Abstract
PurposeQuantitative computed tomography (QCT) provides important prognostic information of coronary atherosclerosis. We investigated intraobserver and interobserver QCT reproducibility in asymptomatic individuals, patients with acute chest pain without acute coronary syndrome (ACS), and patients with acute chest pain and ACS.MethodsFifty patients from each cohort, scanned between 01/02/2010-14/11/2013 and matched according to age and gender, were retrospectively assessed for inclusion. Patients with no coronary artery disease, previous coronary artery bypass graft surgery, and poor image quality were excluded. Coronary atherosclerosis was measured semi-automatically by 2 readers. Reproducibility of minimal lumen area (MLA), minimal lumen diameter (MLD), area stenosis, diameter stenosis, vessel remodeling, plaque eccentricity, plaque burden, and plaque volumes was assessed using concordance correlation coefficient (CCC), Bland-Altman, coefficient of variation, and Cohen’s kappa.ResultsA total of 84 patients (63 matched) were included. Intraobserver and interobserver reproducibility estimates were acceptable for MLA (CCC = 0.94 and CCC = 0.91, respectively), MLD (CCC = 0.92 and CCC = 0.86, respectively), plaque burden (CCC = 0.86 and CCC = 0.80, respectively), and plaque volume (CCC = 0.97 and CCC = 0.95, respectively). QCT detected area and diameter stenosis ≥50%, positive remodeling, and eccentric plaque with moderate-good intraobserver and interobserver reproducibility (kappa: 0.64–0.66, 0.69–0.76, 0.46–0.48, and 0.41–0.62, respectively). Reproducibility of plaque composition decreased with decreasing plaque density (intraobserver and interobserver CCC for dense calcium (>0.99; 0.98), fibrotic (0.96; 0.93), fibro-fatty (0.95; 0.91), and necrotic core tissue (0.89; 0.84). Reproducibility generally decreased with worsening clinical risk profile.ConclusionsSemi-automated QCT of coronary plaque morphology is reproducible, albeit with some decline in reproducibility with worsening patient risk profile.
Highlights
Multidetector computed tomography (MDCT) is a guideline recommended non-invasive imaging modality for the assessment of obstructive coronary artery disease (CAD)[1]
Intraobserver and interobserver reproducibility estimates were acceptable for minimal lumen area (MLA) (CCC = 0.94 and correlation coefficient (CCC) = 0.91, respectively), minimal lumen diameter (MLD) (CCC = 0.92 and CCC = 0.86, respectively), plaque burden (CCC = 0.86 and CCC = 0.80, respectively), and plaque volume (CCC = 0.97 and CCC = 0.95, respectively)
Recent advancements in software technology allow for semi-automated quantitative assessment of coronary atherosclerosis, thereby providing a detailed description of coronary plaque morphology with the potential for improved reproducibility and accuracy compared to traditional qualitative MDCT assessments[2]
Summary
Multidetector computed tomography (MDCT) is a guideline recommended non-invasive imaging modality for the assessment of obstructive coronary artery disease (CAD)[1]. Recent advancements in software technology allow for semi-automated quantitative assessment of coronary atherosclerosis, thereby providing a detailed description of coronary plaque morphology with the potential for improved reproducibility and accuracy compared to traditional qualitative MDCT assessments[2]. Good reproducibility of quantitative computed tomography (QCT) is important for diagnostic purposes and for risk-stratification purposes in various patient populations[3,4,5]. Studies investigating intraobserver and interobserver reproducibility using semi-automated QCT are, few and reproducibility has only been investigated in relatively small numbers of highly selected patients with low-intermediate plaque burdens[8,9,10,11]
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