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J Am Coll Cardiol, 2006; 47:672-677, doi:10.1016/j.jacc.2005.10.058 (Published online 4 January 2006).
© 2006 by the American College of Cardiology Foundation
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EXPEDITED REVIEW: EXPEDITED REVIEW

Accuracy of 64-Slice Computed Tomography to Classify and Quantify Plaque Volumes in the Proximal Coronary System

A Comparative Study Using Intravascular Ultrasound

Alexander W. Leber, MD*,§,*, Alexander Becker, MD*, Andreas Knez, MD*, Franz von Ziegler, MD*, Marc Sirol, MD§, Konstantin Nikolaou, MD{dagger}, Bernd Ohnesorge, PhD{ddagger}, Zahi A. Fayad, PhD§, Christoph R. Becker, MD{dagger}, Maximilian Reiser, MD{dagger}, Gerhard Steinbeck, MD* and Peter Boekstegers, MD*

* Department of Cardiology
{dagger} Institute for Diagnostic Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
{ddagger} Siemens Medical Solutions CT-Division, Forchheim, Germany
§ Mount Sinai Medical Center New York, Imaging Science Laboratory, New York, New York

Manuscript received April 21, 2005; revised manuscript received September 28, 2005, accepted October 10, 2005.

* Reprint requests and correspondence: Dr. Alexander W. Leber, University of Munich, Klinikum Grosshadern, Medizinische Klinik I, Marchioninistraße 15, 81377 München, Germany. (Email: aleber{at}med.uni-muenchen.de).

OBJECTIVES: We evaluated the accuracy of a new 64-slice computed tomography (CT) scanner, compared with intravascular ultrasound, to visualize atherosclerosis in the proximal coronary system.

BACKGROUND: Noninvasive determination of plaque composition and plaque burden may be important to improve risk stratification.

METHODS: In 20 patients, a 64-slice CT scan (Sensation 64, Siemens Medical Solutions, Forchheim, Germany) and an intravascular ultrasound investigation of vessels without stenosis >50% was performed. Diagnostic image quality with 64-slice CT was obtained in 36 vessels in 19 patients.

RESULTS: In these vessels, which were divided in 3-mm sections, 64-slice CT enabled a correct detection of plaque in 54 of 65 (83%) sections containing noncalcified plaques, 50 of 53 (94%) sections containing mixed plaques, and 41 of 43 (95%) sections containing calcified plaques. In 192 of 204 (94%) sections, atherosclerotic lesions were excluded correctly. In addition, 64-slice CT enabled the visualization of 7 of 10 (70%) sections revealing a lipid pool and could identify a spotty calcification pattern in 27 of 30 (90%) sections. The correlation coefficient to determine plaque volumes per vessel was r2 = 0.69 (p < 0.001) with an underestimation of mixed and noncalcified plaque volumes (p < 0.03) and a trend to overestimate calcified plaque volumes by 64-slice CT. The interobserver variability to determine plaque volumes was 37%. Interobserver agreement to identify atherosclerotic sections was good (Cohen's kappa coefficient = 0.75).

CONCLUSIONS: We conclude that 64-slice CT reveals encouraging results to noninvasively detect different types of coronary plaques located in the proximal coronary system. The ability to determine plaque burden currently is hampered by mainly an insufficient reproducibility.

Abbreviations and Acronyms
  CT = computed tomography
  IVUS = intravascular ultrasound
  MDCT = multi-detector computer tomography




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