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Nakao Y, Yoshida K, Inaba S, Tanabe Y, Kurata A, Uetani T, Kido T, Inoue K, Mochizuki T, Yamaguchi O. Plaque Characterization with Computed Tomography Angiography Based on a Diluted-contrast Injection Protocol. Intern Med 2021; 60:3671-3678. [PMID: 34853256 PMCID: PMC8710393 DOI: 10.2169/internalmedicine.6683-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Coronary plaques with low attenuation on computed tomography (CT) angiography may indicate vulnerable plaques. However, plaque CT attenuation is reported to be significantly affected by intracoronary attenuation. Recently, the diluted-contrast injection protocol was established to facilitate more uniform intracoronary attenuation than can be achieved with the generally used body-weight-adjusted protocol. We validated the relationship between low-attenuation plaque on CT and lipid-rich plaque using integrated backscatter-intravascular ultrasound (IB-IVUS) as the standard reference. Methods Plaques were divided into tertiles (T1, T2, and T3) according to the plaque CT attenuation, calculated as the average of five intra-plaque regions of interest, and compared with the plaque characteristics noted on IB-IVUS. Patients Patients who underwent both CT angiography using a diluted-contrast injection protocol and IB-IVUS were retrospectively analyzed. Results Thirty-nine plaques in 32 patients were analyzed by CT angiography and IB-IVUS. The median plaque CT attenuation (Hounsfield units) of each tertile was 30 (T1), 48 (T2), and 68 (T3). Although no significant difference was noted in conventional quantitative IVUS parameters (e.g. plaque burden), the T1 with lowest plaque CT attenuation had the highest percentage lipid area by IB-IVUS [75.1% (T1), 57.8% (T2), and 50.8% (T3), respectively, p<0.01]. Furthermore, the plaque CT attenuation had a significant negative correlation with the percentage lipid area (r=-0.59, p<0.01). Conclusion CT angiography-based plaque characterization using a diluted-contrast injection protocol may aid in the quantitative detection of lipid-rich plaque.
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Affiliation(s)
- Yasuhisa Nakao
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
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El Manaa HE, Shchekochikhin DY, Shabanova MS, Lomonosova AA, Gognieva DG, Ternovoy SK, Shariya MA, Mesitskaya DF, Kopylov PY, Syrkin AL. Multislice Computed Tomography Capabilities in Assessment of the Coronary Arteries Atherosclerotic Lesions. ACTA ACUST UNITED AC 2019; 59:24-31. [PMID: 30853018 DOI: 10.18087/cardio.2019.2.10214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/18/2022]
Abstract
Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.
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Affiliation(s)
- H E El Manaa
- Sechenov First Moscow State Medical University (Sechenov University)..
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3
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de Knegt MC, Linde JJ, Fuchs A, Nordestgaard BG, Køber LV, Hove JD, Kofoed KF. Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments. Int J Cardiovasc Imaging 2016; 32:1555-66. [PMID: 27378095 DOI: 10.1007/s10554-016-0932-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/25/2016] [Indexed: 02/07/2023]
Abstract
To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.
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Affiliation(s)
- Martina C de Knegt
- Department of Cardiology, The Heart Center, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jesper J Linde
- Department of Cardiology, The Heart Center, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jens D Hove
- Department of Cardiology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Karády J, Drobni ZD, Kolossváry M, Maurovich-Horvat P. Non-invasive Assessment of Coronary Plaque Morphology. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE. In this article, we review the histopathologic classification of coronary atherosclerotic plaques and describe the possibilities and limitations of CT regarding the evaluation of coronary artery plaques. CONCLUSION. The composition of atherosclerotic plaques in the coronary arteries displays substantial variability and is associated with the likelihood for rupture and downstream ischemic events. Accurate identification and quantification of coronary plaque components on CT is challenging because of the limited temporal, spatial, and contrast resolutions of current scanners. Nonetheless, CT may provide valuable information that has potential for characterization of coronary plaques. For example, the extent of calcification can be determined, lipid-rich lesions can be separated from more fibrous ones, and positive remodeling can be identified.
