT, progress in reduction of ionizing radiation using iterative reconstruction [39, 40], visualization of vessel lumina along stents and calcifications [41, 42] and characterization of atherosclerotic plaques [43, 44] has been made. The development of free-breathing, ECG-triggered, navigator-gated, T2-prepared, 3-dimensional coronary MR angiography using steady state free precession (SSFP) sequence allows coronary imaging in MRI now, in principle without the need for contrast agents [45].…”

Reproducibility of quantitative coronary computed tomography angiography in asymptomatic individuals and patients with acute chest pain

“…These funding sources had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Fifty patients were randomly selected from the VERDICT cohort and subsequently matched according to age and gender with participants from the CGPS and CATCH trial, as described in a previous study where all 150 participants have been reported [2]. This prior study dealt with the reproducibility of qualitatively assessed coronary atherosclerosis [2].…”

“…Fifty patients were randomly selected from the VERDICT cohort and subsequently matched according to age and gender with participants from the CGPS and CATCH trial, as described in a previous study where all 150 participants have been reported [2]. This prior study dealt with the reproducibility of qualitatively assessed coronary atherosclerosis [2]. Matching was prioritised in this study as increasing burden of CAD and increasing calcification with age and gender are well known factors that could influence reproducibility estimates if not accounted for.…”

“…Multidetector computed tomography (MDCT) is a guideline recommended non-invasive imaging modality for the assessment of obstructive coronary artery disease (CAD) [1]. Recent advancements in software technology now allow for semi-automated quantitative assessment of coronary atherosclerosis, thereby providing a detailed description of coronary plaque morphology with the potential for improved reproducibility and accuracy compared to traditional qualitative MDCT assessments [2].…”

“…Coronary plaque morphology has, however, been shown to differ in different patient populations, with the majority of research conducted in patients with stable angina and in patients with acute coronary syndrome (ACS) [6,7]. It can be hypothesized that these differences may affect QCT reproducibility assessments as correct identification of mild levels of coronary disease, especially non-calcified plaque [2], as well as correct discernment of lumen and vessel contours in severe levels of coronary disease, especially combined with even slight motion, noise, or blooming artifacts, can be difficult. Studies investigating intraobserver and interobserver reproducibility using semi-automated QCT are, however, few and reproducibility has only been investigated in relatively small numbers of highly selected patients with low-intermediate plaque burdens [8][9][10][11].…”