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Dwivedi A, Al'Aref SJ, Lin FY, Min JK. Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging. Korean Circ J 2018; 48:124-133. [PMID: 29441745 PMCID: PMC5861003 DOI: 10.4070/kcj.2017.0392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.
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Affiliation(s)
- Aeshita Dwivedi
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
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Kwan AC, Aronis KN, Sandfort V, Blumenthal RS, Bluemke DA. Bridging the gap for lipid lowering therapy: plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine. Expert Rev Cardiovasc Ther 2017; 15:547-558. [PMID: 28657444 PMCID: PMC8286171 DOI: 10.1080/14779072.2017.1348228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient's personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual's atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.
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Affiliation(s)
- Alan C. Kwan
- Department of Medicine of the Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
- Radiology and Imaging Sciences Department of the National Institutes of Health, Bethesda, MD 20892
| | - Konstantinos N. Aronis
- Department of Cardiology of the Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Veit Sandfort
- Radiology and Imaging Sciences Department of the National Institutes of Health, Bethesda, MD 20892
| | - Roger S. Blumenthal
- Department of Cardiology of the Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - David A. Bluemke
- Radiology and Imaging Sciences Department of the National Institutes of Health, Bethesda, MD 20892
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Sandfort V, Lima JAC, Bluemke DA. Noninvasive Imaging of Atherosclerotic Plaque Progression: Status of Coronary Computed Tomography Angiography. Circ Cardiovasc Imaging 2015; 8:e003316. [PMID: 26156016 DOI: 10.1161/circimaging.115.003316] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high-risk patients. For low-to-moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary computed tomography angiography to evaluate the extent and subtypes of coronary plaque. Computed tomographic technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on computed tomography angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of coronary computed tomography angiography compared with competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low-to-moderate cardiovascular risk.
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Affiliation(s)
- Veit Sandfort
- From the Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S., D.A.B.); and Department of Radiology (J.A.C.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, MD
| | - Joao A C Lima
- From the Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S., D.A.B.); and Department of Radiology (J.A.C.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, MD
| | - David A Bluemke
- From the Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S., D.A.B.); and Department of Radiology (J.A.C.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, MD.
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Clinical Feasibility of 3D Automated Coronary Atherosclerotic Plaque Quantification Algorithm on Coronary Computed Tomography Angiography: Comparison with Intravascular Ultrasound. Eur Radiol 2015; 25:3073-83. [DOI: 10.1007/s00330-015-3698-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/10/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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5
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Accuracy of coronary computed tomography angiography vs intravascular ultrasound for evaluation of vessel area. J Cardiovasc Comput Tomogr 2014; 8:141-8. [DOI: 10.1016/j.jcct.2013.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/12/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
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6
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Fischer C, Hulten E, Belur P, Smith R, Voros S, Villines TC. Coronary CT angiography versus intravascular ultrasound for estimation of coronary stenosis and atherosclerotic plaque burden: A meta-analysis. J Cardiovasc Comput Tomogr 2013; 7:256-66. [DOI: 10.1016/j.jcct.2013.08.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/23/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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7
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de Graaf MA, Broersen A, Kitslaar PH, Roos CJ, Dijkstra J, Lelieveldt BPF, Jukema JW, Schalij MJ, Delgado V, Bax JJ, Reiber JHC, Scholte AJ. Automatic quantification and characterization of coronary atherosclerosis with computed tomography coronary angiography: cross-correlation with intravascular ultrasound virtual histology. Int J Cardiovasc Imaging 2013; 29:1177-90. [PMID: 23417447 DOI: 10.1007/s10554-013-0194-x] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/04/2013] [Indexed: 01/27/2023]
Abstract
