TY - JOUR
T1 - Patterns of coronary arterial lesion calcification by a novel, cross-sectional CT angiographic assessment
AU - Cerci, Rodrigo
AU - Vavere, Andrea L.
AU - Miller, Julie M.
AU - Yoneyama, Kihei
AU - Rochitte, Carlos E.
AU - Dewey, Marc
AU - Niinuma, Hiroyuki
AU - Clouse, Melvin E.
AU - Laham, Roger
AU - Bush, David
AU - Shapiro, Edward P.
AU - Lardo, Albert C.
AU - Cox, Christopher
AU - Brinker, Jeffrey
AU - Lima, Joǎo A.C.
AU - Arbab-Zadeh, Armin
PY - 2013/10
Y1 - 2013/10
N2 - To investigate the patterns and diagnostic implications of coronary arterial lesion calcification by CT angiography (CTA) using a novel, cross-sectional grading method, we studied 371 patients enrolled in the CorE-64 study who underwent CTA and invasive angiography for detecting coronary artery stenoses by quantitative coronary angiography (QCA). The number of quadrants involving calcium on a cross-sectional view for ≥30 and ≥50 % lesions in 4,511 arterial segments was assessed by CTA according to: noncalcified, mild (one-quadrant), moderate (two-quadrant), severe (three-quadrant) and very severe (four-quadrant calcium). Area under the receiver operating characteristic curve (AUC) were used to evaluate CTA diagnostic accuracy and agreement versus. QCA for plaque types. Only 4 % of ≥50 % stenoses by QCA were very severely calcified while 43 % were noncalcified. AUC for CTA to detect ≥50 % stenoses by QCA for non-calcified, mildly, moderately, severely, and very severely calcified plaques were 0.90, 0.88, 0.83, 0.76 and 0.89, respectively (P<0.05). In 198 lesions with severe calcification, the presence or absence of a visible residual lumen by CTA was associated with≥50 %stenosis by QCA in 20.3 and 76.9 %, respectively. Kappa was 0.93 for interobserver variability in evaluating plaque calcification. We conclude that calcification of individual coronary artery lesions can be reliably graded using CTA. Most ≥50 % coronary artery stenoses are not or only mildly calcified. If no residual lumen is seen on CTA, calcified lesions are predictive of ≥50 % stenoses and vice versa. CTA diagnostic accuracy for detecting ≥50 % stenoses is reduced in lesions with more than mild calcification due to lower specificity.
AB - To investigate the patterns and diagnostic implications of coronary arterial lesion calcification by CT angiography (CTA) using a novel, cross-sectional grading method, we studied 371 patients enrolled in the CorE-64 study who underwent CTA and invasive angiography for detecting coronary artery stenoses by quantitative coronary angiography (QCA). The number of quadrants involving calcium on a cross-sectional view for ≥30 and ≥50 % lesions in 4,511 arterial segments was assessed by CTA according to: noncalcified, mild (one-quadrant), moderate (two-quadrant), severe (three-quadrant) and very severe (four-quadrant calcium). Area under the receiver operating characteristic curve (AUC) were used to evaluate CTA diagnostic accuracy and agreement versus. QCA for plaque types. Only 4 % of ≥50 % stenoses by QCA were very severely calcified while 43 % were noncalcified. AUC for CTA to detect ≥50 % stenoses by QCA for non-calcified, mildly, moderately, severely, and very severely calcified plaques were 0.90, 0.88, 0.83, 0.76 and 0.89, respectively (P<0.05). In 198 lesions with severe calcification, the presence or absence of a visible residual lumen by CTA was associated with≥50 %stenosis by QCA in 20.3 and 76.9 %, respectively. Kappa was 0.93 for interobserver variability in evaluating plaque calcification. We conclude that calcification of individual coronary artery lesions can be reliably graded using CTA. Most ≥50 % coronary artery stenoses are not or only mildly calcified. If no residual lumen is seen on CTA, calcified lesions are predictive of ≥50 % stenoses and vice versa. CTA diagnostic accuracy for detecting ≥50 % stenoses is reduced in lesions with more than mild calcification due to lower specificity.
KW - Cardiac CT
KW - Coronary artery disease
KW - Coronary atherosclerotic disease
KW - Coronary calcium
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U2 - 10.1007/s10554-013-0240-8
DO - 10.1007/s10554-013-0240-8
M3 - Article
C2 - 23702949
AN - SCOPUS:84893670577
VL - 29
SP - 1619
EP - 1627
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
SN - 1569-5794
IS - 7
ER -