Where Do Things Stand with AI-Powered Plaque Quantification for CCTA Exams?: An Interview with Ron Blankstein, MD

With the increased use of coronary computed tomography angiography (CCTA) in recent years, Ron Blankstein, M.D., said there was a shift that the amount of plaque was a “strong, if not a stronger, predictor of future (cardiovascular) events” than stenosis. More recently, there has been an increased interest in artificial intelligence (AI) quantification of coronary plaque on CCTA scans but a fair amount of certainly as well regarding use of this new technology.

Accordingly, the American College of Cardiology (ACC) recently issued a consensus statement about AI-enabled plaque quantification. In a recent interview with Diagnostic Imaging, Dr. Blankstein, a co-author of the consensus statement, noted that the ACC statement provides updated definitions of plaque burden and insights into optimal use of the technology. While Dr. Blankstein cautioned that more research is needed to assess the impact of AI-enabled quantification of plague on patient outcomes, he suggested that the technology may add more clarity to cardiovascular risk stratification.

“I think the key message there is that we can use plaque analysis to refine risk assessment to tell us which patients have a larger burden of plaque than maybe we anticipated otherwise, and therefore we would treat those patients more aggressively,” noted Dr. Blankstein, the director of cardiac CT and associate director of the cardiovascular imaging program at Brigham and Women’s Hospital in Boston.

While there has been increasing interest in the possibility of serial plaque analysis to assess the impact of treatment, Dr. Blankstein emphasized that this is not ready for prime time. In addition to limited evidence for serial plaque analysis thus far, he said this is “a very technical analysis” that requires utilizing the same scanner, tube voltage, reconstruction parameters and the same algorithm.

“When we use plaque analysis in the research world, we pay a lot of attention to this. But in the clinical world, if plaque analysis is ever going to be used serially, it's really important to pay attention to those details,” maintained Dr. Blankstein, a professor of medicine at Harvard Medical School.

(Editor’s note: For related content, see “Can AI Assessment of Non-Calcified Plaque Volume Enhance CT Assessment of MACE Risk Beyond CAC Scoring?,” “Why Plaque Burden is Critical to Assessing Cardiovascular Risk: An Interview with Ibrahim Danad, MD, PhD” and “Emerging CCTA Research Shows Prognostic Value of AI Quantification of Plaque Burden for Assessing Cardiovascular Risks.”)

For more insights from Dr. Blankstein, watch the video below.