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Hybrid CCTA/IVUS: breaking the traditional boundaries of coronary imaging

Oliver Gaemperli, Philipp A. Kaufmann
DOI: http://dx.doi.org/10.1093/eurheartj/ehs006 941-943 First published online: 27 January 2012

This editorial refers to ‘Automated quantification of coronary plaque with computed tomography: comparison with intravascular ultrasound using a dedicated registration algorithm for fusion-based quantification’, by M.J. Boogers et al., on page 1007

The modern paradigm of unstable plaques has led to the abandonment of the central role of luminal narrowing as a risk factor of plaque rupture and embraced an integrated concept of plaque vulnerability including a variety of microanatomical features such as plaque size, lipid content of the core, fibrous cap thickness, and positive plaque remodelling.1,2 A large number of studies have documented a high diagnostic accuracy of coronary computed tomography angiography (CCTA) to detect coronary stenoses (a finding with strong clinical implications). However, unlike invasive angiography, CCTA can provide non-invasive visualization of the vessel wall, including information regarding plaque size, extent, composition, and arterial remodelling. Several studies have demonstrated that beyond coronary stenoses, the presence of non-obstructive plaques is associated with an increased risk for cardiovascular events.3 Confirmation of these findings emerged from the recent multinational, multiethnic CONFIRM registry, including >23 000 patients where the presence of non-obstructive coronary disease was associated with a 50–70% increase in total mortality.4

CCTA has an excellent accuracy to detect coronary plaques compared with the gold standard intravascular ultrasound (IVUS), with an area under the curve for the receiver operating characteristics analysis of 0.94, a sensitivity of 90%, and a specificity of 92%.5 The sensitivity is highest for the right coronary artery (RCA), and lowest for the circumflex artery (LCX). Several studies have assessed the value of CCTA for the quantification of the extent of coronary atheroma. Leber and colleagues showed that plaque volumes assessed with 64-slice CCTA correlated well with IVUS (r = 0.83).6 Unfortunately, depiction of further microanatomical details such …