Rationale and Objectives
To investigate the diagnostic accuracy of subtraction coronary computed tomographic
angiography (CCTAsub) in identifying ≥ 50% and ≥ 70% coronary stenosis in patients with different degrees
of calcification.
Materials and Methods
In this study, 180 patients with coronary calcified plaques who underwent both coronary
CT angiography and invasive coronary angiography (ICA) were prospectively enrolled
at five centers. Patients were divided into three groups according to the Agatston
score: group A (low to moderate, < 400), group B (high, 400-999), and group C (very
high, ≥ 1000). Diagnostic accuracies estimated by area under the receiver operating
characteristic curve (AUC) were compared between conventional CCTA (CCTAcon) and CCTAsub, with ICA as a reference standard.
Results
There were 86 patients in group A, 44 in group B, and 50 in group C. In identifying
≥ 70% coronary stenosis, subtraction improved the diagnostic accuracies on a per-segment
basis in group B (AUC: 0.80 vs 0.92, p = 0.001) and group C (AUC: 0.75 vs 0.84, p = 0.001) after subtraction. When identifying ≥ 50% coronary stenosis, the per-segment
AUC of CCTAsub in group B and C were significantly higher than that in CCTAcon (group B: 0.81 vs 0.92, p < 0.001; group C: 0.77 vs 0.88, p < 0.001). However, no improvement was observed in group A.
Conclusion
Subtraction achieved better diagnostic accuracy in patients with Agatston score ≥
400, both in identifying ≥ 50% and ≥ 70% coronary stenosis, which was instructive
for the application of subtraction in clinical practice.
Key Words
Abbreviations:
CCTA (Coronary computed tomographic angiography), CAD (coronary artery disease), CAC (coronary artery calcium), CCTAsub (subtraction coronary computed tomographic angiography), CACS (coronary artery calcium score), CCTAcon (conventional coronary computed tomographic angiography), ICA (invasive coronary angiography), RCA (right coronary artery), LAD (left anterior descending), LCx (left circumflex artery), IQR (interquartile ranges), AUC (area under the curve), ROC (receiver operating characteristic curve), FFR (fractional flow reserve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 29, 2022
Accepted:
November 27,
2022
Received in revised form:
November 6,
2022
Received:
September 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
