Automated Quantitative Plaque Analysis for Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion in Computed Tomography Angiography.
OBJECTIVE
The aim of this study was to evaluate the utility of automated plaque analysis in differentiating chronic total occlusion (CTO) from subtotal occlusion (SO) in patients with ambiguous coronary lesions on coronary computed tomography angiography (CTA).


METHODS
A total of 63 patients with 63 ambiguous coronary lesions on CTA were included. The lesion length (LL), diameter stenosis, plaque volume and composition, remodeling index, and contrast density difference (CDD) (reflecting intraluminal contrast kinetics over the lesion) were assessed using an automatic software tool. All patients underwent invasive coronary angiography.


RESULTS
Coronary angiography confirmed 28 CTOs and 35 SOs. CTOs showed significantly longer LL (6.4±12.3 vs. 1.0±2.2 mm, P=0.03) and higher CDD (74%±31% vs. 55%±32%, P=0.02) compared with SO. The optimal thresholds for prediction of CTO for CDD and LL were ≥43% and ≥1 mm, respectively (max. sensitivity: 82% for CDD, max. specificity: 77% for LL). The guidewire manipulation time correlated with LL (r=0.529, P=0.004) and CDD (r=0.435, P=0.021) in lesions attempted by percutaneous coronary intervention.


CONCLUSIONS
Automated computed tomography plaque analysis may be applied as a noninvasive tool to differentiate CTO from SO.
Departments of *Interventional Cardiology and Angiology §Coronary and Structural Heart Diseases, Institute of Cardiology ‡Medical University of Warsaw, Warsaw, Poland †Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Adam D
AD
Staruch
Maksymilian P
MP
Opolski
Piotr J
PJ
Slomka
Michal
M
Staruch
Cezary
C
Kepka
Adam
A
Witkowski
Mariusz
M
Kruk
Damini
D
Dey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity