Abstract
To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss’ Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.
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Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52:1724–1732. doi:10.1016/j.jacc.2008.07.031
Sajjadieh A, Hekmatnia A, Keivani M et al (2013) Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography. ARYA Atheroscler 9:157–163
Authors/Task Force Members Roffi M, Patrono C et al (2015) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. doi:10.1093/eurheartj/ehv320
Min JK, Shaw LJ, Devereux RB et al (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50:1161–1170. doi:10.1016/j.jacc.2007.03.067
Sato A, Aonuma K (2015) Role of cardiac multidetector computed tomography beyond coronary angiography. Circ J Off J Jpn Circ Soc 79:712–720. doi:10.1253/circj.CJ-15-0102
Maurovich-Horvat P, Ferencik M, Voros S et al (2014) Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. doi:10.1038/nrcardio.2014.60
Fischer C, Hulten E, Belur P et al (2013) Coronary CT angiography versus intravascular ultrasound for estimation of coronary stenosis and atherosclerotic plaque burden: a meta-analysis. J Cardiovasc Comput Tomogr 7:256–266. doi:10.1016/j.jcct.2013.08.006
Obaid DR, Calvert PA, Gopalan D et al (2013) Atherosclerotic plaque composition and classification identified by coronary computed tomography: assessment of computed tomography-generated plaque maps compared with virtual histology intravascular ultrasound and histology. Circ Cardiovasc Imaging 6:655–664. doi:10.1161/CIRCIMAGING.112.000250
Motoyama S, Sarai M, Harigaya H et al (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57. doi:10.1016/j.jacc.2009.02.068
Hoffmann U, Moselewski F, Nieman K et al (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47:1655–1662. doi:10.1016/j.jacc.2006.01.041
Kristensen TS, Kofoed KF, Kühl JT et al (2011) Prognostic implications of nonobstructive coronary plaques in patients with non-ST-segment elevation myocardial infarction: a multidetector computed tomography study. J Am Coll Cardiol 58:502–509. doi:10.1016/j.jacc.2011.01.058
Schuhbäck A, Marwan M, Gauss S et al (2012) Interobserver agreement for the detection of atherosclerotic plaque in coronary CT angiography: comparison of two low-dose image acquisition protocols with standard retrospectively ECG-gated reconstruction. Eur Radiol 22:1529–1536. doi:10.1007/s00330-012-2389-2
Øvrehus KA, Marwan M, Bøtker HE et al (2012) Reproducibility of coronary plaque detection and characterization using low radiation dose coronary computed tomographic angiography in patients with intermediate likelihood of coronary artery disease (ReSCAN study). Int J Cardiovasc Imaging 28:889–899. doi:10.1007/s10554-011-9895-1
Ferencik M, Nieman K, Achenbach S (2006) Noncalcified and calcified coronary plaque detection by contrast-enhanced multi-detector computed tomography: a study of interobserver agreement. J Am Coll Cardiol 47:207–209. doi:10.1016/j.jacc.2005.10.005
Choi HS, Choi BW, Choe KO et al (2004) Pitfalls, artifacts, and remedies in multi-detector row CT coronary angiography. Radiogr Rev Publ Radiol Soc N Am Inc 24:787–800. doi:10.1148/rg.243035502
Kjaergaard AD, Johansen JS, Bojesen SE, Nordestgaard BG (2015) Elevated plasma YKL-40, lipids and lipoproteins, and ischemic vascular disease in the general population. Stroke J Cereb Circ 46:329–335. doi:10.1161/STROKEAHA.114.007657
Linde JJ, Kofoed KF, Sørgaard M et al (2013) Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain: results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH). Int J Cardiol 168:5257–5262. doi:10.1016/j.ijcard.2013.08.020
Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358. doi:10.1016/j.jcct.2014.07.003
Tuinenburg JC, Koning G, Rareş A et al (2011) Dedicated bifurcation analysis: basic principles. Int J Cardiovasc Imaging 27:167–174. doi:10.1007/s10554-010-9795-9
Hallgren KA (2012) Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8:23–34
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284–290
Rousson V, Gasser T, Seifert B (2002) Assessing intrarater, interrater and test–retest reliability of continuous measurements. Stat Med 21:3431–3446. doi:10.1002/sim.1253
de Vet HCW, Terwee CB, Knol DL, Bouter LM (2006) When to use agreement versus reliability measures. J Clin Epidemiol 59:1033–1039. doi:10.1016/j.jclinepi.2005.10.015
Hoffmann H, Frieler K, Hamm B, Dewey M (2008) Intra- and interobserver variability in detection and assessment of calcified and noncalcified coronary artery plaques using 64-slice computed tomography: variability in coronary plaque measurement using MSCT. Int J Cardiovasc Imaging 24:735–742. doi:10.1007/s10554-008-9299-z
van Velzen JE, de Graaf FR, de Graaf MA et al (2011) Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis. J Nucl Cardiol 18:893–903. doi:10.1007/s12350-011-9428-2
Nakazato R, Shalev A, Doh J-H et al (2013) Quantification and characterisation of coronary artery plaque volume and adverse plaque features by coronary computed tomographic angiography: a direct comparison to intravascular ultrasound. Eur Radiol 23:2109–2117. doi:10.1007/s00330-013-2822-1
Higashi M (2011) Noninvasive assessment of coronary plaque using multidetector row computed tomography: does MDCT accurately estimate plaque vulnerability? (Con). Circ J Off J Jpn Circ Soc 75:1522–1528
Motoyama S, Kondo T, Sarai M et al (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50:319–326. doi:10.1016/j.jacc.2007.03.044
Funding
Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark and Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research (EDITORS: Eastern Denmark Initative to improve Revascularization Strategies, Grant 09-066994). This study did not receive any financial support from industry.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Martina de Knegt is sub-investigator on studies sponsored by Novartis, Bayer, CSL-Behring, GlaxoSmithKline, AstraZeneca, Pheizer, Sanofi, and Amgen but does not receive any financial support from these industries. Jesper Linde has previously received lecturing fees from Toshiba Medical Systems. Lars Køber has received personal fees for presentation at symposiums, outside the submitted work. Klaus Kofoed has received research grants from AP Møller og hustru Chastine McKinney Møllers Fond, The John and Birthe Meyer Foundation, Research Council of Rigshopitalet, The University of Copenhagen, The Danish Heart Foundation, The Lundbeck Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research; is principle investigator of the investigator initiated CATCH-2 trial, CSub320 trial and at the steering committee of the CORE320 trial –supported in part by Toshiba Medical Corporation; and is on the Speakers Bureau of Toshiba Medical Systems, Advisory board work for VITAL Images Inc. All other authors report no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
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de Knegt, M.C., Linde, J.J., Fuchs, A. et al. Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments. Int J Cardiovasc Imaging 32, 1555–1566 (2016). https://doi.org/10.1007/s10554-016-0932-y
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DOI: https://doi.org/10.1007/s10554-016-0932-y