Cardiac allograft vasculopathy (CAV) is an increasingly important complication after cardiac transplant. We assessed the additive diagnostic benefit of quantitative plaque analysis in patients undergoing coronary computed tomography-angiography (CCTA). Consecutive patients undergoing CCTA for CAV surveillance were identified. Scans were visually interpreted for coronary stenosis. Semiautomated software was used to quantify noncalcified plaque (NCP), as well as its components. Optimal diagnostic cut-offs for CAV, with coronary angiography as gold standard, were defined using receiver operating characteristic curves. In total, 36 scans were identified in 17 patients. CAV was present in 17 (46.0%) reference coronary angiograms, at a median of 1.9 years before CCTA. Median NCP (147 vs 58, P < .001), low-density NCP (median 4.5 vs 0.9, P = .003), fibrous plaque (median 76.1 vs 31.1, P = .003), and fibrofatty plaque (median 63.6 vs 27.6, P < .001) volumes were higher in patients with CAV, whereas calcified plaque was not (median 0.0 vs 0.0, P = .510). Visual assessment of CCTA alone was 70.6% sensitive and 100% specific for CAV. The addition of total NCP volume increased sensitivity to 82.4% while maintaining 100% specificity. NCP volume is significantly higher in patients with CAV. The addition of quantitative analysis to visual interpretation improves the sensitivity for detecting CAV without reducing specificity.

中文翻译：

---

冠状动脉计算机断层扫描-血管造影定量斑块分析提高了早期心脏同种异体移植血管病变的检测：一项初步研究。

心脏同种异体移植物血管病变 (CAV) 是心脏移植后越来越重要的并发症。我们评估了定量斑块分析对接受冠状动脉计算机断层扫描血管造影术 (CCTA) 的患者的附加诊断益处。确定了接受 CCTA 以进行 CAV 监测的连续患者。对冠状动脉狭窄进行视觉解释扫描。半自动软件用于量化非钙化斑块 (NCP) 及其成分。CAV 的最佳诊断截止值，以冠状动脉造影作为金标准，使用接受者操作特征曲线定义。总共对 17 名患者进行了 36 次扫描。CAV 在 17 (46.0%) 参考冠状动脉造影中存在，在 CCTA 之前的中位数为 1.9 年。NCP 中位数（147 对 58，P < .001），低密度 NCP（中位数 4.5 对 0.9，P = .003），CAV 患者的纤维斑块（中位数 76.1 对 31.1，P = .003）和纤维脂肪斑块（中位数 63.6 对 27.6，P < .001）体积较大，而钙化斑块则没有（中位数 0.0 对 0.0，P = .001） 510）。仅 CCTA 的视觉评估对 CAV 的敏感性为 70.6%，特异性为 100%。添加总 NCP 体积可将灵敏度提高到 82.4%，同时保持 100% 的特异性。CAV 患者的 NCP 体积明显更高。在视觉解释中添加定量分析可提高检测 CAV 的灵敏度，而不会降低特异性。CAV 的灵敏度为 6%，特异性为 100%。添加总 NCP 体积可将灵敏度提高到 82.4%，同时保持 100% 的特异性。CAV 患者的 NCP 体积明显更高。在视觉解释中添加定量分析可提高检测 CAV 的灵敏度，而不会降低特异性。CAV 的灵敏度为 6%，特异性为 100%。添加总 NCP 体积可将灵敏度提高到 82.4%，同时保持 100% 的特异性。CAV 患者的 NCP 体积明显更高。在视觉解释中添加定量分析可提高检测 CAV 的灵敏度，而不会降低特异性。