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Kwon JM, Kim J, Kim K, Kim T, Jo YH, Lee JH, Lee JH, Kim YJ, Jung JY. Can emergency physicians reliably interpret cardiac CT images? A prospective observational study. Clin Exp Emerg Med 2015; 2:38-43. [PMID: 27752571 PMCID: PMC5052854 DOI: 10.15441/ceem.14.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Cardiac computed tomography (CCT) is useful for evaluation of acute chest pain in the emergency department (ED). Though the test needs proper interpretation by someone with expertise in cardiovascular imaging, the critical nature of the information the test provides frequently lead emergency physicians (EPs) to act on their own interpretation. We performed this study to assess how often EPs' interpretations are in agreement with radiologists'. METHODS This study is a prospective observational study. The target population was patients assessed with CCT for acute chest pain or discomfort. EPs with at least one year CCT experience underwent a one-hour training session before study participation. The most significant lesion, if any, in each arterial segment was assessed for coronary stenosis and plaque calcification. The agreement between EPs' and radiologists' interpretation was assessed with Cohen's kappa and Gwet's AC1. RESULTS One hundred and three patients were enrolled and 412 segments were analyzed. Stenosis grading was identical in 363 segments (88.1%) and the interrater agreement was good (kappa=0.6439, AC1=0.8810). Similarly, the plaque calcification grading was identical in 354 segments (86.6%) and the kappa and AC1 values were 0.5660 and 0.8501, respectively. EPs classified 6 of the 17 arterial segments with significant stenosis reported by radiologists as non-significant stenosis (n=5) or clear (n=2), all of which were proved to be significant by following subsequent invasive coronary angiography. CONCLUSION There was substantial discordance of CCT interpretation between EPs and radiologists. For now, EPs need more education prior to independent CCT reading.
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Affiliation(s)
- Joon-Myoung Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeyun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Arterial calcification: Friend or foe? Int J Cardiol 2013; 167:322-7. [PMID: 22809537 DOI: 10.1016/j.ijcard.2012.06.110] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/13/2012] [Accepted: 06/24/2012] [Indexed: 01/28/2023]
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8
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Gallino A, Stuber M, Crea F, Falk E, Corti R, Lekakis J, Schwitter J, Camici P, Gaemperli O, Di Valentino M, Prior J, Garcia-Garcia HM, Vlachopoulos C, Cosentino F, Windecker S, Pedrazzini G, Conti R, Mach F, De Caterina R, Libby P. “In vivo” imaging of atherosclerosis. Atherosclerosis 2012; 224:25-36. [DOI: 10.1016/j.atherosclerosis.2012.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 04/18/2012] [Accepted: 04/18/2012] [Indexed: 12/20/2022]
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9
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Yamaki T, Kawasaki M, Jang IK, Raffel OC, Ishihara Y, Okubo M, Kubota T, Hattori A, Nishigaki K, Takemura G, Fujiwara H, Minatoguchi S. Comparison between integrated backscatter intravascular ultrasound and 64-slice multi-detector row computed tomography for tissue characterization and volumetric assessment of coronary plaques. Cardiovasc Ultrasound 2012; 10:33. [PMID: 22867277 PMCID: PMC3495226 DOI: 10.1186/1476-7120-10-33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 07/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine the cut-off values of Hounsfield units (HU) for the discrimination of plaque components and to evaluate the feasibility of measurement of the volume of plaque components using multi-detector row computed tomography (MDCT). Methods Coronary lesions (125 lesions in 125 patients) were visualized by both integrated backscatter intravascular ultrasound (IB-IVUS) and 64-slice MDCT at the same site. The IB values were used as a gold standard to determine the cut off values of HU for the discrimination of plaque components. Results Plaques were classified as lipid pool (n =50), fibrosis (n =65) or calcification (n =35) by IB-IVUS. The HU of lipid pool, fibrosis and calcification were 18 ± 18 HU (−19 to 58 HU), 95 ± 24 HU (46 to 154 HU) and 378 ± 99 HU (188 to 605 HU), respectively. Using receiver operating characteristic curve analysis, a threshold of 50 HU was the optimal cutoff values to discriminate lipid pool from fibrosis. Lipid volume measured by MDCT was correlated with that measured by IB-IVUS (r =0.66, p <0.001), whereas fibrous volume was not (r =0.21, p =0.059). Conclusion Lipid volume measured by MDCT was moderately correlated with that measured by IB-IVUS. MDCT may be useful for volumetric assessment of the lipid volume of coronary plaques, whereas the assessment of fibrosis volume was unstable.
