title: Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound.
abstract: OBJECTIVE
  We evaluated the accuracy of a new 64-slice computed tomography (CT) scanner, compared with intravascular ultrasound, to visualize atherosclerosis in the proximal coronary system.
  
  
  BACKGROUND
  Noninvasive determination of plaque composition and plaque burden may be important to improve risk stratification.
  
  
  METHODS
  In 20 patients, a 64-slice CT scan (Sensation 64, Siemens Medical Solutions, Forchheim, Germany) and an intravascular ultrasound investigation of vessels without stenosis >50% was performed. Diagnostic image quality with 64-slice CT was obtained in 36 vessels in 19 patients.
  
  
  RESULTS
  In these vessels, which were divided in 3-mm sections, 64-slice CT enabled a correct detection of plaque in 54 of 65 (83%) sections containing noncalcified plaques, 50 of 53 (94%) sections containing mixed plaques, and 41 of 43 (95%) sections containing calcified plaques. In 192 of 204 (94%) sections, atherosclerotic lesions were excluded correctly. In addition, 64-slice CT enabled the visualization of 7 of 10 (70%) sections revealing a lipid pool and could identify a spotty calcification pattern in 27 of 30 (90%) sections. The correlation coefficient to determine plaque volumes per vessel was r2 = 0.69 (p < 0.001) with an underestimation of mixed and noncalcified plaque volumes (p < 0.03) and a trend to overestimate calcified plaque volumes by 64-slice CT. The interobserver variability to determine plaque volumes was 37%. Interobserver agreement to identify atherosclerotic sections was good (Cohen's kappa coefficient = 0.75).
  
  
  CONCLUSIONS
  We conclude that 64-slice CT reveals encouraging results to noninvasively detect different types of coronary plaques located in the proximal coronary system. The ability to determine plaque burden currently is hampered by mainly an insufficient reproducibility.
authors.affiliation: Department of Cardiology, Klinikum Grosshadern, University of Munich, Munich, Germany. aleber@med.uni-muenchen.de
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Marc
authors.initials: M
authors.lastname: Sirol
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Bernd
authors.initials: B
authors.lastname: Ohnesorge
authors.forename: Zahi A
authors.initials: ZA
authors.lastname: Fayad
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Becker
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed