{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:53:57Z","timestamp":1787018037174,"version":"build-2736575974"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction\/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds.<\/jats:p>\n                    <jats:p>\n                      Of 472 patients, 255 patients (56\u00b17.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82;\n                      <jats:italic>P<\/jats:italic>\n                      =0.014) and plaque burden (odds ratio: 5.71;\n                      <jats:italic>P<\/jats:italic>\n                      =0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78;\n                      <jats:italic>P<\/jats:italic>\n                      =0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742;\n                      <jats:italic>P<\/jats:italic>\n                      =0.066).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL TRIAL REGISTRATION<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      . Unique identifier: NCT01084239\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.118.007657","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T15:50:22Z","timestamp":1536940222000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Coronary Computed Tomography Angiography\u2013Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome"],"prefix":"10.1161","volume":"11","author":[{"given":"Daniel O.","family":"Bittner","sequence":"first","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"},{"name":"Massachusetts General Hospital and Harvard Medical School, Boston. Department of Cardiology, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), University Hospital Erlangen, Germany (D.O.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mayrhofer","sequence":"additional","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"},{"name":"School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan B.","family":"Puchner","sequence":"additional","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"},{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria (S.B.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pal","family":"Maurovich-Horvat","sequence":"additional","affiliation":[{"name":"MTA-SE Lend\u00fclet Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary (P.M.-H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khristine","family":"Ghemigian","sequence":"additional","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter H.","family":"Kitslaar","sequence":"additional","affiliation":[{"name":"Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.)."},{"name":"Medis Medical Imaging Systems B.V, Leiden, the Netherlands (P.H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Broersen","sequence":"additional","affiliation":[{"name":"Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Bamberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quynh A.","family":"Truong","sequence":"additional","affiliation":[{"name":"Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Schlett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maros","family":"Ferencik","sequence":"additional","affiliation":[{"name":"Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)"},{"name":"Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.),"},{"name":"Department of Radiology, University of Tuebingen, Germany 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