Three dimensional imaging of carotid plaque offers the potential to further improve the accuracy of plaque measurements. According to the paper by Sillesen, the quartile classification kappe value was 0.55, which is acceptable, but
not really a good interobserver agreement. In our paper comparing CAC with TPA, only 8% had no carotid plaque, albeit being 10 years younger at average than the Sillesen group, where 22% had no carotid plaque, so they may have missed quite an amount of plaque burden, probably not iamging up and down sufficiently, and a 10 s sweep is also not very long. So, I think, this paper has some important shortcomings, since the feasibility was not reported, e.g. number of patients, in whom the image quality was not acceptable.
However, this study shows very clearly and for the first time in 6101 subjects, that Plaque Area of carotid arteries is an excellent surrogate for coronary calcium. However, 3D carotid plaque is not validated by outcome studies. TPA ist validated for the outcomes myocardial infarction and stroke, and the r2 correlation with plaque volume is 0.94 (reference).
Therefore, TPA is feasible, highly accurate when compared to 3D carotid plaque imaging and validated for the outcome of myocardial infarction and stroke.