Deep Learning-based Automated Coronary Plaque Quantification: First Demonstration With Ultra-high Resolution...

The aim of this study was to evaluate the feasibility and reproducibility of a novel deep learning (DL)-based coronary plaque quantification tool with automatic case preparation in patients undergoing ultra-high resolution (UHR) photon-counting detector CT coronary angiography (CCTA), and to assess the influence of temporal resolution on plaque quantification.

In this retrospective single-center study, 45 patients undergoing clinically indicated UHR CCTA were included. In each scan, 2 image data sets were reconstructed: one in the dual-source mode with 66 ms temporal resolution and one simulating a single-source mode with 125 ms temporal resolution. A novel, DL-based algorithm for fully automated coronary segmentation and intensity-based plaque quantification was applied to both data sets in each patient. Plaque volume quantification was performed at the vessel-level for the entire left anterior descending artery (LAD), left circumflex artery (CX), and right coronary artery (RCA), as well as at the lesion-level for the largest coronary plaque in each vessel. Diameter stenosis grade was quantified for the coronary lesion with the greatest longitudinal extent in each vessel. To assess reproducibility, the algorithm was rerun 3 times in 10 randomly selected patients, and all outputs were visually reviewed and confirmed by an expert reader. Paired Wilcoxon signed-rank tests with Benjamini-Hochberg correction were used for statistical comparisons.

One hundred nineteen out of 135 (88.1%) coronary arteries showed atherosclerotic plaques and were included in the analysis. In the reproducibility analysis, repeated runs of the algorithm yielded identical results across all plaque and lumen measurements ( P > 0.999). All outputs were confirmed to be anatomically correct, visually consistent, and did not require manual correction. At the vessel level, total plaque volumes were higher in the 125 ms reconstructions compared with the 66 ms reconstructions in 28 of 45 patients (62%), with both calcified and noncalcified plaque volumes being higher in 32 (71%) and 28 (62%) patients, respectively. Total plaque volumes in the LAD, CX, and RCA were significantly higher in the 125 ms reconstructions (681.3 vs. 647.8  mm 3 , P  < 0.05). At the lesion level, total plaque volumes were higher in the 125 ms reconstructions in 44 of 45 patients (98%; 447.3 vs. 414.9  mm 3 , P  < 0.001), with both calcified and noncalcified plaque volumes being higher in 42 of 45 patients (93%). The median diameter stenosis grades for all vessels were significantly higher in the 125 ms reconstructions (35.4% vs. 28.1%, P  < 0.01).

This study evaluated a novel DL-based tool with automatic case preparation for quantitative coronary plaque in UHR CCTA data sets. The algorithm was technically robust and reproducible, delivering anatomically consistent outputs not requiring manual correction. Reconstructions with lower temporal resolution (125 ms) systematically overestimated plaque burden compared with higher temporal resolution (66 ms), underscoring that protocol standardization is essential for reliable DL-based plaque quantification.