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      The Diagnostic Performance of Coronary CT Angiography for the Assessment of Coronary Stenosis in Calcified Plaque

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          Abstract

          Purpose

          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.

          Materials and Methods

          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.

          Results

          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%).

          Conclusion

          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.

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          Most cited references 26

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          Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons.

          Coronary artery disease is the No. 1 cause of death in the developed world. Effective means of treatment such as drug therapy to lower cholesterol levels are available, but clinical application to patients at highest risk remains imprecise. Electron beam computed tomography (EBCT) has been suggested as a means to diagnose subclinical coronary disease and facilitate risk stratification, but no current interpretive consensus exists in clinical practice. We critically reviewed current, pertinent literature regarding EBCT coronary calcium scanning from a clinical perspective and, in particular, studies that evaluated it as a measure of atherosclerotic coronary disease. Additionally, we reviewed studies that quantified the EBCT "calcium score" in relationship to coronary heart disease events. The available data suggest that the EBCT calcium score can help identify persons at higher than anticipated risk of future coronary events: the greater the EBCT coronary calcium score, the greater the extent of atherosclerotic plaque disease. Based on the literature review, we offer EBCT interpretation guidelines as they relate to drug therapy and risk reduction in asymptomatic persons with borderline cholesterol levels. Considerable evidence shows that coronary calcium is specific for atherosclerotic plaque and that it can be sensitively detected and accurately quantified by using EBCT. The coronary calcium score can help guide initiation of clinical prevention programs as part of a risk stratification and management scheme aimed at improving outcomes in patients determined to be at highest risk of coronary disease for their respective age and gender.
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            High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography.

            The diagnostic performance of the latest 64-slice CT scanner, with increased temporal (165 ms) and spatial (0.4 mm3) resolution, to detect significant stenoses in the clinically relevant coronary tree is unknown. We studied 52 patients (34 men; mean age, 59.6+/-12.1 years) with atypical chest pain, stable or unstable angina pectoris, or non-ST-segment elevation myocardial infarction scheduled for diagnostic conventional coronary angiography. All patients had stable sinus rhythm. Patients with initial heart rates > or =70 bpm received beta-blockers. Mean scan time was 13.3+/-0.9 seconds. The CT scans were analyzed by 2 observers unaware of the results of invasive coronary angiography, which was used as the standard of reference. All available coronary segments, regardless of size, were included in the evaluation. Lesions with > or =50 luminal narrowing were considered significant stenoses. Invasive coronary angiography demonstrated the absence of significant disease in 25% (13 of 52), single-vessel disease in 31% (16 of 52), and multivessel disease in 45% (23 of 52) of patients. One unsuccessful CT scan was classified as inconclusive. Ninety-four significant stenoses were present in the remaining 51 patients. Sensitivity, specificity, and positive and negative predictive values of CT for detecting significant stenoses on a segment-by-segment analysis were 99% (93 of 94; 95% CI, 94 to 99), 95% (601 of 631; 95% CI, 93 to 96), 76% (93 of 123; 95% CI, 67 to 89), and 99% (601 of 602; 95% CI, 99 to 100), respectively. Noninvasive 64-slice CT coronary angiography accurately detects coronary stenoses in patients in sinus rhythm and presenting with atypical chest pain, stable or unstable angina, or non-ST-segment elevation myocardial infarction.
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              Accuracy of MSCT coronary angiography with 64-slice technology: first experience.

              The aim of our study was to investigate the accuracy of 64-slice computed tomography (CT) for assessing haemodynamically significant stenoses of coronary arteries. CT angiography was performed in 67 patients (50 male, 17 female; mean age 60.1+/-10.5 years) with suspected coronary artery disease and compared with invasive coronary angiography. All vessels > or =1.5 mm were considered for the assessment of significant coronary artery stenosis (diameter reduction >50%). Forty-seven patients were identified as having significant coronary stenoses on invasive angiography with 18% (176/1005) affected segments. None of the coronary segments needed to be excluded from analysis. CT correctly identified all 20 patients having no significant stenosis on invasive angiography. Overall sensitivity for classifying stenoses was 94%, specificity was 97%, positive predictive value was 87%, and negative predictive value was 99%. Sixty-four-slice CT provides a high diagnostic accuracy in assessing coronary artery stenoses.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                5 May 2016
                2016
                : 11
                : 5
                Affiliations
                [1 ]Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
                [2 ]Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, PR China
                University of Washington School of Medicine, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: HBS RBY. Performed the experiments: LQ LJT. Analyzed the data: XMZ YDZ. Contributed reagents/materials/analysis tools: YX RBY. Wrote the paper: LQ.

                [¤a]

                Current address: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhoulu 300, Nanjing, PR China

                [¤b]

                Current address: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Hanzhonglu 140, Nanjing, PR China

                Article
                PONE-D-15-53505
                10.1371/journal.pone.0154852
                4858195
                27149622
                © 2016 Qi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 4, Tables: 2, Pages: 11
                Product
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Stenosis
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Stenosis
                Medicine and Health Sciences
                Vascular Medicine
                Coronary Artery Disease
                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Coronary Arteries
                Medicine and Health Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Coronary Arteries
                Medicine and Health Sciences
                Cardiovascular Medicine
                Cardiovascular Imaging
                Angiography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Cardiovascular Imaging
                Angiography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Cardiovascular Imaging
                Angiography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Cardiovascular Imaging
                Angiography
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Calcification
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Calcification
                Research and Analysis Methods
                Imaging Techniques
                Neuroimaging
                Computed Axial Tomography
                Biology and Life Sciences
                Neuroscience
                Neuroimaging
                Computed Axial Tomography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Medicine and Health Sciences
                Diagnostic Medicine
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Mathematical Functions
                Convolution
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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