Coronary CT Angiography and the Napkin-ring Sign Indicates High-Risk Atherosclerotic Lesions

Abstract

Coronary computed tomography angiography CCT" is used extensively nowadays as a non-invasive imaging method for the evaluation of patients suspected of coronary artery disease, providing data on calcium burden, the presence of coronary artery stenoses, but also, more recently, on coronary atherosclerotic plaque morphology and composition. Plaque morphology analysis by CCT" aims to accurately identify vulnerable plaques, in an attempt to reduce the number of ischemic events triggered by high-risk atherosclerotic lesions. Recent research provides CCT" descriptions of vulnerable plaques and a particular radiological sign shows promising perspectives. The napkin-ring sign refers to a rupture-prone plaque in a coronary artery, comprising a necrotic core covered by a thin cap fibro-atheroma. The napkin-ring sign is described on CCT" in cross-sectional images of coronary arteries as a central low-attenuation area surrounded by an open ring area of high attenuation, having a high specificity and positive predictive value for the presence of advanced lesions. These lesions have been designated as vulnerable plaques, indicating an increased probability of rupture, and were shown to correlate with a higher incidence of cardiovascular events. In acute coronary syndromes, the location of the napkin-ring sign was shown to correspond to the culprit lesions. The aim of the current paper is to provide an overview of the current literature on available methods for quantitative measurement of atherosclerotic plaque features from CCT" and to discuss the clinical implications of the napkin-ring sign as detected by CCT".

Hubungan kadar troponin I dan high-sensitivity troponin I dengan angiografi koroner pada pasien suspek coronary artery disease: studi di Rumah Sakit Umum Pusat dr.Wahidin Sudirohusodo Makassar-Indonesia tahun 2017

“…Penyumbatan total mendadak dapat terjadi akibat ruptur plak non-stenotik sehingga membentuk trombosis, dan pada akhirnya menyebabkan penurunan suplai darah yang membawa oksigen ke jantung. 5,6 Troponin merupakan biomarker yang sangat sensitif dan spesifik pada nekrosis miokardium serta telah digunakan untuk mendiagnosis infark miokard akut. Troponin merupakan protein yang terdapat pada filamen tipis aparatus regulator otot bergaris.…”

Automated detection of calcified plaque using higher‐order spectra cumulant technique in computer tomography angiography images

“…Cardiovascular disease (CVD) is a main factor contributing to mortality worldwide, and it is usually caused by atherosclerosis, which is brought upon by lipoprotein storage, calcification, muscle cell proliferation, inflammation, necrosis, apoptosis, and fibrosis in the arterial wall . The development of atherosclerosis triggers important variations in the coronary blood vessels, often leading to coronary artery disease (CAD) …”