Napkin-Ring Sign on Coronary CT Angiography for the Prediction of Acute Coronary Syndrome

Abstract

The present study demonstrated for the first time that the napkin-ring sign demonstrated on coronary CTA was strongly associated with future ACS events, independent of other high-risk coronary CTA features. Detection of the napkin-ring sign could help identify coronary artery disease patients at high risk of future ACS events.

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

“…Two retrospective studies conducted by Motoyama et al that included 1059 and 3158 patients showed that the presence of attenuated plaques and positive remodeling indicated plaque vulnerability [95,98]. These findings were confirmed by Otsuka et al in a retrospective analysis that included 895 patients who underwent CTCA for suspected CAD and were followed up for 2.3 years [96]. During this period, 24 ACSs occurred.…”

“…In parallel, several retrospective analyses have demonstrated that CTCA-based imaging provides useful prognostic information and enables detection of patients that are likely to suffer a cardiovascular event amongst individuals with suspected CAD [95][96][97][98]146,147]. In patients with established CAD, a small scale study showed that CTCAderived variables were predictors of MACE at 5-year followup and improved considerably the prognostic accuracy of the model developed from the clinical variables (from 0.68 to 0.76) [148].…”

“…Despite the limited accuracy of CTCA in evaluating plaque morphology and composition, there is consistent evidence that this modality is able to identify lesions that are likely to progress and cause cardiovascular events [95][96][97][98]. Two retrospective studies conducted by Motoyama et al that included 1059 and 3158 patients showed that the presence of attenuated plaques and positive remodeling indicated plaque vulnerability [95,98].…”

“…Several software have been developed for the fast processing of CTCA imaging data, coronary reconstruction, and blood flow simulation [85,87,139] and evidence supports the use of CTCA in detecting vulnerable plaques in low risk patients [95][96][97][98]; nevertheless, there is lack of prospective data, and the efficacy of CTCA in identifying vulnerable lesions in patients with established CAD and extensive atherosclerotic burden remains unclear. Future studies are anticipated to explore the efficacy of CTCA in detecting vulnerable lesions in high-risk patients and the additive value of PET imaging in this challenging setting.…”

Impact of plaque characteristics on the degree of functional stenosis

“…Although still not in the clinical arena, one of the most appealing features of CCTA is the ability to look be-yond the luminal stenosis and provide a detailed evaluation of the coronary wall depicting several features like plaque composition (calcified, noncalcified or mixed), plaque burden, remodeling index and degree of attenuation measured in Hounsfield units (HU), and several of these features have been associated with the future development of events (2)(3)(4)(5)(6)(7)(8) (Figure 1). In fact, the potential prognostic value of these detailed plaque features provided by CCTA has opened a new field of research in coronary artery disease, which in the last 2-3 decades has been struggling in the search of the vulnerable plaque (10,11).…”