Patient characteristics as predictors of image quality and diagnostic accuracy of MDCT compared with conventional coronary angiography for detecting coronary artery stenoses: CORE-64 multicenter international trial

Marc Dewey, Andrea L. Vavere, Armin Zadeh, Julie M Miller, Leonardo Sara, Christopher Cox, Ilan Gottlieb, Kunihiro Yoshioka, Narinder Paul, John Hoe, Albert De Roos, Albert C. Lardo, Joao Lima, Melvin E. Clouse

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of the study was to investigate patient characteristics associated with image quality and their impact on the diagnostic accuracy of MDCT for the detection of coronary artery stenosis. MATERIALS AND METHODS. Two hundred ninety-one patients with a coronary artery calcification (CAC) score of ≤ 600 Agatston units (214 men and 77 women; mean age, 59.3 ± 10.0 years [SD]) were analyzed. An overall image quality score was derived using an ordinal scale. The accuracy of quantitative MDCT to detect significant (≥ 50%) stenoses was assessed using quantitative coronary angiography (QCA) per patient and per vessel using a modified 19-segment model. The effect of CAC, obesity, heart rate, and heart rate variability on image quality and accuracy were evaluated by multiple logistic regression. Image quality and accuracy were further analyzed in subgroups of significant predictor variables. Diagnostic analysis was determined for image quality strata using receiver operating characteristic (ROC) curves. RESULTS. Increasing body mass index (BMI) (odds ratio [OR] = 0.89, p <0.001), increasing heart rate (OR = 0.90, p <0.001), and the presence of breathing artifact (OR = 4.97, p ≤ 0.001) were associated with poorer image quality whereas sex, CAC score, and heart rate variability were not. Compared with examinations of white patients, studies of black patients had significantly poorer image quality (OR = 0.58, p = 0.04). At a vessel level, CAC score (10 Agatston units) (OR = 1.03, p = 0.012) and patient age (OR = 1.02, p = 0.04) were significantly associated with the diagnostic accuracy of quantitative MDCT compared with QCA. A trend was observed in differences in the areas under the ROC curves across image quality strata at the vessel level (p = 0.08). CONCLUSION. Image quality is significantly associated with patient ethnicity, BMI, mean scan heart rate, and the presence of breathing artifact but not with CAC score at a patient level. At a vessel level, CAC score and age were associated with reduced diagnostic accuracy.

Original languageEnglish (US)
Pages (from-to)93-102
Number of pages10
JournalAmerican Journal of Roentgenology
Volume194
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Coronary Stenosis
Coronary Angiography
Multicenter Studies
Coronary Vessels
Odds Ratio
Heart Rate
ROC Curve
Artifacts
Respiration
Body Mass Index
Pathologic Constriction
Obesity
Logistic Models

Keywords

  • Angiography
  • Body mass index
  • CORE-64
  • Coronary artery calcium
  • Heart rate
  • Hemodynamics
  • Image quality
  • MDCT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Patient characteristics as predictors of image quality and diagnostic accuracy of MDCT compared with conventional coronary angiography for detecting coronary artery stenoses : CORE-64 multicenter international trial. / Dewey, Marc; Vavere, Andrea L.; Zadeh, Armin; Miller, Julie M; Sara, Leonardo; Cox, Christopher; Gottlieb, Ilan; Yoshioka, Kunihiro; Paul, Narinder; Hoe, John; De Roos, Albert; Lardo, Albert C.; Lima, Joao; Clouse, Melvin E.

In: American Journal of Roentgenology, Vol. 194, No. 1, 01.2010, p. 93-102.

Research output: Contribution to journalArticle

Dewey, Marc ; Vavere, Andrea L. ; Zadeh, Armin ; Miller, Julie M ; Sara, Leonardo ; Cox, Christopher ; Gottlieb, Ilan ; Yoshioka, Kunihiro ; Paul, Narinder ; Hoe, John ; De Roos, Albert ; Lardo, Albert C. ; Lima, Joao ; Clouse, Melvin E. / Patient characteristics as predictors of image quality and diagnostic accuracy of MDCT compared with conventional coronary angiography for detecting coronary artery stenoses : CORE-64 multicenter international trial. In: American Journal of Roentgenology. 2010 ; Vol. 194, No. 1. pp. 93-102.
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abstract = "OBJECTIVE. The purpose of the study was to investigate patient characteristics associated with image quality and their impact on the diagnostic accuracy of MDCT for the detection of coronary artery stenosis. MATERIALS AND METHODS. Two hundred ninety-one patients with a coronary artery calcification (CAC) score of ≤ 600 Agatston units (214 men and 77 women; mean age, 59.3 ± 10.0 years [SD]) were analyzed. An overall image quality score was derived using an ordinal scale. The accuracy of quantitative MDCT to detect significant (≥ 50{\%}) stenoses was assessed using quantitative coronary angiography (QCA) per patient and per vessel using a modified 19-segment model. The effect of CAC, obesity, heart rate, and heart rate variability on image quality and accuracy were evaluated by multiple logistic regression. Image quality and accuracy were further analyzed in subgroups of significant predictor variables. Diagnostic analysis was determined for image quality strata using receiver operating characteristic (ROC) curves. RESULTS. Increasing body mass index (BMI) (odds ratio [OR] = 0.89, p <0.001), increasing heart rate (OR = 0.90, p <0.001), and the presence of breathing artifact (OR = 4.97, p ≤ 0.001) were associated with poorer image quality whereas sex, CAC score, and heart rate variability were not. Compared with examinations of white patients, studies of black patients had significantly poorer image quality (OR = 0.58, p = 0.04). At a vessel level, CAC score (10 Agatston units) (OR = 1.03, p = 0.012) and patient age (OR = 1.02, p = 0.04) were significantly associated with the diagnostic accuracy of quantitative MDCT compared with QCA. A trend was observed in differences in the areas under the ROC curves across image quality strata at the vessel level (p = 0.08). CONCLUSION. Image quality is significantly associated with patient ethnicity, BMI, mean scan heart rate, and the presence of breathing artifact but not with CAC score at a patient level. At a vessel level, CAC score and age were associated with reduced diagnostic accuracy.",
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AU - Dewey, Marc

AU - Vavere, Andrea L.

AU - Zadeh, Armin

AU - Miller, Julie M

AU - Sara, Leonardo

AU - Cox, Christopher

AU - Gottlieb, Ilan

AU - Yoshioka, Kunihiro

AU - Paul, Narinder

AU - Hoe, John

AU - De Roos, Albert

AU - Lardo, Albert C.

AU - Lima, Joao

AU - Clouse, Melvin E.

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N2 - OBJECTIVE. The purpose of the study was to investigate patient characteristics associated with image quality and their impact on the diagnostic accuracy of MDCT for the detection of coronary artery stenosis. MATERIALS AND METHODS. Two hundred ninety-one patients with a coronary artery calcification (CAC) score of ≤ 600 Agatston units (214 men and 77 women; mean age, 59.3 ± 10.0 years [SD]) were analyzed. An overall image quality score was derived using an ordinal scale. The accuracy of quantitative MDCT to detect significant (≥ 50%) stenoses was assessed using quantitative coronary angiography (QCA) per patient and per vessel using a modified 19-segment model. The effect of CAC, obesity, heart rate, and heart rate variability on image quality and accuracy were evaluated by multiple logistic regression. Image quality and accuracy were further analyzed in subgroups of significant predictor variables. Diagnostic analysis was determined for image quality strata using receiver operating characteristic (ROC) curves. RESULTS. Increasing body mass index (BMI) (odds ratio [OR] = 0.89, p <0.001), increasing heart rate (OR = 0.90, p <0.001), and the presence of breathing artifact (OR = 4.97, p ≤ 0.001) were associated with poorer image quality whereas sex, CAC score, and heart rate variability were not. Compared with examinations of white patients, studies of black patients had significantly poorer image quality (OR = 0.58, p = 0.04). At a vessel level, CAC score (10 Agatston units) (OR = 1.03, p = 0.012) and patient age (OR = 1.02, p = 0.04) were significantly associated with the diagnostic accuracy of quantitative MDCT compared with QCA. A trend was observed in differences in the areas under the ROC curves across image quality strata at the vessel level (p = 0.08). CONCLUSION. Image quality is significantly associated with patient ethnicity, BMI, mean scan heart rate, and the presence of breathing artifact but not with CAC score at a patient level. At a vessel level, CAC score and age were associated with reduced diagnostic accuracy.

AB - OBJECTIVE. The purpose of the study was to investigate patient characteristics associated with image quality and their impact on the diagnostic accuracy of MDCT for the detection of coronary artery stenosis. MATERIALS AND METHODS. Two hundred ninety-one patients with a coronary artery calcification (CAC) score of ≤ 600 Agatston units (214 men and 77 women; mean age, 59.3 ± 10.0 years [SD]) were analyzed. An overall image quality score was derived using an ordinal scale. The accuracy of quantitative MDCT to detect significant (≥ 50%) stenoses was assessed using quantitative coronary angiography (QCA) per patient and per vessel using a modified 19-segment model. The effect of CAC, obesity, heart rate, and heart rate variability on image quality and accuracy were evaluated by multiple logistic regression. Image quality and accuracy were further analyzed in subgroups of significant predictor variables. Diagnostic analysis was determined for image quality strata using receiver operating characteristic (ROC) curves. RESULTS. Increasing body mass index (BMI) (odds ratio [OR] = 0.89, p <0.001), increasing heart rate (OR = 0.90, p <0.001), and the presence of breathing artifact (OR = 4.97, p ≤ 0.001) were associated with poorer image quality whereas sex, CAC score, and heart rate variability were not. Compared with examinations of white patients, studies of black patients had significantly poorer image quality (OR = 0.58, p = 0.04). At a vessel level, CAC score (10 Agatston units) (OR = 1.03, p = 0.012) and patient age (OR = 1.02, p = 0.04) were significantly associated with the diagnostic accuracy of quantitative MDCT compared with QCA. A trend was observed in differences in the areas under the ROC curves across image quality strata at the vessel level (p = 0.08). CONCLUSION. Image quality is significantly associated with patient ethnicity, BMI, mean scan heart rate, and the presence of breathing artifact but not with CAC score at a patient level. At a vessel level, CAC score and age were associated with reduced diagnostic accuracy.

KW - Angiography

KW - Body mass index

KW - CORE-64

KW - Coronary artery calcium

KW - Heart rate

KW - Hemodynamics

KW - Image quality

KW - MDCT

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