Implications of computed tomography reconstruction algorithms on coronary atheroma composition: A head-to-head comparison with multimodality near-infrared spectroscopy intravascular ultrasound imaging

Journal of cardiovascular computed tomography, vol. 19, pp. 665–676

Abstract

BACKGROUND: To evaluate the performance of various computed tomography angiography (CTA) reconstruction methods in assessing coronary plaque composition using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) as the reference standard. MATERIALS AND METHODS: Fifteen patients with chronic coronary syndrome underwent CTA and 3-vessel NIRS-IVUS imaging. CTA datasets were reconstructed using a medium-smooth b40f kernel with two slice thicknesses, 0.75 ​mm and 0.50 ​mm, and three strengths of advanced model-based iterative reconstruction (ADMIRE). Plaque components on CTA were classified using fixed and adaptive Hounsfield unit (HU) thresholds while NIRS-IVUS classification employed a deep learning method validated against histology. Matched CTA and NIRS-IVUS images were analyzed to quantify fibrotic tissue (FT), necrotic core (NC), and calcific (Ca) volumes and areas at both segment- and lesion-level. The intraclass correlation coefficient (ICC) and Surface Under the Cumulative Ranking Curve (SUCRA) scores were used to determine the best-performing reconstruction approach. RESULTS: Fifty vessels were included in the final analysis. CTA showed weak correlation with NIRS-IVUS for FT (ICC <0.43), good correlation for Ca (ICC 0.42-0.83), and poor correlation for NC, except when using reconstruction approach ADMIRE 2, 0.50 ​mm slice thickness, and fixed HU cutoffs, which demonstrated moderate correlation for NC (segment-level ICC ​= ​0.67; lesion-level ICC ​= ​0.61). This approach ranked highest on SUCRA plots. CONCLUSIONS: CTA reconstruction parameters influence plaque composition analysis. The combination of an intermediate-strength IR, thin slice thickness, and fixed HU cutoffs yields the most accurate tissue characterization compared to NIRS-IVUS as the reference standard.

Authors 18

1. Nathan Angelo Lecaros Yap

   Queen Mary University of London · William Harvey Research Institute

   Affiliation as printed

   Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK

2. Xingwei He

   Queen Mary University of London · William Harvey Research Institute · Tongji Hospital · Huazhong University of Science and Technology

   Affiliation as printed

   Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

3. İbrahi̇m Hali̇l Tanboğa

   İstanbul Nişantaşı Üniversitesi

   Affiliation as printed

   Department of Biostatistics and Cardiology, Nisantasi University Medical School, Istanbul, Turkey

4. Anantharaman Ramasamy

   Queen Mary University of London · İstanbul Nişantaşı Üniversitesi · William Harvey Research Institute

   Affiliation as printed

   Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Biostatistics and Cardiology, Nisantasi University Medical School, Istanbul, Turkey

5. Sotiris Kyriakou

   Queen Mary University of London · William Harvey Research Institute

   Affiliation as printed

   Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK

6. Pieter H. Kitslaar Aachen

   Leiden University Medical Center

   Affiliation as printed

   Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Medis Medical Imaging Systems, Leiden, the Netherlands

7. Alexander Broersen
   Affiliation as printed

   Medis Medical Imaging Systems, Leiden, the Netherlands

8. Johan H. C. Reiber Aachen

   Leiden University Medical Center

   Affiliation as printed

   Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Medis Medical Imaging Systems, Leiden, the Netherlands

9. Jouke Dijkstra Aachen Division of Image Processing (LKEB) Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

10. Amear Mohammed

    University College London

    Affiliation as printed

    Department of Mechanical Engineering, University College London, London, UK

11. Mick Ozkor

    Barts Health NHS Trust

    Affiliation as printed

    Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK

12. Patrick W.J.C. Serruys

    Ollscoil na Gaillimhe – University of Galway · Imperial College London

    Affiliation as printed

    Faculty of Medicine, National Heart & Lung Institute, Imperial College London, UK; Department of Cardiology, National University of Ireland, Galway, Ireland

13. James Moon

    Barts Health NHS Trust · University College London

    Affiliation as printed

    Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK

14. Anthony Mathur

    Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute

    Affiliation as printed

    Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK

15. Andreas Baumbach

    Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute

    Affiliation as printed

    Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK

16. Ryo Torii

    University College London

    Affiliation as printed

    Department of Mechanical Engineering, University College London, London, UK

17. Francesca Pugliese

    Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute

    Affiliation as printed

    Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK

18. Christos V. Bourantas corresponding

    Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute

    Affiliation as printed

    Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, UK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK. Electronic address: cbourantas@gmail.com