Detection of calcified plaques: comparison between coronary CT angiography and thin-slice non-contrast CT with deep learning-aided image registration
Objectives
To investigate whether coronary CT angiography (CCTA) misses calcified plaques detected by thin-slice non-contrast CT (NCCT).
Materials and methods
This study included patients from two sites in the DISCHARGE trial for whom both 0.5 mm thin-slice NCCT and CCTA were available. Plaques on CCTA were defined as missed if they showed no spatial overlap with NCCT-detected plaques after deep learning-aided co-registration. Comparisons of plaque volume, density, and local coronary luminal attenuation between plaques missed and those detected by CCTA were performed using the Mann–Whitney U-test. In addition, the presence of these plaques on standard calcium scoring CT was assessed. Interobserver agreement was assessed using the intraclass correlation coefficient and Bland‒Altman analysis.
Results
This study included 45 patients (40% female, mean age 62 ± 11 years), in whom CCTA missed 37.6% of calcified plaques detected by NCCT (121/322). Missing calcified plaques on CCTA misclassified 8.9% of patients (4/45) as having no plaques. Compared with detected plaques, plaques missed by CCTA were both significantly smaller in volume (3.0 mm³ [IQR, 1.5–4.9] vs. 9.2 mm³ [IQR, 4.3–21.9], p < 0.001) and had lower density (212.7 HU [IQR, 174.5–242.4] vs. 292.7 HU [IQR, 243.2–361.3], p < 0.001). Only 44.0% of plaques (53/121) missed by CCTA were detected by standard calcium scoring CT. Interobserver analysis demonstrated excellent agreement for calcified plaque volume on CCTA (ICC = 0.91) and NCCT (ICC = 0.98).
Conclusion
CCTA missed more than one-third of coronary calcified plaques that are identifiable on co-registered thin-slice NCCT, which suggests an underutilized role of thin-slice NCCT in clinical practice.
