title: Quantification of three-dimensional computed tomography angiography for evaluating coronary luminal stenosis using digital subtraction angiography as the standard of reference.
abstract: OBJECTIVE
  We sought to evaluate the accuracy of quantitative three-dimensional (3D) CT angiography (CTA) for the assessment of coronary luminal stenosis using digital subtraction angiography (DSA) as the standard of reference.
  
  
  METHODS
  Twenty-three patients with 54 lesions were referred for CTA followed by DSA. The CTA scans were performed with 256-slice spiral CT. 3D CTA were reconstructed from two-dimensional CTA imaging sequences in order to extract the following quantitative indices: minimal lumen diameter, percent diameter stenosis (%DS), minimal lumen area, and percent area stenosis (%AS). Correlation and limits of agreement were calculated using Pearson correlation and Bland-Altman analysis, respectively. The diagnostic performance and the diagnostic concordance of 3D CTA-derived anatomic parameters (%DS, %AS) for the detection of severe coronary arterial stenosis (as assessed by DSA) were presented as sensitivity, specificity, diagnostic accuracy, and Kappa statistics. Of which vessels with %DS >50% or with %AS >75% were identified as severe coronary arterial lesions.
  
  
  RESULTS
  The correlations of the anatomic parameters between 3D CTA and DSA were significant (r = 0.51-0.74, P < 0.001). Bland-Altman analysis confirmed that the mean differences were small (from -1.11 to 27.39%), whereas the limits of agreement were relatively wide (from ±28.07 to ±138.64%). Otherwise, the diagnostic accuracy (74.1% with 58.3% sensitivity and 86.7% specificity for DS%; 74.1% with 45.8% sensitivity and 96.7% specificity for %AS) and the diagnostic concordance (k = 0.46 for DS%; 0.45 for %AS) of 3D CTA-derived anatomic parameters for the detection of severe stenosis were moderate.
  
  
  CONCLUSIONS
  3D advanced imaging reconstruction technique is a helpful tool to promote the use of CTA as an alternative to assess luminal stenosis in clinical practice.
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. guowei2004@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China. liu.xin@siat.ac.cn.|Key Lab for Health Informatics, Chinese Academy of Sciences, Shenzhen, 518055, China. liu.xin@siat.ac.cn.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China. zf.gao@siat.ac.cn.|Key Lab for Health Informatics, Chinese Academy of Sciences, Shenzhen, 518055, China. zf.gao@siat.ac.cn.|Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Beijing, China. zf.gao@siat.ac.cn.
authors.forename: Zhifan
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China. sandeep@siat.ac.cn.|Key Lab for Health Informatics, Chinese Academy of Sciences, Shenzhen, 518055, China. sandeep@siat.ac.cn.|Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Beijing, China. sandeep@siat.ac.cn.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Pirbhulal
authors.affiliation: Institute of Clinical Anatomy, Southern Medical University, Guangzhou, China. hwh@fimmu.com.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Huang
authors.affiliation: Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China. wh.lin@siat.ac.cn.|Key Lab for Health Informatics, Chinese Academy of Sciences, Shenzhen, 518055, China. wh.lin@siat.ac.cn.
authors.forename: Wan-Hua
authors.initials: WH
authors.lastname: Lin
authors.affiliation: Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China. hy.zhang@siat.ac.cn.|Key Lab for Health Informatics, Chinese Academy of Sciences, Shenzhen, 518055, China. hy.zhang@siat.ac.cn.
authors.forename: Heye
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. tanning100@126.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Tan
authors.affiliation: Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen, 518055, China. ytzhang@ee.cuhk.edu.hk.|Key Lab for Health Informatics, Chinese Academy of Sciences, Shenzhen, 518055, China. ytzhang@ee.cuhk.edu.hk.|Department of Electronic Engineering, The Joint Research Centre for Biomedical Engineering, Chinese University of Hong Kong, Hong Kong, China. ytzhang@ee.cuhk.edu.hk.
authors.forename: Yuan-Ting
authors.initials: YT
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017023:Coronary Angiography / Q000592:standards*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D012680:Sensitivity and Specificity