Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

Stefan B. Puchner; Maros Ferencik; Pal Maurovich-Horvat; Masataka Nakano; Fumiyuki Otsuka; Hans Ulrich Kauczor; Renu Virmani; Udo Hoffmann; Christopher L. Schlett

doi:10.1007/s00330-014-3404-6

Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

Stefan B. Puchner, Maros Ferencik, Pal Maurovich-Horvat, Masataka Nakano, Fumiyuki Otsuka, Hans Ulrich Kauczor, Renu Virmani, Udo Hoffmann, Christopher L. Schlett

Research output: Contribution to journal › Article › peer-review

29 Scopus citations

Abstract

Objectives: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.

Methods and materials: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.

Results: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm²: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.

Conclusion: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

Original language	English (US)
Pages (from-to)	15-23
Number of pages	9
Journal	European Radiology
Volume	25
Issue number	1
DOIs	https://doi.org/10.1007/s00330-014-3404-6
State	Published - Jan 2015
Externally published	Yes

Keywords

Coronary CT angiography
Diagnostic accuracy
Iterative reconstruction algorithm
Low attenuation plaque
Vulnerable plaque

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1007/s00330-014-3404-6

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title = "Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology",

abstract = "Objectives: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.Methods and materials: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.Results: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm2: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.Conclusion: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.",

keywords = "Coronary CT angiography, Diagnostic accuracy, Iterative reconstruction algorithm, Low attenuation plaque, Vulnerable plaque",

author = "Puchner, {Stefan B.} and Maros Ferencik and Pal Maurovich-Horvat and Masataka Nakano and Fumiyuki Otsuka and Kauczor, {Hans Ulrich} and Renu Virmani and Udo Hoffmann and Schlett, {Christopher L.}",

note = "Publisher Copyright: {\textcopyright} 2014, European Society of Radiology.",

year = "2015",

month = jan,

doi = "10.1007/s00330-014-3404-6",

language = "English (US)",

volume = "25",

pages = "15--23",

journal = "European Radiology",

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T1 - Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

AU - Puchner, Stefan B.

AU - Ferencik, Maros

AU - Maurovich-Horvat, Pal

AU - Nakano, Masataka

AU - Otsuka, Fumiyuki

AU - Kauczor, Hans Ulrich

AU - Virmani, Renu

AU - Hoffmann, Udo

AU - Schlett, Christopher L.

PY - 2015/1

Y1 - 2015/1

N2 - Objectives: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.Methods and materials: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.Results: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm2: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.Conclusion: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

AB - Objectives: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.Methods and materials: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.Results: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm2: 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.Conclusion: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

KW - Coronary CT angiography

KW - Diagnostic accuracy

KW - Iterative reconstruction algorithm

KW - Low attenuation plaque

KW - Vulnerable plaque

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Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque – a comparison with histology

Abstract

Keywords

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