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Affiliation(s)
- Takahiko Yamaki
- Department of Cardiology, Gifu University Graduate School of Medicine, Yanagido, Japan
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Koulaouzidis G, Charisopoulou D, Jenkins PJ, Koulaouzidis A, McArthur T. Prevalence of noncalcified coronary plaque in patients with calcium score of 0: the silent enemy. Angiology 2012; 64:205-10. [PMID: 22492253 DOI: 10.1177/0003319712440618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Noncalcified coronary artery plaques (NCAPs) are susceptible to rupture, resulting in coronary artery thrombosis. Using computer tomography coronary angiography (CTCA), we evaluated the prevalence and degree of stenosis caused by NCAP in patients without coronary artery calcification (CAC). A retrospective analysis of 447 symptomatic patients with 0 CAC score revealed negative CTCA in 400 (89.5%). Noncalcified coronary artery plaques were demonstrated in 47 (10.5%), with 4 presenting stenosis >50%. Patients with positive CTCA, compared to those with normal CTCA, had significantly higher mean age (56.2 years vs 50.6 years, P < .004) and higher pretest coronary artery disease (CAD) probability (26% vs 34%, P < .0001). Noncalcified coronary artery plaque was predominantly developed in the proximal segment of the left anterior descending artery. Noncalcified coronary artery plaque is present in up to 10% of patients with a CAC score of 0. Computer tomography coronary angiography could be of diagnostic value in symptomatic patients with multiple risk factors for CAD, even in the absence of CAC.
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Jinzaki M, Okabe T, Endo A, Kawamura A, Koga S, Yamada M, Fukuda K, Kuribayashi S. Detection of Attenuated Plaque in Stable Angina With 64-Multidetector Computed Tomography. Circ J 2012; 76:1182-9. [DOI: 10.1253/circj.cj-11-1078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Teruo Okabe
- Cardiology Department, International University of Health and Welfare, Mita Hospital
| | - Ayaka Endo
- Cardiopulmonary Division, Keio University School of Medicine
| | - Akio Kawamura
- Cardiopulmonary Division, Keio University School of Medicine
| | - Seiko Koga
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Minoru Yamada
- Cardiovascular Imaging Laboratory in Research Park, Keio University School of Medicine
| | - Keiichi Fukuda
- Cardiopulmonary Division, Keio University School of Medicine
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Kobayashi N, Hata N, Kume N, Yokoyama S, Shinada T, Tomita K, Kitamura M, Shirakabe A, Inami T, Yamamoto M, Seino Y, Mizuno K. Matrix metalloproteinase-9 for the earliest stage acute coronary syndrome. Circ J 2011; 75:2853-61. [PMID: 21963570 DOI: 10.1253/circj.cj-11-0640] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Matrix metalloproteinase-9 (MMP-9) is regarded as a biomarker of plaque rupture or vulnerability and is elevated in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate the diagnostic value of MMP-9 for early ACS (≤4h of onset) and late ACS (>4h after onset), compared with high-sensitivity troponin T (hs-TnT). METHODS AND RESULTS MMP-9 and hs-TnT were measured in 200 patients with ST elevation ACS (STEACS; 115 early STEACS and 85 late STEACS patients), and 66 patients with non-ST elevation ACS (NSTEACS; 25 early NSTEACS and 41 late NSTEACS patients). Forty patients with stable angina pectoris (SAP) were enrolled as a control group. MMP-9 levels were significantly higher in patients with early STEACS (P<0.001), early NSTEACS (P<0.001), late STEACS (P<0.001) and late NSTEACS (P=0.025) than SAP. MMP-9 levels were significantly higher in patients with early STEACS (P=0.017) and early NSTEACS (P=0.034) than late STEACS and late NSTEACS, respectively. Levels of hs-TnT were significantly lower in patients with early STEACS (P<0.001) and early NSTEACS (P=0.007) than late STEACS and late NSTEACS, respectively. On receiver operating characteristic curve analysis, area under the curve of early STEACS, early NSTEACS, late STEACS and late NSTEACS was 0.880, 0.782, 0.790 and 0.648 for MMP-9, and 0.707, 0.725, 0.993 and 0.920 for hs-TnT, respectively. CONCLUSIONS MMP-9 levels were elevated earlier than hs-TnT and had a higher diagnostic value for early ACS, but not for late ACS, reflecting plaque rupture or vulnerability.
