Department of Cardiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
PLoS One. 2018 Dec 14;13(12):e0207980. doi: 10.1371/journal.pone.0207980. eCollection 2018.
Quantitative computed tomography (QCT) provides important prognostic information of coronary atherosclerosis. We investigated intraobserver and interobserver QCT reproducibility in asymptomatic individuals, patients with acute chest pain without acute coronary syndrome (ACS), and patients with acute chest pain and ACS.
Fifty patients from each cohort, scanned between 01/02/2010-14/11/2013 and matched according to age and gender, were retrospectively assessed for inclusion. Patients with no coronary artery disease, previous coronary artery bypass graft surgery, and poor image quality were excluded. Coronary atherosclerosis was measured semi-automatically by 2 readers. Reproducibility of minimal lumen area (MLA), minimal lumen diameter (MLD), area stenosis, diameter stenosis, vessel remodeling, plaque eccentricity, plaque burden, and plaque volumes was assessed using concordance correlation coefficient (CCC), Bland-Altman, coefficient of variation, and Cohen's kappa.
A total of 84 patients (63 matched) were included. Intraobserver and interobserver reproducibility estimates were acceptable for MLA (CCC = 0.94 and CCC = 0.91, respectively), MLD (CCC = 0.92 and CCC = 0.86, respectively), plaque burden (CCC = 0.86 and CCC = 0.80, respectively), and plaque volume (CCC = 0.97 and CCC = 0.95, respectively). QCT detected area and diameter stenosis ≥50%, positive remodeling, and eccentric plaque with moderate-good intraobserver and interobserver reproducibility (kappa: 0.64-0.66, 0.69-0.76, 0.46-0.48, and 0.41-0.62, respectively). Reproducibility of plaque composition decreased with decreasing plaque density (intraobserver and interobserver CCC for dense calcium (>0.99; 0.98), fibrotic (0.96; 0.93), fibro-fatty (0.95; 0.91), and necrotic core tissue (0.89; 0.84). Reproducibility generally decreased with worsening clinical risk profile.
Semi-automated QCT of coronary plaque morphology is reproducible, albeit with some decline in reproducibility with worsening patient risk profile.
定量计算机断层扫描（QCT）提供了冠状动脉粥样硬化的重要预后信息。我们研究了无症状个体、急性胸痛无急性冠状动脉综合征（ACS）患者和急性胸痛伴 ACS 患者的观察者内和观察者间 QCT 可重复性。
2010 年 2 月 1 日至 2013 年 11 月 14 日期间，每个队列各纳入 50 例患者，根据年龄和性别进行匹配，回顾性评估入选情况。排除无冠状动脉疾病、先前冠状动脉旁路移植术和图像质量差的患者。两名读者采用半自动方法测量冠状动脉粥样硬化。采用一致性相关系数（CCC）、Bland-Altman 法、变异系数和 Cohen's kappa 评估最小管腔面积（MLA）、最小管腔直径（MLD）、面积狭窄、直径狭窄、血管重构、斑块偏心、斑块负荷和斑块体积的可重复性。
共纳入 84 例患者（63 例匹配）。观察者内和观察者间的 MLA（CCC=0.94 和 CCC=0.91）、MLD（CCC=0.92 和 CCC=0.86）、斑块负荷（CCC=0.86 和 CCC=0.80）和斑块体积（CCC=0.97 和 CCC=0.95）的估计值可接受。QCT 检测到面积和直径狭窄≥50%、正性重构和偏心斑块的观察者内和观察者间的可重复性为中等至良好（kappa：0.64-0.66、0.69-0.76、0.46-0.48 和 0.41-0.62）。随着斑块密度的降低，斑块成分的可重复性降低（观察者内和观察者间的致密钙（>0.99；0.98）、纤维（0.96；0.93）、纤维-脂肪（0.95；0.91）和坏死核心组织（0.89；0.84）的 CCC）。可重复性通常随患者风险状况的恶化而降低。
冠状动脉斑块形态的半自动 QCT 具有可重复性，但随着患者风险状况的恶化，可重复性略有下降。
