Anatomical and functional assessment of coronary artery disease using computed tomography angiography
Vattay Borbála
Theoretical and Translational Medicine
Dr. Kellermayer Miklós
SE Ér- és Szívsebészeti Klinika előadóterme
2026-01-08 13:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Szilveszter Bálint
Dr. Keltai Katalin
Dr. Végh Eszter
Dr. Benyó Zoltán
Dr. Sármán Balázs
Dr. Marton Nikolett
This thesis aimed to improve the assessment of CAD burden, its progression and functional consequences by leveraging advanced coronary CTA postprocessing tools and PCCT imaging. The first objective was to define plaque progression using different CAD definitions applied to serial CTA scans, identifying predictors of progression and comparing detection rates across semi-quantitative CAD definitions, including the widely used CAD-RADS stenosis classification. Current CAD definitions vary, leading to inconsistent identification of patients with CAD progression and differing risk factor associations. Our study revealed important limitations in current CAD assessment methods. CAD-RADS failed to detect progression in nearly half of patients with serial CTA. This finding underscores the need for more comprehensive, standardized definitions incorporating semiquantitative plaque burden metrics.
The second objective focused on elucidating the relationship between quantitative coronary plaque metrics derived from coronary CTA and segmental myocardial ischemia as assessed by DPCT. This aimed to clarify whether plaque burden provides incremental value over stenosis severity in predicting ischemia, which is crucial for clinical decision-making. Importantly, TPV was independently associated with segmental myocardial ischemia based on MBF, whereas traditional measures were not. This suggests that total plaque burden is a more sensitive and clinically relevant marker for ischemia than stenosis alone, supporting a shift toward comprehensive plaque quantification in clinical practice to better identify ischemic myocardial territories.
The third objective investigated how quantitative measurements of individual plaque components change across different VMI reconstructions obtained from a novel PCCT system and assessed the quantitative image quality. Plaque volume estimates differed substantially between VMIs at different VMI levels, especially for LAP, which is currently defined by fixed HU thresholds. Since PCCT offers enhanced spectral imaging capabilities, understanding how HU values vary with energy levels is critical for establishing reliable plaque quantification protocols and therefore our results represent an important step towards normalization of coronary plaque volume using different VMIs. Collectively, these results show the potential of novel technologies to refine CAD diagnosis and management and might also improve personalized medicine in CAD management provided that standardized definitions and imaging protocols are adopted.
