Automated 3-dimensional quantification of noncalcified and calcified coronary plaque from coronary CT angiography

Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building, A238, Los Angeles, CA 90048, USA.
Journal of cardiovascular computed tomography (Impact Factor: 2.29). 11/2009; 3(6):372-82. DOI: 10.1016/j.jcct.2009.09.004
Source: PubMed


We aimed to develop an automated algorithm (APQ) for accurate volumetric quantification of non-calcified (NCP) and calcified plaque (CP) from coronary CT angiography (CCTA).
APQ determines scan-specific attenuation thresholds for lumen, NCP, CP and epicardial fat, and applies knowledge-based segmentation and modeling of coronary arteries, to define NCP and CP components in 3D. We tested APQ in 29 plaques for 24 consecutive scans, acquired with dual-source CT scanner. APQ results were compared to volumes obtained by manual slice-by-slice NCP/CP definition and by interactive adjustment of plaque thresholds (ITA) by 2 independent experts.
APQ analysis time was <2 sec per lesion. There was strong correlation between the 2 readers for manual quantification (r = 0.99, p < 0.0001 for NCP; r = 0.85, p < 0.0001 for CP). The mean HU determined by APQ was 419 +/- 78 for luminal contrast at mid-lesion, 227 +/- 40 for NCP upper threshold, and 511 +/- 80 for the CP lower threshold. APQ showed a significantly lower absolute difference (26.7 mm(3) vs. 42.1 mm(3), p = 0.01), lower bias than ITA (32.6 mm(3) vs 64.4 mm(3), p = 0.01) for NCP. There was strong correlation between APQ and readers (R = 0.94, p < 0.0001 for NCP volumes; R = 0.88, p < 0.0001, for CP volumes; R = 0.90, p < 0.0001 for NCP and CP composition).
We developed a fast automated algorithm for quantification of NCP and CP from CCTA, which is in close agreement with expert manual quantification.

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    • "Although the prognostic impact links to not only calcified plaque volume, but also noncalcified plaque volume, the metric assessment of plaque volume may be time consuming. Recently, novel techniques can allow the measurement of coronary plaque volume observed on CCTA including calcified and/or noncalcified plaque using semiautomated CT software [66, 67], with high accuracy compared to IVUS [68]. The relation of the total coronary plaque volume as determined by the overall coronary atherosclerotic burden in predicting the future cardiovascular events has not yet been examined. "
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    ABSTRACT: For a decade, coronary computed tomographic angiography (CCTA) has been used as a promising noninvasive modality for the assessment of coronary artery disease (CAD) as well as cardiovascular risks. CCTA can provide more information incorporating the presence, extent, and severity of CAD; coronary plaque burden; and characteristics that highly correlate with those on invasive coronary angiography. Moreover, recent techniques of CCTA allow assessing hemodynamic significance of CAD. CCTA may be potentially used as a substitute for other invasive or noninvasive modalities. This review summarizes risk stratification by anatomical and hemodynamic information of CAD, coronary plaque characteristics, and burden observed on CCTA.
    09/2014; 2014:278039. DOI:10.1155/2014/278039
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    • "Recently, many studies had shown different ranges of the attenuation values in various compositions of plaque [6, 10, 14, 15, 17, 20]. However, according to previous studies, even IVUS has some limitations in the assessment of the true composition and vulnerability of plaque, due to substantial overlap of the corresponding attenuation values [17, 21]. As such, we further subdivided attenuation values on the wall into six levels to describe the various severities of the plaques. "
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    ABSTRACT: Noncalcified plaques (NCPs) are associated with the presence of lipid-core plaques that are prone to rupture. Thus, it is important to detect and monitor the development of NCPs. Contrast-enhanced coronary Computed Tomography Angiography (CTA) is a potential imaging technique to identify atherosclerotic plaques in the whole coronary tree, but it fails to provide information about vessel walls. In order to overcome the limitations of coronary CTA and provide more meaningful quantitative information for percutaneous coronary intervention (PCI), we proposed a Voxel-Map based on mathematical morphology to quantitatively analyze the noncalcified plaques on a three-dimensional coronary artery wall model (3D-CAWM). This approach is a combination of Voxel-Map analysis techniques, plaque locating, and anatomical location related labeling, which show more detailed and comprehensive coronary tree wall visualization.
    Computational and Mathematical Methods in Medicine 11/2013; 2013:957195. DOI:10.1155/2013/957195 · 0.77 Impact Factor
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    • "Robust and time efficient automated software has been recently introduced in the context of automated 3-dimensional (3D) quantification for coronary plaques and showed very good agreement with expert manual plaque quantification as well as excellent correlation to coronary intravascular ultrasound plaque volumetry (24, 25). The latest software developments aim to further improve myocardial contour detection (26). "
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    ABSTRACT: We aimed to evaluate the time efficiency and diagnostic accuracy of automated myocardial computed tomography perfusion (CTP) image analysis software. 320-row CTP was performed in 30 patients, and analyses were conducted independently by three different blinded readers by the use of two recent software releases (version 4.6 and novel version 4.71GR001, Toshiba, Tokyo, Japan). Analysis times were compared, and automated epi- and endocardial contour detection was subjectively rated in five categories (excellent, good, fair, poor and very poor). As semi-quantitative perfusion parameters, myocardial attenuation and transmural perfusion ratio (TPR) were calculated for each myocardial segment and agreement was tested by using the intraclass correlation coefficient (ICC). Conventional coronary angiography served as reference standard. The analysis time was significantly reduced with the novel automated software version as compared with the former release (Reader 1: 43:08 ± 11:39 min vs. 09:47 ± 04:51 min, Reader 2: 42:07 ± 06:44 min vs. 09:42 ± 02:50 min and Reader 3: 21:38 ± 3:44 min vs. 07:34 ± 02:12 min; p < 0.001 for all). Epi- and endocardial contour detection for the novel software was rated to be significantly better (p < 0.001) than with the former software. ICCs demonstrated strong agreement (≥ 0.75) for myocardial attenuation in 93% and for TPR in 82%. Diagnostic accuracy for the two software versions was not significantly different (p = 0.169) as compared with conventional coronary angiography. The novel automated CTP analysis software offers enhanced time efficiency with an improvement by a factor of about four, while maintaining diagnostic accuracy.
    Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(1):21-9. DOI:10.3348/kjr.2013.14.1.21 · 1.57 Impact Factor
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