• Szilard Voros, Sarah Rinehart, Zhen Qian, Gustavo Vazquez, Hunt Anderson, Laura Murrieta, Charles Wilmer, Harold Carlson, Kenneth Taylor, William Ballard, Dimitri Karmpaliotis, Anna Kalynych, and Charles Brown.
• Piedmont Heart Institute, Atlanta, Georgia 30309, USA. szilard.voros@piedmont.org
• JACC Cardiovasc Interv. 2011 Feb 1; 4 (2): 198-208.

ObjectivesThis study sought to determine the accuracy of 3-dimensional, quantitative measurements of coronary plaque by computed tomography angiography (CTA) against intravascular ultrasound with radiofrequency backscatter analysis (IVUS/VH).BackgroundQuantitative, 3-dimensional coronary CTA plaque measurements have not been validated against IVUS/VH.MethodsSixty patients in a prospective study underwent coronary X-ray angiography, IVUS/VH, and coronary CTA. Plaque geometry and composition was quantified after spatial coregistration on segmental and slice-by-slice bases. Correlation, mean difference, and limits of agreement were determined.ResultsThere was significant correlation for all pre-specified parameters by segmental and slice-by-slice analyses (r = 0.41 to 0.84; all p < 0.001). On a segmental basis, CTA underestimated minimal lumen diameter by 21% and overestimated diameter stenosis by 39%. Minimal lumen area was overestimated on CTA by 27% but area stenosis was only underestimated by 5%. Mean difference in noncalcified plaque volume and percent and calcified plaque volume and percent were 38%, -22%, 104%, and 64%. On a slice-by-slice basis, lumen, vessel, noncalcified-, and calcified-plaque areas were overestimated on CTA by 22%, 19%, 44%, and 88%. There was significant correlation for percentage of atheroma volume (0.52 vs. 0.54; r = 0.51; p < 0.001). Compositional analysis suggested that high-density noncalcified plaque on CTA best correlated with fibrous tissue and low-density noncalcified plaque correlated with necrotic core plus fibrofatty tissue by IVUS/VH.ConclusionsThis is the first validation that standardized, 3-dimensional, quantitative measurements of coronary plaque correlate with IVUS/VH. Mean differences are small, whereas limits of agreement are wide. Low-density noncalcified plaque correlates with necrotic core plus fibrofatty tissue on IVUS/VH.Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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