Purpose: To evaluate the infl uence of cross-sectional arc calcifi cation on the diagnostic accuracy of computed tomography (CT) angiography compared with conventional coronary angiography for the detection of obstructive coronary artery disease (CAD). Materials and Methods: Institutional Review Board approval and written informed consent were obtained from all centers and participants for this HIPAA-compliant study. Overall, 4511 segments from 371 symptomatic patients (279 men, 92 women; median age, 61 years [interquartile range, 53-67 years]) with clinical suspicion of CAD from the CORE-64 multicenter study were included in the analysis. Two independent blinded observers evaluated the percentage of diameter stenosis and the circumferential extent of calcium (arc calcium). The accuracy of quantitative multidetector CT angiography to depict substantial ( ≥50%) stenoses was assessed by using quantitative coronary angiography (QCA). Cross-sectional arc calcium was rated on a segment level as follows: noncalcifi ed or mild ( < 90° ), moderate (90° -180° ), or severe ( > 180° ) calcifi cation. Univariable and multivariable logistic regression, receiver operation characteristic curve, and clustering methods were used for statistical analyses. Results: A total of 1099 segments had mild calcifi cation, 503 had moderate calcifi cation, 338 had severe calcifi cation, and 2571 segments were noncalcifi ed. Calcifi ed segments were highly associated ( P < .001) with disagreement between CTA and QCA in multivariable analysis after controlling for sex, age, heart rate, and image quality. The prevalence of CAD was 5.4% in noncalcifi ed segments, 15.0% in mildly calcifi ed segments, 27.0% in moderately calcifi ed segments, and 43.0% in severely calcifi ed segments. A signifi cant difference was found in area under the receiver operating characteristic curves (noncalcifi ed: 0.86, mildly calcifi ed: 0.85, moderately calcifi ed: 0.82, severely calcifi ed: 0.81; P < .05). Conclusion: In a symptomatic patient population, segment-based coronary artery calcifi cation signifi cantly decreased agreement between multidetector CT angiography and QCA to detect a coronary stenosis of at least 50%.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging