The value of quantified plaque analysis by dual-source coronary CT angiography to detect vulnerable plaques: a comparison study with intravascular ultrasound

Abstract

Background: To investigate the diagnostic performance of quantified plaque analysis and high-risk plaque characterization by coronary computed tomography angiography (CCTA) for identifying thin-cap fibroatheroma (TCFA).Methods: Patients who underwent both CCTA and intravascular ultrasound (IVUS) within 4 weeks were retrospectively included. CT-derived quantitative and qualitative parameters, including diameter stenosis, minimal lumen area (MLA), low attenuation plaque (LAP) volume napkin-ring sign (NRS), positive remodeling (PR) and spotty calcification, were recorded. TCFA lesions and non-TCFA lesions were determined by IVUS.Multivariate regression analysis was used to determine the independent predictors of TCFA lesions.Results: Sixty-five patients (mean age: 69.8±9.2 years, 29 females) with 89 lesions were finally included.LAP and NRS were more frequently presented in the group of TCFA lesions. The mean LAP volume of TCFA lesions was significantly larger than that of non-TCFA lesions [16.5 (11.0-23.0) vs. 0 (0-1.5) mm 3 , P<0.001]. According to multivariate logistic regression analysis, LAP volume was the only significant predictor for IVUS-confirmed vulnerable plaques (odds ratio =3.294, 95% confidence interval: 1.177-9.223, P=0.023). LAP volume showed largest area under curve (AUC) for diagnosing TCFA lesions (AUC =0.901, 95% confidence interval: 0.819-0.954, P<0.0001). When using >8 mm 3 as the best cutoff value, the diagnostic accuracy, sensitivity and specificity of LAP volume for predicting TCFA lesions were 91.0% (81/89), 84.6% (22/26) and 96.8% (61/63) respectively.Conclusions: CT-derived LAP volume of TCFA lesions was significantly higher than those of non-TCFA lesions. LAP volume was the strongest predictor for TCFA lesions as validated by IVUS.

Clinical and imaging predictors of impaired myocardial perfusion in symptomatic patients after percutaneous coronary intervention: insights from dynamic CT myocardial perfusion imaging

“…The CCTA has been recognized as a useful tool for highrisk plaque analysis (21). It may bear valuable information regarding the association between plaque characteristics and post-PCI myocardial perfusion.…”

A Novel Computed Tomography-Based Imaging Approach for Etiology Evaluation in Patients With Acute Coronary Syndrome and Non-obstructive Coronary Angiography

“…Moreover, CCTA provides comprehensive evaluation of coronary anatomy, including overlooked side branch occlusion, intramural hematoma, and HRP features of suspected culprit lesions. Although it is not a direct imaging method for diagnosis of plaque disruption, CCTA has been validated for identification of thin-cap fibroatheroma with reference to intravascular ultrasound ( 28 ). It complements dynamic CT-MPI for exploration of potential epicardial etiologies when myocardial injury is presented.…”

Computed Tomography Coronary Angiography Possibilities in “High Risk” Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound

“…В отечественной литературе описан еще один признак нестабильности АСБ -неровность контура бляшки [25]. Поэтому одним из направлений исследований уязвимых АСБ стала оценка перечисленных КТ-признаков или их сочетаний в качестве суррогатных маркеров таких бляшек, верифицированных по ВСУЗИ или ОКТ [13,[26][27][28][29][30][31][32][33]. Однако результаты этих исследований противоречивы, в том числе относительно определения, какие именно КТ-признаки нестабильности и их сочетания являются наиболее точными маркерами уязвимых бляшек, и вообще, являются ли?…”