The Napkin-Ring Sign Indicates Advanced Atherosclerotic Lesions in Coronary CT Angiography

Abstract

The assessment of the plaque pattern improves diagnostic accuracy of CCTA to identify advanced atherosclerotic lesions. The CCTA finding of NRS has a high specificity and high positive predictive value for the presence of advanced lesions.

Plaque Imaging Using Coronary Computed Tomography Angiography

“…1b). The specificity of this NRS for detecting vulnerable plaque is relatively high based on autopsy studies but the sensitivity of this sign is low (6). segments in 895 subjects (mean: 2.…”

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

“…Several histology and intravascular-based imaging studies have shown that CTCA allows accurate evaluation of the luminal and outer vessel wall dimensions, assessment of plaque burden and remodeling pattern, and characterization of its composition [85][86][87][88][89][90][91][92]. Reports have demonstrated that CTCA enables detection of calcific tissue but it has a limited accuracy in differentiating lipid from fibrotic tissue component [86,87,89,91,92]; while recent histology-based studies have shown that CTCAdespite its limited imaging resolution -allows characterization of the phenotype of the plaque and detection of high-risk vulnerable lesions -which on CTCA exhibit a napkin-ring sign morphology -with high specificity but low sensitivity [93,94].…”

CT Determination of Fractional Flow Reserve in Coronary Lesions

“…14,15 Although CCTA can provide accurate 3D anatomic evaluation of the coronary arteries, determining the extent of luminal stenosis with plaque morphology characterization, numerous studies comparing CCTA-and ICA-assessed stenoses with invasive FFR determination demonstrated that the severity of coronary lesions does not always reflect the hemodynamic significance of a plaque. [16][17][18][19] Meijboom et al evaluated 89 lesions which caused ≥50% luminal stenosis assessed by CCTA and concluded that only 49% of these lesions were functionally significant, with a measured FFR <0.75. 20 Having these aforementioned tools, the development of a noninvasive technique that is able to offer both anatomical and functional evaluation of coronary lesions was imperative.…”