The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiography |
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| Institution: | 1. Department of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA;2. BHF Centre for Cardiovascular Science, University of Edinburgh,Edinburgh,United Kingdom, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK;3. Department of Cardiac Sciences, University of Calgary,Calgary AB,Canada, 2500, University Dr. NW, Calgary, Alberta, T2N 1N4, Canada;4. Department of Cardiology and Cardiovascular Imaging, Minneapolis Heart Institute, Minneapolis, MN, 800 E 28th St, Minneapolis, MN, 55407, USA;1. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA;2. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA;3. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA;4. Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institute, Stockholm;5. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA;1. Department of Cardiology - The Heart Center, University Hospital of Copenhagen - Rigshospitalet, Blegdamsvej 9, 2100-CPH, Denmark;2. Department of Radiology, University Hospital of Copenhagen - Rigshospitalet, Blegdamsvej 9, 2100-CPH, Denmark;1. Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre/St. Joseph’s Health Care London, University of Western Ontario, London, Ontario, Canada;2. Division of Radiology, Department of Medical Imaging, London Health Sciences Centre/St. Joseph’s Health Care London, University of Western Ontario, London, Ontario, Canada;1. Centro Cardiologico Monzino, IRCCS, Milan, Italy;2. Division of Radiotherapy IEO, European Institute of Oncology, IRCCS, Milan, Italy;3. Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy;4. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy;5. Scientific Directorate, IEO European Institute of Oncology, IRCCS, Milan, Italy;6. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy;1. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;2. Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;3. Manchester Heart Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom;4. Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands;5. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands;6. Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, Netherlands;7. Medical Imaging Centre, Semmelweis University, Budapest, Hungary;8. Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States;1. GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy;2. IRCCS San Raffaele Scientific Institute, Italy;3. Vita-Salute San Raffaele University, Italy;4. Guglielmo da Saliceto Hospital, Piacenza, Italy;5. Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy;6. Ospedale di Cremona, Cremona, Italy;7. Centro Cardiologico Monzino IRCCS, Milano, Italy;8. Ospedale Maggiore, Bologna, Italy;9. San Gerardo Hospital, Monza, Italy;10. ASST Bolognini Hospital, Bergamo Est, Italy;11. Parma University Hospital, Parma, Italy;12. ASST Valtellina and Alto Lario, “Eugenio Morelli Hospital”, Sondalo, Italy;13. San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy;14. Casa di Cura Villa dei Pini, Civitanova Marche, Italy;15. ICC Istituto Clinico Casalpalocco, Rome, Italy;p. San L. Mandic Hospital, Merate, Italy;q. ASST Papa Giovanni XXIII, Bergamo, Italy |
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| Abstract: | BackgroundHigh amounts of coronary artery calcium (CAC) pose challenges in interpretation of coronary CT angiography (CCTA). The accuracy of stenosis assessment by CCTA in patients with very extensive CAC is uncertain.MethodsRetrospective study was performed including patients who underwent clinically directed CCTA with CAC score >1000 and invasive coronary angiography within 90 days. Segmental stenosis on CCTA was graded by visual inspection with two-observer consensus using categories of 0%, 1–24%, 25–49%, 50–69%, 70–99%, 100% stenosis, or uninterpretable. Blinded quantitative coronary angiography (QCA) was performed on all segments with stenosis ≥25% by CCTA. The primary outcome was vessel-based agreement between CCTA and QCA, using significant stenosis defined by diameter stenosis ≥70%. Secondary analyses on a per-patient basis and inclusive of uninterpretable segments were performed.Results726 segments with stenosis ≥25% in 346 vessels within 119 patients were analyzed. Median coronary calcium score was 1616 (1221–2118). CCTA identification of QCA-based stenosis resulted in a per-vessel sensitivity of 79%, specificity of 75%, positive predictive value (PPV) of 45%, negative predictive value (NPV) of 93%, and accuracy 76% (68 false positive and 15 false negative). Per-patient analysis had sensitivity 94%, specificity 55%, PPV 63%, NPV 92%, and accuracy 72% (30 false-positive and 3 false-negative). Inclusion of uninterpretable segments had variable effect on sensitivity and specificity, depending on whether they are considered as significant or non-significant stenosis.ConclusionsIn patients with very extensive CAC (>1000 Agatston units), CCTA retained a negative predictive value ?> ?90% to identify lack of significant stenosis on a per-vessel and per-patient level, but frequently overestimated stenosis. |
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| Keywords: | Coronary CT angiography Coronary calcium score Coronary artery calcium Accuracy Stenosis Quantitative coronary angiography |
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