Coronary plaque imaging and characterization by CT
ABSTRACT Multi-slice spiral CT (MDCT) is a noninvasive modality for visualization and evaluation of atherosclerosis in vivo in different
arterial beds. Rapid technical advances led to a significant improvement of the diagnostic accuracy of coronary MDCT angiography.
The most popular clinical application of MDCT with the best scientific evidence is the noninvasive detection and quantification
of coronary calcifications. In particular, the concept of coronary age by evaluating an individual’s biological age (rather
than chronological age) is attractive and currently under scientific evaluation. Additionally, when evaluating contrast-enhanced
coronary arteries, different stages of atherosclerosis can be visualized. It could be shown by comparative studies with intracoronary
ultrasound that echogenicity corresponds well with the density measured within atherosclerotic plaques expressed in Hounsfield
units using MDCT. Continuously improving and still under development, the potential of MDCT to evaluate plaque composition
and plaque volumes noninvasively in vivo is promising.
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ABSTRACT: To evaluate the diagnostic accuracy of 16 slice computed tomography (CT) in determining plaque morphology and composition in an experimental setting. The results were compared with histopathological analysis as the reference standard. Nine human popliteal arteries derived from amputations because of atherosclerotic disease were investigated with multislice spiral CT (MSCT). Atherosclerotic lesions were morphologically classified (completely or partially occlusive, concentric, eccentric), and tissue densities were determined within these plaques. In addition, vessel dimensions were quantitatively measured. The results were compared with histological analysis. The concordance index kappa for morphological classification was 0.88. Plaque density (n = 51 lesions) was significantly different (p < 0.0001) between lipid rich, fibrotic, and calcified lesions (Stary stage III: n = 2, 58 (8) Hounsfield units (HU); Stary V: n = 11, 50 (21) HU; Stary VI: n = 14, 96 (42) HU; Stary VII: n = 6, 858 (263) HU; Stary VIII: n = 18, 126 (99) HU). The concordance index kappa for the classification of plaques based on density was 0.51. Vessel dimensions had a good correlation (r = 0.98). 16 slice CT was found to be a reliable non-invasive imaging technique for assessing atherosclerotic plaque morphology and composition. Although calcified lesions can be differentiated from non-calcified lesions, the diagnostic accuracy in further subclassifying non-calcified plaques as lipid rich and fibrotic is low, even under experimental conditions.Heart (British Cardiac Society) 12/2004; 90(12):1471-5. · 5.01 Impact Factor
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ABSTRACT: The purpose of this study was to determine the prognostic accuracy of electron beam computed tomographic (CT) scanning of the coronary arteries and the relationship of coronary calcification to standard coronary disease risk factors and C-reactive protein (CRP) in the prediction of atherosclerotic cardiovascular disease (ASCVD) events in apparently healthy middle-age persons. As a screening test for coronary artery disease (CAD), electron beam CT scanning remains controversial. In a prospective, population-based study, 4,903 asymptomatic persons age 50 to 70 years underwent electron beam CT scanning of the coronary arteries. At 4.3 years, follow-up was available in 4,613 participants (94%), and 119 had sustained at least one ASCVD event. Subjects with ASCVD events had higher baseline coronary calcium scores (median [interquartile range], Agatston method) than those without events: 384 (127, 800) versus 10 (0, 86) (p < 0.0001). For coronary calcium score threshold > or = 100 versus < 100, relative risk (95% confidence interval) was 9.6 (6.7 to 13.9) for all ASCVD events, 11.1 (7.3 to 16.7) for all CAD events, and 9.2 (4.9 to 17.3) for non-fatal myocardial infarction and death. The coronary calcium score predicted CAD events independently of standard risk factors and CRP (p = 0.004), was superior to the Framingham risk index in the prediction of events (area under the receiver-operating characteristic curve of 0.79 +/- 0.03 vs. 0.69 +/- 0.03, p = 0.0006), and enhanced stratification of those falling into the Framingham categories of low, intermediate, and high risk (p < 0.0001). The electron beam CT coronary calcium score predicts CAD events independent of standard risk factors, more accurately than standard risk factors and CRP, and refines Framingham risk stratification.Journal of the American College of Cardiology 07/2005; 46(1):158-65. · 14.09 Impact Factor
- Atherosclerosis 05/2004; 173(2):381-91. · 3.71 Impact Factor