Non-invasive volumetric assessment of aortic atheroma: a core laboratory validation using computed tomography angiography

Muhammad Hammadah, Mohammed Qintar, Steven E. Nissen, Julie St John, Saqer Alkharabsheh, Motunrayo Mobolaji-Lawal, Femi Philip, Kiyoko Uno, Yu Kataoka, Brett Babb, Roman Poliszczuk, Samir R. Kapadia, E. Murat Tuzcu, Paul Schoenhagen, Stephen J. Nicholls, Rishi Puri

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Aortic atherosclerosis has been linked with worse peri- and post-procedural outcomes following a range of aortic procedures. Yet, there are currently no standardized methods for non-invasive volumetric pan-aortic plaque assessment. We propose a novel means of more accurately assessing plaque volume across whole aortic segments using computed tomography angiography (CTA) imaging. Sixty patients who underwent CTA prior to trans-catheter aortic valve implantation were included in this analysis. Specialized software analysis (3mensio Vascular™, Pie Medical, Maastricht, Netherlands) was used to reconstruct images using a centerline approach, thus creating true cross-sectional aortic images, akin to those images produced with intravascular ultrasonography. Following aortic segmentation (from the aortic valve to the renal artery origin), atheroma areas were measured across multiple contiguous evenly spaced (10 mm) cross-sections. Percent atheroma volume (PAV), total atheroma volume (TAV) and calcium score were calculated. In our populations (age 79.9 ± 8.5 years, male 52 %, diabetes 27 %, CAD 84 %, PVD 20 %), mean ± SD number of cross sections measured for each patient was 35.1 ± 3.5 sections. Mean aortic PAV and TAV were 33.2 ± 2.51 % and 83,509 ± 17,078 mm3, respectively. Median (IQR) calcium score was 1.5 (0.7–2.5). Mean (SD) inter-observer coefficient of variation and agreement for plaque area among 4 different analysts was 14.1 (5.4), and the mean (95 % CI) Lin’s concordance correlation coefficient was 0.79 (0.62–0.89), effectively simulating a Core Laboratory scenario. We provide an initial validation of cross-sectional volumetric aortic atheroma assessment using CTA. This proposed methodology highlights the potential for utilizing non-invasive aortic plaque imaging for risk prediction across a range of clinical scenarios.

Original languageEnglish (US)
Pages (from-to)121-129
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number1
StatePublished - Jan 1 2016
Externally publishedYes


  • Aortic atheroma
  • CT angiogram
  • CTA
  • Plaque volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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