title: Coronary CT angiography versus intravascular ultrasound for estimation of coronary stenosis and atherosclerotic plaque burden: a meta-analysis.
abstract: BACKGROUND
  Numerous studies have compared coronary CT angiography (CTA) with quantitative coronary angiography. However, the ability of coronary CTA to identify atherosclerosis and to accurately measure plaque and coronary area and volume measurements as compared with intravascular ultrasound (IVUS) has not been fully defined.
  
  
  OBJECTIVE
  We sought to assess the ability of coronary CTA to quantify coronary and plaque measurements commonly performed with IVUS.
  
  
  METHODS
  We searched multiple databases for diagnostic studies that directly compared coronary CTA and IVUS for coronary plaque detection, vessel luminal area, percentage of area stenosis, plaque area, and plaque volume. We used a bivariate mixed-effects binomial regression model to pool test sensitivity and specificity for detection of any coronary plaque.
  
  
  RESULTS
  Forty-two studies that evaluated 1360 patients (75% men; mean age, 59 years) were identified. No significant difference was found between coronary CTA and IVUS measurements of vessel lumen cross-sectional area, plaque area, percentage of area stenosis, or plaque volume within the overall cohort and no difference for the measurement of cross-sectional area (n = 5 studies) and plaque volume (n = 8 studies) among a subgroup that used automated or semiautomated measurement techniques. Sensitivity and specificity of coronary CTA to detect any plaque compared with IVUS were 93% and 92%, respectively, with an area under the receiver-operating curve of 0.97.
  
  
  CONCLUSIONS
  Compared with IVUS, coronary CTA appears to be highly accurate for estimation of luminal area, percentage of area stenosis, plaque volume, and plaque area and for detection of plaque. The use of automated vessel and stenosis measurements appears promising in limited studies to date.
authors.affiliation: Cardiology Service, Dwight D. Eisenhower Army Medical Center, 300 Hospital Road, Fort Gordon, GA 30905. Electronic address: collinfischer@msn.com.
authors.forename: Collin
authors.initials: C
authors.lastname: Fischer
authors.forename: Edward
authors.initials: E
authors.lastname: Hulten
authors.forename: Pallavi
authors.initials: P
authors.lastname: Belur
authors.forename: Ryan
authors.initials: R
authors.lastname: Smith
authors.forename: Szilard
authors.initials: S
authors.lastname: Voros
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
mesh_terms: D019540:Area Under Curve; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D006801:Humans; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional
keywords: Coronary computed tomography angiography; Intravascular ultrasound; Meta-analysis; Plaque detection; Plaque quantification