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  • Title: Iterative image reconstruction algorithms in coronary CT angiography improve the detection of lipid-core plaque--a comparison with histology.
    Author: Puchner SB, Ferencik M, Maurovich-Horvat P, Nakano M, Otsuka F, Kauczor HU, Virmani R, Hoffmann U, Schlett CL.
    Journal: Eur Radiol; 2015 Jan; 25(1):15-23. PubMed ID: 25182630.
    Abstract:
    OBJECTIVES: To evaluate whether iterative reconstruction algorithms improve the diagnostic accuracy of coronary CT angiography (CCTA) for detection of lipid-core plaque (LCP) compared to histology. METHODS AND MATERIALS: CCTA and histological data were acquired from three ex vivo hearts. CCTA images were reconstructed using filtered back projection (FBP), adaptive-statistical (ASIR) and model-based (MBIR) iterative algorithms. Vessel cross-sections were co-registered between FBP/ASIR/MBIR and histology. Plaque area <60 HU was semiautomatically quantified in CCTA. LCP was defined by histology as fibroatheroma with a large lipid/necrotic core. Area under the curve (AUC) was derived from logistic regression analysis as a measure of diagnostic accuracy. RESULTS: Overall, 173 CCTA triplets (FBP/ASIR/MBIR) were co-registered with histology. LCP was present in 26 cross-sections. Average measured plaque area <60 HU was significantly larger in LCP compared to non-LCP cross-sections (mm(2): 5.78 ± 2.29 vs. 3.39 ± 1.68 FBP; 5.92 ± 1.87 vs. 3.43 ± 1.62 ASIR; 6.40 ± 1.55 vs. 3.49 ± 1.50 MBIR; all p < 0.0001). AUC for detecting LCP was 0.803/0.850/0.903 for FBP/ASIR/MBIR and was significantly higher for MBIR compared to FBP (p = 0.01). MBIR increased sensitivity for detection of LCP by CCTA. CONCLUSION: Plaque area <60 HU in CCTA was associated with LCP in histology regardless of the reconstruction algorithm. However, MBIR demonstrated higher accuracy for detecting LCP, which may improve vulnerable plaque detection by CCTA. KEY POINTS: • A low attenuation plaque area is associated with the presence of lipid-core plaque • MBIR leads to higher diagnostic accuracy for detecting lipid-core plaque • The benefit of MBIR is mainly due to increased sensitivity at high specificities • Semiautomated CCTA assessment can detect vulnerable plaques non-invasively.
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