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Quantification of Obstructive and Nonobstructive Coronary Lesions by 64-Slice Computed Tomography

A Comparative Study With Quantitative Coronary Angiography and Intravascular Ultrasound

Alexander W. Leber, MD^_*,_*, Andreas Knez, MD^_*, Franz von Ziegler, MD^_*, Alexander Becker, MD^_*, Konstantin Nikolaou, MD, Stephan Paul, MD^_*, Bernd Wintersperger, MD, Maximilian Reiser, MD, Christoph R. Becker, MD, Gerhard Steinbeck, MD^_* and Peter Boekstegers, MD^_*

Department of Cardiology, University of Munich, Munich, Germany.
Department of Clinical Radiology, University of Munich, Munich, Germany.

View larger version (133K): [in a new window]   Figure 1 Angiographically nonobstructive lesion of the left anterior descending artery. (A) Invasive angiogram: arrow indicates a nonobstructive smooth lesion. (B) 64-slice computed tomography: arrowheads indicate a noncalcified plaque in the left anterior descending artery. (C) Intravascular ultrasound: longitudinal reconstruction. (D) Intravascular ultrasound cross section: lumen area 4 mm2, plaque area 11 mm2. (E) Cross-sectional view of the coronary vessel. (F) Window setting for lumen measurements: width is reduced to 1 HU, window level is set to 65% (210 HU in this case) of the mean intensity measured in the lumen. (G) Window level to determine outer vessel boundaries (width at 155% of mean value within the lumen, level at 65% of mean value). Lumen area is 4 mm2, plaque area is 1 mm2.

View larger version (128K): [in a new window]   Figure 2 Correlation of quantitative coronary angiography (QCA) and 64-slice computed tomography (CT) angiography: Visualization and quantification of a high-grade stenosis in the left circumflex artery. (Diameter in the reference section 3.1 mm on QCA, 3.0 mm on 64-slice CT; minimal diameter within the stenotic section 0.6 mm on QCA, 0.5 mm on 64-slice CT). (A) Invasive coronary angiogram of the left coronary artery (right anterior oblique projection). (B) Multiplanar reformatted projection of the left circumflex artery by 64-slice CT.

View larger version (17K): [in a new window]   Figure 3 Correlation of quantitative coronary angiography (QCA) and 64-slice computed tomography (CT) measurements of diameter stenosis in diseased coronary segments. Pearson’s correlation coefficient r = 0.54.

View larger version (15K): [in a new window]   Figure 4 Correlation of the percentage of plaque area contributing to entire vessel area (ratio of plaque area to the external elastic membrane [EEM] cross-sectional area [CSA]) determined by intravascular ultrasound (IVUS) and 64-slice computed tomography (CT). The correlation coefficient between the measurements with both methods is r = 0.61. On average, the percentage of vessel area occupied by plaque is significantly underestimated by 64-slice computed tomography (50.4% vs. 41.1%, p < 0.001).