Diagnostic Accuracy of 320-Row Computed Tomography for Characterizing Coronary Atherosclerotic Plaques: Comparison with Intravascular Optical Coherence Tomography

Cardiovasc Revasc Med. 2020 May;21(5):640-646. doi: 10.1016/j.carrev.2019.08.010. Epub 2019 Aug 15.

Abstract

Background/purpose: This study sought to determine the diagnostic accuracy of 320-row computed tomography (320CT) for characterizing coronary atherosclerotic plaques in comparison with optical coherence tomography (OCT).

Methods/materials: From 32 patients, 42 coronary segments were evaluated and co-registered by both 320CT and OCT. 320CT vulnerable plaque characteristics included low attenuation plaque (LAP) (<30HU), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcification (SC). The presence of macrophage, neovascularization and cholesterol crystals was also determined by OCT.

Results: Minimal lumen area was 2.78 ± 1.23 mm by OCT and 3.29 ± 1.49 mm by 320CT (p < 0.001). Noncalcified plaques were classified accordingly by both methods in 88.2% of the cases (p = 0.005). There was no association between any 320CT plaque type and OCT fibroatheroma (p = 0.62). The combination of 2 or more of the 320CT vulnerable plaque characteristics was associated with the presence of macrophage (74.2 vs. 25.8%; p = 0.034) and cholesterol crystals (85.7 vs. 14.3%; p = 0.04), but not with neovascularization (p = 0.65). The presence of all four characteristics demonstrated an accuracy of 75.1% for detecting OCT fibroatheroma.

Conclusions: 320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all four 320CT vulnerable plaque characteristics provided the highest accuracy for detecting fibroatheromas.

Summary: 320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all 320CT vulnerable plaque characteristics (low attenuation plaque (<30HU), napkin-ring sign, positive remodeling and spotty calcification) provided the highest accuracy for detecting fibroatheromas compared to optical coherence tomography.

Keywords: Coronary artery disease; Multi-row computed tomography; Optical coherence tomography; Tissue characterization.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cholesterol / analysis
  • Computed Tomography Angiography*
  • Coronary Angiography*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / metabolism
  • Coronary Artery Disease / pathology
  • Coronary Vessels / chemistry
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / pathology
  • Crystallization
  • Female
  • Fibrosis
  • Humans
  • Macrophages / pathology
  • Male
  • Middle Aged
  • Multidetector Computed Tomography*
  • Neovascularization, Pathologic
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Prognosis
  • Registries
  • Reproducibility of Results
  • Retrospective Studies
  • Tomography, Optical Coherence*
  • Vascular Calcification / diagnostic imaging*
  • Vascular Calcification / metabolism
  • Vascular Calcification / pathology

Substances

  • Cholesterol