Plaque constitution on computed tomography coronary angiography (CTA) is associated with prognosis. At present only visual assessment of plaque constitution is possible. An accurate automatic, quantitative approach for CTA plaque constitution assessment would improve reproducibility and allows higher accuracy. The present study assessed the feasibility of a fully automatic and quantitative analysis of atherosclerosis on CTA. Clinically derived CTA and intravascular ultrasound virtual histology (IVUS VH) datasets were used to investigate the correlation between quantitatively automatically derived CTA parameters and IVUS VH. A total of 57 patients underwent CTA prior to IVUS VH. First, quantitative CTA quantitative computed tomography (QCT) was performed. Per lesion stenosis parameters and plaque volumes were assessed. Using predefined HU thresholds, CTA plaque volume was differentiated in 4 different plaque types necrotic core (NC), dense calcium (DC), fibrotic (FI) and fibro-fatty tissue (FF). At the identical level of the coronary, the same parameters were derived from IVUS VH. Bland-Altman analyses were performed to assess the agreement between QCT and IVUS VH. Assessment of plaque volume using QCT in 108 lesions showed excellent correlation with IVUS VH (r = 0.928, p < 0.001) (Fig. 1). The correlation of both FF and FI volume on IVUS VH and QCT was good (r = 0.714, p < 0.001 and r = 0.695, p < 0.001 respectively) with corresponding bias and 95 % limits of agreement of 24 mm(3) (-42; 90) and 7.7 mm(3) (-54; 70). Furthermore, NC and DC were well-correlated in both modalities (r = 0.523, p < 0.001) and (r = 0.736, p < 0.001). Automatic, quantitative CTA tissue characterization is feasible using a dedicated software tool. Fig. 1 Schematic illustration of the characterization of coronary plaque on CTA: cross-correlation with IVUS VH. First, the 3-dimensional centerline was generated from the CTA data set using an automatic tree extraction algorithm (Panel I). Using a unique registration a complete pullback series of IVUS images was mapped on the CTA volume using true anatomical markers (Panel II). Fully automatic lumen and vessel wall contour detection was performed for both imaging modalities (Panel III). Finally, fusion-based quantification of atherosclerotic lesions was based on the lumen and vessel wall contours as well as the corresponding reference lines (estimate of normal tapering of the coronary artery), as shown in panel IV. At the level of the minimal lumen area (MLA) (yellow lines), stenosis parameters, could be calculated for both imaging techniques. Additionally, plaque volumes and plaque types were derived for the whole coronary artery lesion, ranging from the proximal to distal lesion marker (blue markers). Fibrotic tissue was labeled in dark green, Fibro-fatty tissue in light green, dense calcium in white and necrotic core was labeled in red.
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Affiliation(s)
- Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA Leiden, The Netherlands.
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Boogers MJ, Broersen A, van Velzen JE, de Graaf FR, El-Naggar HM, Kitslaar PH, Dijkstra J, Delgado V, Boersma E, de Roos A, Schuijf JD, Schalij MJ, Reiber JHC, Bax JJ, Jukema JW. Automated quantification of coronary plaque with computed tomography: comparison with intravascular ultrasound using a dedicated registration algorithm for fusion-based quantification. Eur Heart J 2012; 33:1007-16. [PMID: 22285583 DOI: 10.1093/eurheartj/ehr465] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Previous studies have used semi-automated approaches for coronary plaque quantification on multi-detector row computed tomography (CT), while an automated quantitative approach using a dedicated registration algorithm is currently lacking. Accordingly, the study aimed to demonstrate the feasibility and accuracy of automated coronary plaque quantification on cardiac CT using dedicated software with a novel 3D coregistration algorithm of CT and intravascular ultrasound (IVUS) data sets. METHODS AND RESULTS Patients who had undergone CT and IVUS were enrolled. Automated lumen and vessel wall contour detection was performed for both imaging modalities. Dedicated automated quantitative software (QCT) with a unique registration algorithm was used to fuse a complete IVUS run with a CT angiography volume using true anatomical markers. At the level of the minimal lumen area (MLA), percentage lumen area stenosis, plaque burden, and degree of remodelling were obtained on CT. Additionally, mean plaque burden was assessed for the whole coronary plaque. At the identical level within the coronary artery, the same variables were derived from IVUS. Fifty-one patients (40 men, 58 ± 11 years, 103 coronary arteries) with 146 lesions were evaluated. Quantitative computed tomography and IVUS showed good correlation for MLA (n = 146, r = 0.75, P < 0.001). At the level of the MLA, both techniques were well-correlated for lumen area stenosis (n = 146, r = 0.79, P < 0.001) and plaque burden (n = 146, r = 0.70, P < 0.001). Mean plaque burden (n = 146, r = 0.64, P < 0.001) and remodelling index (n = 146, r = 0.56, P < 0.001) showed significant correlations between QCT and IVUS. CONCLUSION Automated quantification of coronary plaque on CT is feasible using dedicated quantitative software with a novel 3D registration algorithm.
