Limitations of coronary computed tomographic angiography for delineating the lumen and vessel contours of coronary arteries in patients with stable angina.
OBJECTIVE
We sought to evaluate whether coronary computed tomographic angiography (CCTA) could accurately and reproducibly delineate the lumen and vessel contours of coronary arteries.


RESULTS
One hundred coronary stenotic lesions representing 91 patients with stable angina who received both CCTA and intravascular ultrasound (IVUS) were analysed. Three segments with minimal lumen cross-sectional area (CSA), proximal reference, and distal reference on IVUS images were selected for each lesion. Five observers measured lumen and vessel CSAs at three matching segments on CCTA images. These CSAs were compared with the IVUS-measured CSAs as a reference standard. All five observers underestimated lumen CSA at the three selected segments by CCTA. The minimal lumen CSA assessed by CCTA exhibited very weak correlations with those obtained by IVUS (r =0.23, 0.24, 0.15, 0.25, and 0.28, respectively). In contrast to the lumen CSA, the vessel CSA at the three segments was overestimated by all observers when assessed by CCTA. At the segment with minimal lumen CSA, the vessel CSA obtained by CCTA showed weak correlations with those assessed by IVUS (r = 0.43, 0.33, 0.44, 0.37, and 0.42, respectively). Moreover, intra-class correlation coefficients ranged from 0.44 to 0.73 among the five observers for lumen or vessel CSA measurements by CCTA at the segment with minimal lumen CSA.


CONCLUSIONS
CCTA has potential limitations in the accurate delineation of lumen and vessel contours in patients with angina, as there was a high level of discordance with the IVUS-measured lumen and vessel CSAs and high inter-observer variability.
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
Choongki
C
Kim
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
Sung-Jin
SJ
Hong
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Dong-Ho
DH
Shin
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Jung-Sun
JS
Kim
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Byeong-Keuk
BK
Kim
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Young-Guk
YG
Ko
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Donghoon
D
Choi
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yangsoo
Y
Jang
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea mkhong61@yuhs.ac.
Myeong-Ki
MK
Hong
D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000473:pathology; D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional
D003287:Contrast Media
coronary artery disease; coronary computed tomographic angiography; intravascular ultrasound