Computed Tomography Biomarkers of Vulnerable Coronary Plaques

Abstract

An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography.

Association of Coronary Wall Shear Stress With Atheromatous Plaque Vulnerability: A Systematic Review

“…FFR-CT is calculated from standard CTA datasets being able to provide relevant information of functional relevance of a plaque. Several recent studies suggested that FFR is significantly lower in unstable plaques as compared to stable ones with the same anatomical severity [3]. In a retrospective analysis of the images scanned with 1 year prior to an AMI, FFR-CT was lowest and APS was highest in the segments located upstream of the maximum stenosis [24,25].…”

“…The most sensitive biomarkers associated with plaque vulnerability differ largely according to the imaging technique used for assessment of VP. While computed tomographic angiography (CTA) imaging has a definite role in visualization of several vulnerability features such as positive remodeling, napkin ring sign, spotty calcifications or very low density plaques appearing as dark spots on CTA images, its value remains low in assessing the thickness of the fibrous cap, mainly due to the insufficient resolution [3]. Intravascular imaging techniques, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been proposed to represent efficient alternatives to CTA imaging for detecting thin cap fibroatheroma as well as for quantification of plaque components [4].…”

Intracoronary Shear Stress and CT Characteristics of Vulnerable Coronary Plaques

“…The most important CT vulnerability markers at this time are the volume of low density atheroma, the plaque burden, the thin fibrous cap, and the positive remodeling. [1][2][3][4] So the main question today remains: is it possible to define a new vulnerability marker based on the CT images, and, more importantly, would it be possible for shear stress to become that new vulnerability marker?It is known that shear stress plays an important role in the development of atherosclerosis, 5-7 through complex processes that are more and more better known with the help of computer fluid dynamics. [8][9][10][11][12] There were also several successful attempts of finding the correlation between shear stress and other vulnerability factors, defined by the use of invasive imagUnauthenticated Download Date | 5/12/18 9:06 AM…”

“…The most important CT vulnerability markers at this time are the volume of low density atheroma, the plaque burden, the thin fibrous cap, and the positive remodeling. [1][2][3][4] So the main question today remains: is it possible to define a new vulnerability marker based on the CT images, and, more importantly, would it be possible for shear stress to become that new vulnerability marker?…”

Multimodality Cardiac Imaging — a Complex Interdisciplinary Approach Resulting from the CARDIO IMAGE Project

“…1 However, the description of morphological features associated with vulnerable plaques cannot serve as a decision tool in the absence of clear data regarding their hemodynamic impact, which is the key determinant of myocardial ischemia.…”