Accuracy of quantitative coronary angiography with computed tomography and its dependency on plaque composition : Plaque composition and accuracy of cardiac CT

Husmann, Lars ; Gaemperli, Oliver ; Schepis, Tiziano ; Scheffel, Hans ; Valenta, Ines ; Hoefflinghaus, Tobias ; Stolzmann, Paul ; Desbiolles, Lotus ; Herzog, Bernhard ; Leschka, Sebastian ; Marincek, Borut ; Alkadhi, Hatem ; Kaufmann, Philipp

In: The International Journal of Cardiovascular Imaging, 2008, vol. 24, no. 8, p. 895-904

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    Summary
    Objective: To determine the impact of plaque composition on accuracy of quantitative 64-slice computed tomography coronary angiography (CTCA). Methods: The institutional review board approved this study; written informed consent was obtained from all patients. One hundred consecutive patients (42 women, mean age 64.6±9.4years, age range 39-87years) underwent CTCA and invasive quantitative coronary angiography (QCA) to determine (a) the diagnostic accuracy of CTCA for the detection of significant stenosis (diameter reduction of≥50%), and (b) the accuracy of stenosis grading. In CTCA stenosis severity was graded in 10% steps and evaluated separately for calcified and non-calcified coronary lesions using Pearson-linear-regression analysis, Bland/Altman-analysis (BA), and Mann-Whitney-U-test. Results: In 60/100 patients 139 significant coronary artery stenoses were identified with QCA. On a per-segment analysis, sensitivity of CTCA was 75.5%, and specificity was 96.6% (positive predictive value: 72.9%, negative predictive value: 97.0%). Quantification of stenosis grading correlated moderately between methods (r=0.60; P<0.001), with an overestimation by CTCA of 5.5% (BA limits-of-agreement −29 to 39%). BA limits-of-agreement were greater in calcified lesions (−29.2 to 45.6%; mean error 8.2%) than in non-calcified lesions (−25.9 to 30.2%; mean error 2.2%) and differed significantly (P<0.05). Conclusions: Diagnostic accuracy of CTCA is high, however agreement for quantitative lesion severity assessment between CTCA and QCA is moderate for calcified but superior for non-calcified lesions