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Prediction Rules for the Detection of Coronary Artery Plaques: Evidence From Cardiac CT

Saur, Stefan C. MSc*; Cattin, Philippe C. PhD*†; Desbiolles, Lotus MD‡; Fuchs, Thomas J. MSc§; Székely, Gábor PhD*; Alkadhi, Hatem MD‡

doi: 10.1097/RLI.0b013e3181a8afc4
Original Article

Objectives: To evaluate spatial plaque distribution patterns in coronary arteries based on computed tomography coronary angiography data sets and to express the learned patterns in prediction rules. An application is proposed to use these prediction rules for the detection of initially missed plaques.

Material and Methods: Two hundred fifty two consecutive patients with chronic coronary artery disease underwent contrast-enhanced dual-source computed tomography coronary angiography for clinical indications. Coronary artery plaques were manually labeled on a 16-segment coronary model and their position (ie, segments and bifurcations) and composition (ie, calcified, mixed, or noncalcified) were noted. The frequent itemset mining algorithm was used to statistically search for plaque distribution patterns. The patterns were expressed as prediction rules: given plaques at certain locations as conditions, a prediction rule gave evidence—with a certain confidence value—for a plaque at another location within the coronary artery tree. Prediction rules with the highest confidence values were evaluated and described. Furthermore, to improve manual plaque detection, all prediction rules were applied on the patient data to search for segments with potentially missed plaques. These segments were then reviewed in a second, guided reading for the existence of plaques. The same number of segments was also determined by a weighted random approach to evaluate the quality of prediction resulting from frequent itemset mining.

Results: In 200 of 252 (79.4%) patients, at least one coronary plaque (range, 1–22 plaques) was found. In total 1229 plaques (990 calcified, 80.6%; 227 mixed, 18.5%; 12 noncalcified, 1%) distributed, over 916 coronary segments and 507 vessels were manually labeled. Four plaque distribution patterns were identified: 20.6% of the patients had no plaques at all; 31.7% had plaques in the left coronary artery tree; 46.4% had plaques both in left and right coronary arteries, whereas 1.2% of the patients had plaques solely in the right coronary artery (RCA). General rules were found predicting plaques in the left anterior descending artery (LAD), given plaques in segments of the RCA or in the left main artery. Further general rules predicted plaques in the LAD, given plaques in the circumflex artery. In the guided review, the segment selection based on the prediction rules from frequent itemset mining performed significantly better (P < 0.001) than the weighted random approach by revealing 48 initially missed plaques.

Conclusions: This study demonstrates spatial plaque distribution patterns in coronary arteries as determined with cardiac CT. Use of the frequent itemset mining algorithm yielded rules that predicted plaques at certain sites given plaques at other sites of the coronary artery tree. Use of these prediction rules improved the manual labeling of coronary plaques as initially missed plaques could be predicted with the guided review.

From the *Computer Vision Laboratory, ETH Zurich, Zurich, Switzerland; †Medical Image Analysis Center, University of Basel, Basel, Switzerland; ‡Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; and §Department of Computer Science, ETH Zurich, Zurich, Switzerland.

Received January 5, 2009, and accepted for publication, after revision, March 29, 2009.

Supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions of the Swiss National Science Foundation available at: (

Reprints: Hatem Alkadhi, MD, Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.