Quantitative coronary plaque analysis predicts high-risk plaque morphology on coronary computed tomography angiography: results from the ROMICAT II trial

Ting Liu, Pál Maurovich-Horvat, Thomas Mayrhofer, Stefan B. Puchner, Michael T. Lu, Khristine Ghemigian, Pieter H. Kitslaar, Alexander Broersen, Amit Pursnani, Udo Hoffmann, Maros Ferencik

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Semi-automated software can provide quantitative assessment of atherosclerotic plaques on coronary CT angiography (CTA). The relationship between established qualitative high-risk plaque features and quantitative plaque measurements has not been studied. We analyzed the association between quantitative plaque measurements and qualitative high-risk plaque features on coronary CTA. We included 260 patients with plaque who underwent coronary CTA in the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) II trial. Quantitative plaque assessment and qualitative plaque characterization were performed on a per coronary segment basis. Quantitative coronary plaque measurements included plaque volume, plaque burden, remodeling index, and diameter stenosis. In qualitative analysis, high-risk plaque was present if positive remodeling, low CT attenuation plaque, napkin-ring sign or spotty calcium were detected. Univariable and multivariable logistic regression analyses were performed to assess the association between quantitative and qualitative high-risk plaque assessment. Among 888 segments with coronary plaque, high-risk plaque was present in 391 (44.0%) segments by qualitative analysis. In quantitative analysis, segments with high-risk plaque had higher total plaque volume, low CT attenuation plaque volume, plaque burden and remodeling index. Quantitatively assessed low CT attenuation plaque volume (odds ratio 1.12 per 1 mm3, 95% CI 1.04–1.21), positive remodeling (odds ratio 1.25 per 0.1, 95% CI 1.10–1.41) and plaque burden (odds ratio 1.53 per 0.1, 95% CI 1.08–2.16) were associated with high-risk plaque. Quantitative coronary plaque characteristics (low CT attenuation plaque volume, positive remodeling and plaque burden) measured by semi-automated software correlated with qualitative assessment of high-risk plaque features.

Original languageEnglish (US)
Pages (from-to)311-319
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number2
StatePublished - Feb 1 2018


  • Coronary CT angiography
  • Coronary atherosclerosis
  • High-risk coronary plaque
  • Quantitative assessment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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