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Updated: May 17, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Quantification of coronary artery stenosis with high-resolution CT in comparison with histopathology in an ex vivo
Matthias Dettmer1, Nicola Glaser-Gallion, Paul Stolzmann
1Department of Pathology and Laboratory Medicine, University of Pittsburgh, S-417 BST 200 Lothrop Street, Pittsburgh, PA 15261, USA. dettmerms@upmc.edu
Insights
High-resolution computed tomography (CT) shows good correlation with histopathology for assessing coronary artery stenosis. However, CT overestimates stenosis in calcified plaques and underestimates it in non-calcified plaques.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Pathology
Background:
- Accurate assessment of coronary artery stenosis is crucial for cardiovascular disease management.
- Histopathology remains the gold standard for evaluating coronary plaques, but it is invasive.
- High-resolution computed tomography (CT) offers a non-invasive imaging modality for coronary artery assessment.
Purpose of the Study:
- To evaluate the ex vivo performance of high-resolution CT for quantitative assessment of coronary artery stenosis.
- To compare the percentage diameter stenosis measured by high-resolution CT against histopathology findings.
Main Methods:
- High-resolution CT was performed on 26 human heart specimens post-contrast injection.
- Coronary artery plaques were identified, and stenosis degree was measured using electronic calipers on CT images.
- Histopathological analysis characterized plaques (Stary classification) and measured stenosis percentage.
Main Results:
- High-resolution CT depicted 84% of all coronary plaques identified by histology.
- A significant correlation (r=0.81, p<0.001) was found between CT and histology for stenosis degree.
- CT systematically overestimated stenosis in calcified plaques and underestimated it in non-calcified plaques.
Conclusions:
- High-resolution CT reliably visualizes advanced coronary plaques with good correlation to histology.
- Quantitative assessment of stenosis by CT is affected by plaque composition, overestimating calcified and underestimating non-calcified lesions.
- CT is a valuable tool for coronary plaque assessment, but its limitations regarding plaque type must be considered.
Purpose:
To investigate the ex vivo performance of high-resolution computed tomography (CT) for quantitative assessment of percentage diameter stenosis in coronary arteries compared to histopathology.
Materials And Methods:
High-resolution CT was performed in 26 human heart specimens after the injection of iodinated contrast media into the coronary arteries. Coronary artery plaques were visually identified on CT images and the grade of stenosis for each plaque was measured with electronic calipers. All coronary plaques were characterized by histopathology according to the Stary classification, and the percentage of stenosis was measured.
Results:
CT depicted 84% (274/326) of all coronary plaques identified by histology. Missed plaques by CT were of Stary type I (n=31), type II (n=16), and type III (n=5). The stenosis degree significantly correlated between CT and histology (r=0.81, p<0.001). CT systematically overestimated the stenosis of calcified plaques (mean difference - 11.0 ± 9.5%, p<0.01) and systematically underestimated the stenosis of non-calcified plaques (mean difference -6.8 ± 10.4%, p<0.05), while there was no significant difference for mixed-type plaques (mean difference -0.4 ± 11.7%, p=0.85). There was a significant underestimation of stenosis degree as measured by CT for Stary II plaques (mean difference -14 ± 9%, p<0.01) and a significant overestimation for Stary VII plaques (mean difference 9 ± 10%, p<0.05), but there was no significant difference in stenosis degree between both modalities for other plaque types.
Conclusions:
High-resolution CT reliably depicts advanced stage coronary plaques with an overall good correlation of stenosis degree compared to histology, however, the degree of stenosis is systematically overestimated in calcified and underestimated in non-calcified plaques.
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