title: The Diagnostic Performance of Coronary CT Angiography for the Assessment of Coronary Stenosis in Calcified Plaque.
abstract: To prospectively evaluate the diagnostic performance of coronary CT angiography (CCTA) for the assessment of coronary stenosis in a calcified plaque, by using conventional coronary angiography (CAG) as a standard reference.
  
  
  
  Eight hundred and ninety-four patients were known to have or have been suspicious of having coronary artery disease, underwent CCTA and conventional coronary angiography (CAG). All the images acquired were assessed. The calcified plaque in CCTA was classified into four types (I-IV) according to the ratio of calcified plaque volume to vessel circumference (RVTC). Overall diagnostic accuracy was made under receiver operating characteristic curve (AUC) analysis. CAG was used as the standard reference.
  
  
  
  A total of 12845 segments were evaluated in 894 patients, among which 4955 calcified plaques were detected on 3645(28.4%) segments by CCTA. The overall AUC, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.939, 97.8%, 90.1%, 71.2% and 99.4%, respectively. In type I-II calcification, CCTA had high diagnostic performance in AUC (type I: 0.983; type II: 0.976), sensitivity (96.7%; 98.1%), specificity (99.8%; 97.0%), PPV (95.7%; 90.1%), NPV (99.8%; 99.5%) and accuracy (99.6%; 97.3%). In type III-IV calcification, CCTA has high performance in sensitivity (type III: 97.6%; type IV: 97.9%) and NPV (98.3%; 98.7%), moderate performance in AUC (0.877; 0.829), while remarkable decrease in specificity (78.7%; 67.9%), PPV (71.0%; 56.2%) and accuracy (84.9%; 76.8%).
  
  
  
  CCTA has highest accuracy in diagnosing the coronary artery stenosis of type I-II calcified plaques, but has a significant decrease in specificity, PPV and accuracy in type III-IV calcified plaque.
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
authors.forename: Liang
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Tang
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Zhu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Zhang
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Shi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, PR China.
authors.forename: Rong-Bin
authors.initials: RB
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D061205:Vascular Calcification / Q000000981:diagnostic imaging*