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Affiliation(s)
- Mark J Boogers
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Intermediate lesions: retrieving black from shades of gray. JACC Cardiovasc Interv 2011; 4:209-12. [PMID: 21349460 DOI: 10.1016/j.jcin.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lee MS, Chun EJ, Kim KJ, Kim JA, Vembar M, Choi SI. Reproducibility in the assessment of noncalcified coronary plaque with 256-slice multi-detector CT and automated plaque analysis software. Int J Cardiovasc Imaging 2010; 26:237-44. [DOI: 10.1007/s10554-010-9710-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/15/2010] [Indexed: 10/19/2022]
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Influence of statin treatment on coronary atherosclerosis visualised using multidetector computed tomography. Eur Radiol 2010; 20:2824-33. [DOI: 10.1007/s00330-010-1880-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 06/07/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022]
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Automated Quantification of Stenosis Severity on 64-Slice CT. JACC Cardiovasc Imaging 2010; 3:699-709. [DOI: 10.1016/j.jcmg.2010.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 01/21/2010] [Accepted: 03/01/2010] [Indexed: 11/15/2022]
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Bruining N, Roelandt JRTC, Verheye S, Knaapen M, Onuma Y, Regar E, Cademartiri F, de Winter S, Van Langenhove G, Serruys PW, Hamers R, de Feyter PJ. Compositional volumetry of non-calcified coronary plaques by multislice computed tomography: an ex vivo feasibility study. EUROINTERVENTION 2010; 5:558-64. [PMID: 20142176 DOI: 10.4244/eijv5i5a91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Non-invasive quantitative compositional analysis of coronary plaque would be a major advantage to study coronary artery disease. This study explores the application to use the Hounsfield units (HU) distribution of coronary plaques imaged by multislice computed tomography-coronary angiography (MSCT-CA). METHODS AND RESULTS A dedicated computer-assisted method was developed to measure the HU distribution within a coronary plaque by MSCT-CA. To test the feasibility of the method, an ex vivo left anterior descending (LAD) coronary specimen, excised during autopsy, was imaged both by non-enhanced and enhanced MSCT-CA. Quantitative histology was used as a reference. To test the feasibility of the new volumetric analytic method, the MSCT-CA data were compared with volumetric histopathology. The coronary specimen, with a heterogeneously distributed plaque composition without large areas of calcification, was histologically sampled at five different locations, 5 mm apart, where at each location 15 sections were taken at 100 microm intervals, resulting in 75 individual histology sections. Tri-chrome Masson staining was used for histology quantification of three plaque/tissue components: smooth muscle cells (SMC), collagen and calcium. MSCT plaque composition was defined as "lower-HU" or "higher-HU" plaque and "calcium" based on the HU distribution. Comparison of the MSCT defined tissue components against histology showed a good relationship without significant differences. CONCLUSIONS This ex vivo study shows the feasibility of using the Hounsfield unit distribution to perform compositional coronary plaque volumetry by MSCT-CA. The results are encouraging.
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Affiliation(s)
- Nico Bruining
- Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands.
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Saur SC, Alkadhi H, Stolzmann P, Baumüller S, Leschka S, Scheffel H, Desbiolles L, Fuchs TJ, Székely G, Cattin PC. Effect of reader experience on variability, evaluation time and accuracy of coronary plaque detection with computed tomography coronary angiography. Eur Radiol 2010; 20:1599-606. [DOI: 10.1007/s00330-009-1709-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/29/2009] [Accepted: 11/12/2009] [Indexed: 11/29/2022]
