How to assess non-calcified plaque in CT angiography: Delineation methods affect diagnostic accuracy of low-attenuation plaque by CT for lipid-core plaque in histology

Christopher L. Schlett, Maros Ferencik, Csilla Celeng, Pál Maurovich-Horvat, Hans Scheffel, Paul Stolzmann, Synho Do, Hans Ulrich Kauczor, Hatem Alkadhi, Fabian Bamberg, Udo Hoffmann

    Research output: Contribution to journalArticle

    17 Scopus citations

    Abstract

    AimsTo compare the accuracy of two plaque delineation methods for coronary computed tomographic angiography (CTA) to identify lipid-core plaque (LCP) using histology as the reference standard.Methods and resultsFive ex vivo hearts were analysed by CTA and histology. LCP was defined by histology as fibroatheroma with core diameter/circumference >200 μm/>60° and cap thickness <450 μm. In CTA, plaque was manually delineated either as the difference between the inner and outer vessel walls (Method A) or as a direct tracing of plaque (Method B). Low-attenuation plaque was defined as an area with <90 Hounsfield units. Of 446 co-registered cross-sections, 55 (12%) contained LCP. In CTA, low-attenuation plaque area was larger as assessed with Method A compared with Method B (difference: 120 ± 60%). Although low-attenuation plaque was associated with the presence of LCP, the delineation Method B yielded higher diagnostic accuracy than Method A [area under the curve (AUC): 0.831 vs. 0.780, respectively, P = 0.005]. After excluding 'normal' cross-sections by CTA (n = 117), AUC for detecting LCP became similar between both methods (0.767 vs. 0.729, P = 0.07, respectively).ConclusionLow-attenuation plaque in CTA is a diagnostic tool for LCP but prone to error if plaque is defined as the area between the inner and outer vessel walls and normal cross-sections are included in the assessment.

    Original languageEnglish (US)
    Pages (from-to)1099-1105
    Number of pages7
    JournalEuropean heart journal cardiovascular Imaging
    Volume14
    Issue number11
    DOIs
    StatePublished - Nov 1 2013

    Keywords

    • (Semi)-Automated plaque assessment
    • Coronary computed tomographic angiography
    • Low-attenuation plaque
    • Plaque delineation techniques

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

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  • Cite this

    Schlett, C. L., Ferencik, M., Celeng, C., Maurovich-Horvat, P., Scheffel, H., Stolzmann, P., Do, S., Kauczor, H. U., Alkadhi, H., Bamberg, F., & Hoffmann, U. (2013). How to assess non-calcified plaque in CT angiography: Delineation methods affect diagnostic accuracy of low-attenuation plaque by CT for lipid-core plaque in histology. European heart journal cardiovascular Imaging, 14(11), 1099-1105. https://doi.org/10.1093/ehjci/jet030