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Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque--a comparison with histology.
Eur Radiol. 2015 Jan; 25(1):15-23.ER

Abstract

OBJECTIVES

To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology.

METHODS AND MATERIALS

CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy.

RESULTS

Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm(2): 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA.

CONCLUSION

Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA.

KEY POINTS

• A low attenuation plaque area is associated with the presence of lipid-core plaque • MBIR leads to higher diagnostic accuracy for detecting lipid-core plaque • The benefit of MBIR is mainly due to increased sensitivity at high specificities • Semiautomated CCTA assessment can detect vulnerable plaques non-invasively.

Authors+Show Affiliations

Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25182630

Citation

Puchner, Stefan B., et al. "Iterative Image Reconstruction Algorithms in Coronary CT Angiography Improve the Detection of Lipid-core Plaque--a Comparison With Histology." European Radiology, vol. 25, no. 1, 2015, pp. 15-23.
Puchner SB, Ferencik M, Maurovich-Horvat P, et al. Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque--a comparison with histology. Eur Radiol. 2015;25(1):15-23.
Puchner, S. B., Ferencik, M., Maurovich-Horvat, P., Nakano, M., Otsuka, F., Kauczor, H. U., Virmani, R., Hoffmann, U., & Schlett, C. L. (2015). Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque--a comparison with histology. European Radiology, 25(1), 15-23. https://doi.org/10.1007/s00330-014-3404-6
Puchner SB, et al. Iterative Image Reconstruction Algorithms in Coronary CT Angiography Improve the Detection of Lipid-core Plaque--a Comparison With Histology. Eur Radiol. 2015;25(1):15-23. PubMed PMID: 25182630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque--a comparison with histology. AU - Puchner,Stefan B, AU - Ferencik,Maros, AU - Maurovich-Horvat,Pal, AU - Nakano,Masataka, AU - Otsuka,Fumiyuki, AU - Kauczor,Hans-Ulrich, AU - Virmani,Renu, AU - Hoffmann,Udo, AU - Schlett,Christopher L, Y1 - 2014/09/03/ PY - 2014/07/29/received PY - 2014/08/14/accepted PY - 2014/9/4/entrez PY - 2014/9/4/pubmed PY - 2015/6/26/medline SP - 15 EP - 23 JF - European radiology JO - Eur Radiol VL - 25 IS - 1 N2 - OBJECTIVES: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology. METHODS AND MATERIALS: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy. RESULTS: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm(2): 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA. CONCLUSION: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA. KEY POINTS: • A low attenuation plaque area is associated with the presence of lipid-core plaque • MBIR leads to higher diagnostic accuracy for detecting lipid-core plaque • The benefit of MBIR is mainly due to increased sensitivity at high specificities • Semiautomated CCTA assessment can detect vulnerable plaques non-invasively. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/25182630/Iterative_image_reconstruction_algorithms_in_coronary_CT_angiography_improve_the_detection_of_lipid_core_plaque__a_comparison_with_histology_ L2 - https://dx.doi.org/10.1007/s00330-014-3404-6 DB - PRIME DP - Unbound Medicine ER -