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Achenbach S, Boehmer K, Pflederer T, Ropers D, Seltmann M, Lell M, Anders K, Kuettner A, Uder M, Daniel WG, Marwan M. Influence of slice thickness and reconstruction kernel on the computed tomographic attenuation of coronary atherosclerotic plaque. J Cardiovasc Comput Tomogr 2010; 4:110-5. [PMID: 20430341 DOI: 10.1016/j.jcct.2010.01.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/09/2009] [Accepted: 01/10/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND The computed tomographic (CT) attenuation of coronary atherosclerotic plaque has been proposed as a marker for tissue characterization and may thus potentially contribute to the assessment of plaque instability. OBJECTIVE We analyzed the influence of reconstruction parameters on CT attenuation measured within noncalcified coronary atherosclerotic lesions. METHODS Seventy-two patients were studied by contrast-enhanced dual-source CT coronary angiography (330 millisecond rotation time, 2 x 64 x 0.6 mm collimation, 120 kV, 400 mAs, 80 mL contrast agent intravenously at 6 mL/s), and a total of 100 distinct noncalcified coronary atherosclerotic plaques were identified. Image data sets were reconstructed with a soft (B20f), medium soft (B26f), and sharp (B46f) reconstruction kernel. With the medium soft kernel, image data sets were reconstructed with a slice thickness/increment of 0.6/0.3 mm, 0.75/0.4 mm, and 1.0/0.5mm. Within each plaque, CT attenuation was measured. RESULTS Mean CT attenuation using the medium soft kernel was 109 +/- 58 HU (range, -16 to 168 HU). Using the soft kernel, mean density was 113 +/- 57 HU (range, -13 to 169 HU), and using a sharp kernel, mean density was 97 +/- 49 HU (range, -23 to 131 HU). Similarly, reconstructed slice thickness had a significant influence on the measured CT attenuation (mean values for medium soft kernel: 102 +/- 52 HU versus 109 +/- 58 HU versus 113 +/- 57 HU for 0.6-mm, 0.75-mm, and 1.0-mm slice thickness). The differences between 0.75-mm and 0.6-mm slice thickness (P = 0.05) and between medium sharp and sharp kernels (P = 0.02) were statistically significant. CONCLUSIONS Image reconstruction significantly influences CT attenuation of noncalcified coronary atherosclerotic plaque. With decreasing spatial resolution (softer kernel or thicker slices), CT attenuation increases significantly. Using absolute CT attenuation values for plaque characterization may therefore be problematic.
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Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany.
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Noncalcified atherosclerotic plaque burden at coronary CT angiography: a better predictor of ischemia at stress myocardial perfusion imaging than calcium score and stenosis severity. AJR Am J Roentgenol 2009; 193:410-8. [PMID: 19620437 DOI: 10.2214/ajr.08.1277] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relation between the coronary CT angiographic findings of calcified and noncalcified plaque burden and stenosis severity and the myocardial perfusion imaging finding of ischemia. MATERIALS AND METHODS Seventy-two patients (41 men, 31 women; mean age, 56 years) underwent coronary CT angiography and stress-rest SPECT myocardial perfusion imaging. Calcium scoring was performed. Coronary CT angiograms were analyzed for stenosis and noncalcified or mixed plaque. A plaque analysis tool was used to calculate the volume of noncalcified plaque components. SPECT images were analyzed for perfusion defects. Data were analyzed per patient and per vessel. RESULTS A total of 53 purely noncalcified, 50 mixed, and 201 purely calcified plaques were detected. Forty-five stenoses were rated > or = 50%, 19 of those being > or = 70%. Myocardial perfusion imaging depicted perfusion defects in 37 vessels (13%) in 24 patients (18 reversible, 19 fixed defects). Vessels with > or = 50% stenosis had significantly (p = 0.0009) more perfusion defects in their supplied territories (11 with, 22 without perfusion defects) than did vessels without significant lesions (26 with, 229 without perfusion defects). In vessel-based analysis, the sensitivity of coronary CT angiography in prediction of any perfusion defect on myocardial perfusion images was 30% with 91% specificity, 33% positive predictive value, and 90% negative predictive value. Between vessels with and those without perfusion defects, there was no significant difference in Agatston or calcium volume score (p = 0.25), but there was a significant difference in noncalcified plaque volume (44 +/- 77 vs 19 +/- 58 mm(3); p = 0.03). Multiple stepwise regression analysis showed noncalcified plaque volume was the only significant predictor of ischemia (p = 0.01). CONCLUSION At coronary CT angiography, noncalcified plaque burden is a better predictor of the finding of myocardial ischemia at stress myocardial perfusion imaging than are calcium score and degree of stenosis.
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Reproducibility of coronary artery plaque volume and composition quantification by 64-detector row coronary computed tomographic angiography: An intraobserver, interobserver, and interscan variability study. J Cardiovasc Comput Tomogr 2009; 3:312-20. [DOI: 10.1016/j.jcct.2009.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/28/2009] [Accepted: 07/20/2009] [Indexed: 11/23/2022]
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Brodoefel H, Burgstahler C, Heuschmid M, Reimann A, Khosa F, Kopp A, Schroeder S, Claussen CD, Clouse ME. Accuracy of dual-source CT in the characterisation of non-calcified plaque: use of a colour-coded analysis compared with virtual histology intravascular ultrasound. Br J Radiol 2009; 82:805-12. [PMID: 19332517 DOI: 10.1259/bjr/35768497] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Non-invasive assessment of plaque volume and composition is important for risk stratification and long-term studies of plaque stabilisation. Our aim was to evaluate dual-source computed tomography (DSCT) and colour-coded analysis in the quantification and classification of coronary atheroma. DSCT and virtual histology intravascular ultrasound (IVUS-VH) were prospectively performed in 14 patients. 22 lesions were compared in terms of plaque volume, maximal per cent vessel stenosis and percentages of fatty, fibrous or calcified components. Plaque characterisation was performed with software that automatically segments luminal or outer vessel boundaries and uses CT attenuation for a colour-coded plaque analysis. Good correlation was found for per cent vessel stenosis in DSCT (53+/-13%) and IVUS (51+/-14%; r(2) = 0.70). Mean volumes for entire plaque and non-calcified atheroma were 68.5+/-33 mm(3) and 56.7+/-30 mm(3), respectively, in DSCT and 60.8+/-29 mm(3) and 55.8+/-26 mm(3), respectively, in IVUS. Mean percentages of fatty, fibrous or calcified components were 28.2+/-6%, 53.2+/-9% and 18.7+/-13%, respectively, in DSCT and 29.9+/-5%, 55.3+/-12% and 14.4+/-9%, respectively, in IVUS-VH. Significant overestimation was present for the entire plaque and the volume of calcified plaque (p = 0.03; p = 0.0004). Although good correlation with IVUS was obtained for the entire plaque (r(2) = 0.76) and non-calcified plaque volume (r(2) = 0.84), correlation proved very poor and insignificant for percentage plaque composition. Interclass correlation coefficients for non-calcified plaque volume and percentages of fatty, fibrous or calcified components were 0.99, 0.99, 0.95 and 0.98, respectively, and intraclass coefficients were 0.98, 0.93, 0.98 and 0.99, respectively. We found that using Hounsfield unit-based analysis, DSCT allows for accurate quantification of non-calcified plaque. Although percentage plaque composition proves highly reproducible, it is not correlated with IVUS-VH.
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Affiliation(s)
- H Brodoefel
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA.
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Sarno G, Vanhoenacker P, Decramer I, Schuijf JD, Schuijf J, Pundziute G, Gabjia P, Margolis P, Gupta S, Bax JJ, Bax J, Wijns W. Characterisation of the "vulnerable" coronary plaque by multi-detector computed tomography: a correlative study with intravascular ultrasound-derived radiofrequency analysis of plaque composition. EUROINTERVENTION 2009; 4:318-23. [PMID: 19110804 DOI: 10.4244/eijv4i3a58] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To assess plaque characteristics by multi-detector computed tomography angiography in patients with known coronary artery disease and to compare these findings with those obtained with intravascular ultrasound-derived radiofrequency analysis of plaque composition. METHODS AND RESULTS By computed tomography, lesions were classified on the basis of Hounsfield Units as non-calcified, calcified, or mixed. By intravascular ultrasound-derived radiofrequency analysis, plaques were classified according to the relative composition of components with specific backscatter characteristics (necrotic core, fibrous, fibro-fatty, calcium). Thin cap fibroatheroma (defined as necrotic core component >10% without evidence of fibrotic cap, calcium >5%, remodelling index >1.05) was considered as vulnerable plaque. Seventy-eight plaques were analysed. By computed tomography, 22 plaques were classified as non-calcified and 56 as mixed. A higher incidence of mixed plaques was observed among lesions causing unstable angina and non-ST elevation myocardial infarction compared to stable angina (76% vs 38%, p=0.04). Plaque composition by radiofrequency analysis was significantly different between mixed and non-calcified plaques by computed tomography. The calcium content was 6.0+/-3.2% vs 2.5+/-1.8% (p=0.001), necrotic core was 14.0+/-6.9% vs 7.5+/-5.6% (p=0.03) and fibrous tissue was 59.0+/-7.5% vs 67.0+/-5.9% (p=0.03), for mixed vs non-calcified plaques, respectively. Positive, negative predictive value and diagnostic accuracy for detection of vulnerable plaque by computed tomography was 77, 54 and 59%. CONCLUSIONS Mixed plaque by computed tomography correlates with plaque composition as determined by intravascular ultrasound-derived radiofrequency analysis. However, the present diagnostic accuracy of computed tomography is not high enough to support its use for non invasive detection of vulnerable coronary plaque.
