Visual and automatic grading of coronary artery stenoses with 64-slice CT angiography in reference to invasive angiography

Busch, Stephanie; Johnson, Thorsten R. C.; Nikolaou, Konstantin; Ziegler, Franz von; Knez, Andreas; Reiser, Maximilian; Becker, Christoph R.

doi:10.1007/s00330-006-0512-y

Cited by 55 publications

(41 citation statements)

References 30 publications

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“…Quantitative assessment of coronary stenoses has been shown to have relatively large limits of agreement when 16-slice CTCA [13,14] and 64-slice CTCA are used [3,27]. Coronary vessel attenuation is known to vary widely in different CTCA examinations [17,18,22,23], and might affect the accuracy of stenosis quantification by CTCA.…”

Section: Discussionmentioning

confidence: 99%

Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT

Husmann

Gaemperli

Valenta

et al. 2009

BJR

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ABSTRACT. The aim of the study was to determine the impact of vessel attenuation on quantitative 64-slice computed tomography coronary angiography (CTCA). CTCA and invasive quantitative coronary angiography (QCA) were performed in 100 consecutive patients (42 women, 58 men; mean age 64.4¡9.4 years; age range 39-87 years). In QCA, stenoses were quantified with dedicated software, whereas in CTCA, stenosis severity was assessed with an electronic caliper tool: stenoses were graded in 10% steps and assigned as either a calcified or non-calcified lesion. Vessel attenuation in the left main (LMA) and the proximal right coronary artery (RCA) were measured and correlated with differences in quantifications of stenosis grade between QCA and CTCA. A total of 113 coronary stenoses were detected by both methods (94 significant and 19 nonsignificant); 52 stenoses were rated as non-calcified and 61 as calcified lesions. The mean difference between QCA and quantitative CTCA grading was 5.1¡16.9% (range 227 to 46%) overall; 1.9¡14.2% (range 227 to 38%) for non-calcified lesions and 7.8¡18.6% (range 223 to 46%) for calcified lesions. Mean vessel attenuation was 362¡76 HU (range 191-584 HU) in the LMA and 333¡81 HU (range 162-564 HU) in the RCA. Attenuation did not significantly correlate with differences in QCA and CTCA gradings, neither overall nor for calcified or non-calcified lesions. When 64-slice CTCA is used, coronary vessel attenuation had no impact on the quantitative grading of stenoses. 64-slice CT has been shown to reliably detect significant coronary artery disease (CAD) [1][2][3][4][5][6][7][8][9][10][11]. For clinical decision-making, exact quantification of lesion severity can be important [12]. However, the quantification of coronary artery stenoses by CT coronary angiography (CTCA) is subjected to relatively large limits of agreement compared to the clinical reference standard, quantitative coronary angiography (QCA) [2,3,[13][14][15]. It has been hypothesised that coronary vessel attenuation affects the accuracy of quantitative CTCA [16][17][18]. Several factors related to the contrast material regimen, such as the type and iodine concentration of the contrast material [18], the technique for bolus timing [17], and the injection volume and rate [19], have been shown to affect the attenuation of coronary arteries. Furthermore, current CTCA protocols [1-11] do not adapt to the individual patient's body mass index or to the individual's cardiac output, although these parameters may contribute to vessel attenuation [20][21][22][23]. As a consequence, attenuation in CTCA has been shown to vary strongly [17,18,22,23] and the ideal attenuation remains undefined.The purpose of this study was to determine the impact of vessel attenuation on quantitative CTCA. Methods and materialsPatients A total of 100 consecutive patients (42 women and 58 men; mean age 64.4¡9.4 years; age range 39-87 years; mean body mass index (BMI) 22.0¡3.5; BMI range 12.8-31.4) underwent QCA and CTCA and were prospectively enrolled in the present...

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Section: Discussionmentioning

confidence: 99%

Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT

Husmann

Gaemperli

Valenta

et al. 2009

BJR

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“…A few authors have assessed the computerised quantification of coronary artery stenosis using commercially available software [12,13]. In a later study by Busch et al [12], quantitative assessment of CTA achieved a high PPV of 89%, whereas the visual assessment revealed a PPV of only 53%.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to automatic detection of the centreline of coronary arteries within 3-dimensional CT datasets [10,11], recent computerbased segmentation and quantification systems also permits the computerised estimation of the percent diameter stenosis. The computerised (i.e., software-assisted) quantification of stenosis degree is suspected to be an important factor in eliminating observer dependency and reducing the variability of MDCT [12]. However, there are few reports concerning the diagnostic performance of computerised quantification [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…The computerised (i.e., software-assisted) quantification of stenosis degree is suspected to be an important factor in eliminating observer dependency and reducing the variability of MDCT [12]. However, there are few reports concerning the diagnostic performance of computerised quantification [12,13]. Furthermore, the impact of plaque composition with respect to computerised quantification has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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CT comparison of visual and computerised quantification of coronary stenosis according to plaque composition

Kang

Park

et al. 2010

Eur Radiol

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Objective To compare the diagnostic performance of computerised quantification with visual assessment for the detection of significant coronary stenosis using MDCT, and to determine the impact of plaque composition on diagnostic procedure. Methods We retrospectively evaluated 1564 coronary segments of 127 patients who underwent 64-slice MDCT and quantitative coronary angiography (QCA). The lesions were analysed with both methods of visual assessment and computerised quantification using an automatic vessel contour detection tool, and the results were compared with the QCA results. Plaques detected with MDCT were classified as calcified, mixed, and non-calcified according to plaque composition. Results The sensitivity and PPV of visual assessment (computerised quantification) were 95% (86%) and 76% (81%), respectively. Bland-Altman analysis demonstrated a mean difference of −5.2±21.6% for all lesions, 2.2±23.7 for calcified plaques, and −12.0±17.2% for non-calcified plaques. The correlation coefficients and limits of agreement between CTA and QCA were 0.48 and ±46.5% (0.74 and ±33.7%) in the lesions with calcified plaques (noncalcified plaques). ConclusionsThe computerised quantification decreases the sensitivity due to underestimation of non-calcified plaques compared with visual assessment, and had a poorer correlation and a larger limit of agreement in the lesions with calcified plaque compared with non-calcified plaques.

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“…The degree of coronary stenosis is manually calculated by subtracting vessel diameter at the site of maximal stenosis from the mean of the vessel reference segment diameters (proximal and distal references) and then dividing the difference by the mean of the vessel reference segment diameters on curved MPR and cross-sectional image (Fig 22). Recent cardiac-vessel analysis packages enables calculating percent stenosis automatically when the user selects the area of maximum narrowing and normal vessel proximal and distal to the stenosis (Busch et al, 2007). However, current spatial resolution of CT has not demonstrated sufficient reproducibility or accuracy in predicting findings of CAG to make such measurements a routine requirement.…”

Section: A Assessment Of Stenosis Severitymentioning

confidence: 99%

Image Post-Processing and Interpretation

Jinzaki¹,

Yamada²,

Kuribayashi³

2011

Advances in the Diagnosis of Coronary Atherosclerosis

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Visual and automatic grading of coronary artery stenoses with 64-slice CT angiography in reference to invasive angiography

Cited by 55 publications

References 30 publications

Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT

Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT

CT comparison of visual and computerised quantification of coronary stenosis according to plaque composition

Image Post-Processing and Interpretation

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