Impact of Coronary Artery Calcium Characteristics on Accuracy of CT Angiography

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• 作者：Mariusz Kruk ; Dariusz Noll ; Stefan Achenbach ; Gary S. Mintz ; Jerzy Pr臋gowski ; Edyta Kaczmarska ; Karolina Kryczka ; Rados艂aw Praco艅 ; Zofia Dzieli艅ska ; Justyna 艢leszycka ; Adam Witkowski ; Marcin Demkow ; Witold Ru偶y艂艂o ; Cezary K臋pka
• 关键词：computed tomography ; coronary angiography ; coronary artery disease ; intravascular ultrasound
• 刊名：JACC: Cardiovascular Imaging
• 出版年：January, 2014
• 年：2014
• 卷：7
• 期：1
• 页码：49-58
• 全文大小：683 K

文摘

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Objectives

This study sought to evaluate which specific calcium characteristics impact diagnostic accuracy of coronary computed tomography angiography (CTA).

Background

Coronary calcifications comprise one of the most significant factors interfering with diagnostic accuracy of coronary CTA. Despite this fact, there is paucity of data regarding this phenomenon.

Methods

A total of 525 coronary lesions (252 calcified and 273 reference [noncalcified] lesions) within 97 arteries of 60 patients (19 women, age 63 卤 10 years) underwent assessment with both 2聽脳 64-slice computed tomography and intravascular ultrasound (IVUS). Nineteen calcium characteristics were determined. The main outcome was coronary CTA inaccuracy defined as the deviation of minimum lumen area within the calcification measured with coronary CTA from that measured with IVUS, in both absolute (mm²) and relative (%) terms.

Results

Presence of calcification was found to be independently correlated to coronary CTA inaccuracy in both absolute and relative terms (p < 0.001 for both). The relative (%) inaccuracy of coronary CTA was independently correlated to total calcium length (p聽= 0.004), total calcium volume (p聽= 0.008), cross section calcium thickness (p聽= 0.023), cross section calcium area (p聽= 0.023), and cross section lumen area (p聽= 0.001). The absolute inaccuracy of CTA was correlated to calcium length (p聽= 0.010), calcium volume (p聽= 0.017), and cross section calcium area (p < 0.001). The presence of both total calcium arc 鈮?7掳 and mean lumen diameter of 鈮?.8 mm provided the best predictive accuracy for detection of excessive lumen underestimation by CTA. The best accuracy for prediction of excessive lumen overestimation provided combination of 2 of 3 features: maximum calcium density <869 HU, OR whole calcium length <2.4 mm, OR total calcium volume <6.4 mm³.

Conclusions

Our results indicate which specific calcium characteristics impact accuracy of coronary CTA in lumen assessment within calcified lesions. This may provide practical assistance in predicting coronary lumen underestimation or overestimation by coronary CTA, therefore mitigating risk of diagnostic errors in clinical practice.