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Abstract
Recent years have witnessed a rapid development of multi-slice computed tomography (MSCT) technology. The number of detector rows has increased from 4-slices to the current availability of 64-slice and even 320-slice systems. In addition, images are acquired with thinner slices and faster rotation times resulting in substantially improved image quality and diagnostic accuracy. Simultaneously, effective dose reduction acquisition techniques have been developed allowing considerable reduction of the radiation dose. Conceivably, these advancements may allow further expansion of the use of MSCT beyond the visual assessment of the presence or absence of significant coronary artery disease. Indeed, a particular advantage of the technique is that in addition to evaluation of the coronary arteries it also allows assessment of cardiac structures and function. The purpose of the current review is to discuss several novel applications of cardiac MSCT, including stenosis quantification, atherosclerotic plaque imaging and prognostification as well as imaging of left ventricular function, aortic and mitral valve anatomy using state-of-the-art technology.
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Quantification of coronary plaque by 64-slice computed tomography: a comparison with quantitative intracoronary ultrasound. Invest Radiol 2008; 43:314-21. [PMID: 18424952 DOI: 10.1097/rli.0b013e31816a88a9] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Noninvasive assessment of coronary atherosclerotic plaque may be useful for risk stratification and treatment of atherosclerosis. MATERIALS AND METHODS We studied 47 patients to investigate the accuracy of coronary plaque volume measurement acquired with 64-slice multislice computed tomography (MSCT), using newly developed quantification software, when compared with quantitative intracoronary ultrasound (QCU). Quantitative MSCT coronary angiography (QMSCT-CA) was performed to determine plaque volume for a matched region of interest (regional plaque burden) and in significant plaque defined as a plaque with > or =50% area obstruction in QCU, and compared with QCU. Dataset with image blurring and heavy calcification were excluded from analysis. RESULTS In 100 comparable regions of interest, regional plaque burden was highly correlated (coefficient r = 0.96; P < 0.001) between QCU and QMSCT-CA, but QMSCT-CA overestimated the plaque burden by a mean difference of 7 +/- 33 mm3 (P = 0.03). In 76 significant plaques detected within the regions of interest, plaque volume determined by QMSCT-CA was highly correlated (r = 0.98; P < 0.001) with a slight underestimation of 2 +/- 17 mm3 (P = not significant) when compared with QCU. Calcified and mixed plaque volume was slightly overestimated by 4 +/- 19 mm3 (P = ns) and noncalcified plaque volume was significantly underestimated by 9 +/- 11 mm3 (P < 0.001) with QMSCT-CA. Overall, the limits of agreement for plaque burden/volume measurement between QCU and QMSCT-CA were relatively large. Reproducibility for the measurements of regional plaque burden with QMSCT-CA was good, with a mean intraobserver and interobserver variability of 0% +/- 16% and 4% +/- 24%, respectively. CONCLUSIONS Quantification of coronary plaque within selected proximal or middle coronary segments without image blurring and heavy calcification with 64-slice CT was moderately accurate with respect to intravascular ultrasound and demonstrated good reproducibility. Further improvement in CT resolution is required for more reliable measurement of coronary plaques using quantification software.
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Bruining N, Tanimoto S, Otsuka M, Weustink A, Ligthart J, de Winter S, van Mieghem C, Nieman K, de Feyter P, van Domburg R, Serruys P. Quantitative multi-modality imaging analysis of a bioabsorbable poly-L-lactic acid stent design in the acute phase: a comparison between 2- and 3D-QCA, QCU and QMSCT-CA. EUROINTERVENTION 2008; 4:285-91. [DOI: 10.4244/eijv4i2a49] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hoffmann H, Frieler K, Hamm B, Dewey M. Intra- and interobserver variability in detection and assessment of calcified and noncalcified coronary artery plaques using 64-slice computed tomography. Int J Cardiovasc Imaging 2008; 24:735-42. [DOI: 10.1007/s10554-008-9299-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 02/01/2008] [Indexed: 10/21/2022]
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Can CT detect the vulnerable coronary plaque? Int J Cardiovasc Imaging 2007; 24:311-2. [DOI: 10.1007/s10554-007-9281-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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