Reproducibility of quantitative plaque measurement in advanced coronary artery disease

The ability to characterize and to quantify the extent of coronary artery disease has the potential to improve the prognostic capability of coronary computed tomography angiography. Although reproducible techniques have been described in those with mild coronary disease, this has yet to be assessed in patients with advanced disease.

Twenty patients with known multivessel disease underwent repeated computed tomography coronary angiography, 2 weeks apart. Coronary artery segments were analysed using semi-automated software by two trained observers to determine intraobserver, interobserver and interscan reproducibility.

Overall, 149 coronary arterial segments were analysed. There was excellent intraobserver and interobserver agreement for all plaque volume measurements (Lin's coefficient 0.95 to 1.0). There were no substantial interscan differences (P ​> ​0.05 for all) for total (2063 ​± ​1246 ​mm³, mean of differences -35.6 ​mm³), non-calcified (1795 ​± ​910 ​mm³, mean of differences -4.3 ​mm³), calcified (298 ​± ​425 ​mm³, mean of differences -31.3 ​mm³) and low-attenuation (13 ​± ​13 ​mm³, mean of differences -2.6 ​mm³) plaque volumes. Interscan agreement was highest for total and noncalcified plaque volumes. Calcified and low-attenuation plaque (-236.6 to 174 ​mm³ and -15.8 to 10.5 ​mm³ respectively) had relatively wider 95% limits of agreement reflecting the lower absolute plaque volumes.

In the presence of advanced coronary disease, semi-automated plaque quantification provides excellent reproducibility, particularly for total and non-calcified plaque volumes. This approach has major potential to assess change in disease over time and optimize risk stratification in patients with established coronary artery disease.