Mohammed N Meah1, Trisha Singh2, Michelle C Williams3, Marc R Dweck2, David E Newby3, Piotr Slomka4, Philip D Adamson5, Alastair J Moss6, Damini Dey4. 1. British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. Electronic address: m.meah@ed.ac.uk. 2. British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. 3. British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK. 4. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 5. British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand. 6. British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; British Heart Foundation Cardiovascular Research Centre. University of Leicester, Leicester, UK.
Abstract
BACKGROUND: The ability to characterize and to quantify the extent of coronary artery disease has the potential to improve the prognostic capability of coronary computed tomography angiography. Although reproducible techniques have been described in those with mild coronary disease, this has yet to be assessed in patients with advanced disease. METHODS: Twenty patients with known multivessel disease underwent repeated computed tomography coronary angiography, 2 weeks apart. Coronary artery segments were analysed using semi-automated software by two trained observers to determine intraobserver, interobserver and interscan reproducibility. RESULTS: Overall, 149 coronary arterial segments were analysed. There was excellent intraobserver and interobserver agreement for all plaque volume measurements (Lin's coefficient 0.95 to 1.0). There were no substantial interscan differences (P > 0.05 for all) for total (2063 ± 1246 mm3, mean of differences -35.6 mm3), non-calcified (1795 ± 910 mm3, mean of differences -4.3 mm3), calcified (298 ± 425 mm3, mean of differences -31.3 mm3) and low-attenuation (13 ± 13 mm3, mean of differences -2.6 mm3) plaque volumes. Interscan agreement was highest for total and noncalcified plaque volumes. Calcified and low-attenuation plaque (-236.6 to 174 mm3 and -15.8 to 10.5 mm3 respectively) had relatively wider 95% limits of agreement reflecting the lower absolute plaque volumes. CONCLUSION: In the presence of advanced coronary disease, semi-automated plaque quantification provides excellent reproducibility, particularly for total and non-calcified plaque volumes. This approach has major potential to assess change in disease over time and optimize risk stratification in patients with established coronary artery disease.
BACKGROUND: The ability to characterize and to quantify the extent of coronary artery disease has the potential to improve the prognostic capability of coronary computed tomography angiography. Although reproducible techniques have been described in those with mild coronary disease, this has yet to be assessed in patients with advanced disease. METHODS: Twenty patients with known multivessel disease underwent repeated computed tomography coronary angiography, 2 weeks apart. Coronary artery segments were analysed using semi-automated software by two trained observers to determine intraobserver, interobserver and interscan reproducibility. RESULTS: Overall, 149 coronary arterial segments were analysed. There was excellent intraobserver and interobserver agreement for all plaque volume measurements (Lin's coefficient 0.95 to 1.0). There were no substantial interscan differences (P > 0.05 for all) for total (2063 ± 1246 mm3, mean of differences -35.6 mm3), non-calcified (1795 ± 910 mm3, mean of differences -4.3 mm3), calcified (298 ± 425 mm3, mean of differences -31.3 mm3) and low-attenuation (13 ± 13 mm3, mean of differences -2.6 mm3) plaque volumes. Interscan agreement was highest for total and noncalcified plaque volumes. Calcified and low-attenuation plaque (-236.6 to 174 mm3 and -15.8 to 10.5 mm3 respectively) had relatively wider 95% limits of agreement reflecting the lower absolute plaque volumes. CONCLUSION: In the presence of advanced coronary disease, semi-automated plaque quantification provides excellent reproducibility, particularly for total and non-calcified plaque volumes. This approach has major potential to assess change in disease over time and optimize risk stratification in patients with established coronary artery disease.
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