Development and validation of a novel deep learning coronary artery plaque quantification model

Coronary Computed Tomography Angiography (CCTA) is an established tool for assessing coronary artery disease. CCTA determined total coronary artery plaque volume predicts cardiovascular events, but manual quantification is impractical for routine use. Deep learning-based methods offer a promising solution for automated plaque volume assessment.

We developed and validated a novel software, QuantiPlaque, powered by deep learning models, for automated segmentation of total and calcified coronary plaque volume. Expert manual annotation served as the reference standard. Correlations between deep learning and expert segmentation were evaluated using intraclass correlation coefficient (ICC), Pearson's r, and Spearman's rho, and agreements were evaluated with Bland-Altman analyses.

A total of 115 CCTA scans were included. Mean (range) age was 58 (51-64) and 51% were females. The mean coronary artery calcium score was 56 Agatston units, ranging from 0 to 601. The model demonstrated strong correlation and agreement with expert annotation for per-patient total plaque volume (ICC 0.95, mean difference - 8.35 mm³, 95% limit of agreement - 102 to 85 mm³, Spearman's rho 0.87, Pearson's r 0.95) and calcified plaque volume (ICC 0.90, mean difference - 0.28 mm³, 95% limits of agreement - 21.97 to 21.42 mm³, Spearman's rho 0.93, Pearson's r 0.90). Per-vessel analysis showed strong correlation in the left anterior descending artery and right coronary artery but was weaker in the left circumflex artery territory.

The evaluated deep learning model provides accurate quantification of total and calcified plaque burden, with strong correlation and agreement to expert annotation.