Can AI Assessment of Non-Calcified Plaque Volume Enhance CT Assessment of MACE Risk Beyond CAC Scoring?

Emerging research from the recent RSNA conference demonstrates that AI assessment of non-calcified plaque volume (NCPV) based on computed tomography (CT) scans may provide more prognostic utility than coronary artery calcium (CAC) scoring for stratification of cardiovascular risk.

For the study, researchers reviewed data for 2,394 patients who had coronary computed tomography angiography (CCTA) exams. The study authors noted that 51 percent of the cohort had hypertension and 43.7 percent had hyperlipidemia. While major adverse cardiovascular events (MACE) occurred with increasing CAC scores, the researchers found that 21 events occurred in patients with a CAC score of zero.

Subsequent multivariable analysis revealed that increasing NCPV (measured with the AI-powered AI-QCT software (Cleerly) had over a sevenfold greater likelihood of predicting MACE (7.8 hazard ratio) in comparison to CAC categories (ranging from a 1.03 to 1.33 HR). The study authors noted that a NCPV assessment > 7.5 percent was associated with the highest predictive capacity for MACE.

In a recent interview with Diagnostic Imaging, lead study author Tyler Coombes, M.D., said the AI-QCT software provides superior assessment of NCPV beyond the limitations of unassisted CCTA interpretation.

“We've been able to show throughout the cardiology and radiology research in this field that these AI-based platforms are better at detecting this non-calcified plaque and non-calcified atheroma volume than we are,” noted Coombes, a cardiologist and clinical associate professor at the University of Tennessee Medical Center in Knoxville, Tenn.

(Editor’s note: For additional coverage of the RSNA conference, click here.)

Parth Patel, M.D., a co-author of the study, emphasized that when they combined CAC scoring with NCPV assessment, CAC scoring had no additional prognostic impact in the multivariable analysis.

“ … It really did not show us any difference in terms of analyzing plaque burden and major cardiac major adverse cardiac events,” added Dr. Patel, a second-year internal medicine resident at the University of Tennessee Medical Center.

(Editor’s note: For related content, see “Why Plaque Burden is Critical to Assessing Cardiovascular Risk: An Interview with Ibrahim Danad, MD, PhD,” “Cardiac MRI Study Affirms Link Between Air Pollution Exposure and Increased Diffuse Myocardial Fibrosis” and “CT-Based Coronary Artery Calcium Score Helps Predict Post-Op Survival Risks in Elderly Lung Cancer Patients.”)

For more insights from Drs. Coombes and Patel, watch the video below.

Reference

1. Coombes T, Patel P, Joshi Y, et al. Prognostic utility of coronary calcification in the consideration of underlying non-calcified plaque burden. Presented at the Radiological Society of North America (RSNA) annual meeting, November 30-December 4, 2025, Chicago.