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Kobayashi N, Hata N, Kume N, Shinada T, Tomita K, Shirakabe A, Kitamura M, Nozaki A, Inami T, Seino Y, Mizuno K. Soluble lectin-like oxidized LDL receptor-1 and high-sensitivity troponin T as diagnostic biomarkers for acute coronary syndrome. Improved values with combination usage in emergency rooms. Circ J 2011; 75:2862-71. [PMID: 21937834 DOI: 10.1253/circj.cj-11-0724] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although highly sensitive assays for troponin T (hs-TnT) have been developed, the sensitivity and specificity of hs-TnT for diagnosing acute coronary syndrome (ACS) remains imperfect. We evaluated the diagnostic value of a new biomarker of plaque vulnerability (soluble lectin-like oxidized low-density lipoprotein receptor-1, sLOX-1) as compared with hs-TnT in the emergency room (ER). METHODS AND RESULTS Plasma sLOX-1 and serum hs-TnT levels were measured in 200 consecutive patients presenting with chest symptoms and ECG abnormalities in the ER (116 ST elevation ACS [STEACS], 44 non-ST elevation ACS [NSTEACS], 40 non-ACS). The non-ACS group consisted of patients with cardiovascular diseases such as coronary spastic angina pectoris, pulmonary thromboembolism, perimyocarditis and takotsubo cardiomyopathy. Levels of sLOX-1 and hs-TnT were significantly higher in STEACS and NSTEACS than in non-ACS patients. The receiver-operating characteristic (ROC) curves of sLOX-1 and hs-TnT for detecting ACS, using the non-ACS patients as negative references, showed that the area under the curve (AUC) values of sLOX-1 and hs-TnT were 0.769 and 0.739, respectively. In the lower hs-TnT (<0.0205ng/ml) subgroup, the AUC value of the ROC curve of sLOX-1 for detecting ACS was 0.869. CONCLUSIONS The diagnostic value for ACS was comparable between sLOX-1 and hs-TnT, and the accuracy of ACS diagnosis appeared to improve when sLOX-1 and hs-TnT were measured in combination.
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Komatsu S, Imai A, Kodama K. Multidetector row computed tomography may accurately estimate plaque vulnerability: does MDCT accurately estimate plaque vulnerability? (Pro). Circ J 2011; 75:1515-21. [PMID: 21532180 DOI: 10.1253/circj.cj-11-0252] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past decade, multidetector row computed tomography (MDCT) has become the most reliable and established of the noninvasive examination techniques for detecting coronary heart disease. Now MDCT is chasing intravascular ultrasound (IVUS) in terms of spatial resolution. Among the components of vulnerable plaque, MDCT may detect lipid-rich plaque, the lipid pool, and calcified spots using computed tomography number. Plaque components are detected by MDCT with high accuracy compared with IVUS and angioscopy when assessing vulnerable plaque. The TWINS study and TOGETHAR trial demonstrated that angioscopic loss of yellow color occurred independently of volumetric plaque change by statin therapy. These 2 studies showed that plaque stabilization and regression reflect independent processes mediated by different mechanisms and time course. Noncalcified plaque and/or low-density plaque was found to be the strongest predictor of cardiac events, regardless of lesion severity, and act as a potential marker of plaque vulnerability. MDCT may be an effective tool for early triage of patients with chest pain who have a normal ECG and cardiac enzymes in the emergency department. MDCT has the potential ability to analyze coronary plaque quantitatively and qualitatively if some problems are resolved. MDCT may become an essential tool for detecting and preventing coronary artery disease in the future.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital, Amagasaki Central Hospital, 1-12-1 Shio-e, Amagasaki 661-0976, Japan.
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