title: Total coronary atherosclerotic plaque burden assessment by CT angiography for detecting obstructive coronary artery disease associated with myocardial perfusion abnormalities.
abstract: BACKGROUND
  Total atherosclerotic plaque burden assessment by CT angiography (CTA) is a promising tool for diagnosis and prognosis of coronary artery disease (CAD) but its validation is restricted to small clinical studies. We tested the feasibility of semi-automatically derived coronary atheroma burden assessment for identifying patients with hemodynamically significant CAD in a large cohort of patients with heterogenous characteristics.
  
  
  METHODS
  This study focused on the CTA component of the CORE320 study population. A semi-automated contour detection algorithm quantified total coronary atheroma volume defined as the difference between vessel and lumen volume. Percent atheroma volume (PAV = [total atheroma volume/total vessel volume] × 100) was the primary metric for assessment (n = 374). The area under the receiver operating characteristic curve (AUC) determined the diagnostic accuracy for identifying patients with hemodynamically significant CAD defined as ≥50% stenosis by quantitative coronary angiography and associated myocardial perfusion abnormality by SPECT.
  
  
  RESULTS
  Of 374 patients, 139 (37%) had hemodynamically significant CAD. The AUC for PAV was 0.78 (95% confidence interval [CI] 0.73-0.83) compared with 0.84 [0.79-0.88] by standard expert CTA interpretation (p = 0.02). Accuracy for both CTA (0.91 [0.87, 0.96]) and PAV (0.86 [0.81-0.91]) increased after excluding patients with history of CAD (p < 0.01 for both). Bland-Altman analysis revealed good agreement between two observers (bias of 280.2 mm(3) [161.8, 398.7]).
  
  
  CONCLUSIONS
  A semi-automatically derived index of total coronary atheroma volume yields good accuracy for identifying patients with hemodynamically significant CAD, though marginally inferior to CTA expert reading. These results convey promise for rapid, reliable evaluation of clinically relevant CAD.
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kishi
authors.affiliation: Department of Medicine, Division of Cardiology, Catholic University of Paraná (PUC-PR), Brazil.
authors.forename: Tiago A
authors.initials: TA
authors.lastname: Magalhães
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Rodrigo J
authors.initials: RJ
authors.lastname: Cerci
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Matheson
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vavere
authors.affiliation: Department of Radiology, Keio University, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanami
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center / Medis Medical Imaging Systems, Leiden, The Netherlands.
authors.forename: Pieter H
authors.initials: PH
authors.lastname: Kitslaar
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brinker
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.affiliation: Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center / Medis Medical Imaging Systems, Leiden, The Netherlands.
authors.forename: Johan H C
authors.initials: JH
authors.lastname: Reiber
authors.affiliation: Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.affiliation: The Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa Faculty of Medicine, Ottawa, Canada.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: azadeh1@jhmi.edu.
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
mesh_terms: D000368:Aged; D000465:Algorithms; D019540:Area Under Curve; D001331:Automation; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Atherosclerotic plaque; CT angiography; Coronary artery disease; Coronary heart disease; Myocardial perfusion
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