Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques. A comparative study with intracoronary ultrasound

• Published in: Journal of the American College of Cardiology 2004-04, Vol.43 (7), p.1241-1247
• Main Authors: LEBER, Alexander W, KNEZ, Andreas, BOEKSTEGERS, Peter, BECKER, Alexander, BECKER, Christoph, VON ZIEGLER, Franz, NIKOLAOU, Konstantin, RIST, Carsten, REISER, Maximilian, WHITE, Carl, STEINBECK, Gerhard
• Format: Article
• Language: English
• Subjects: Accuracy; Acquisitions & mergers; Aged; Angina pectoris; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Catheters; Confidence intervals; Contrast Media; Coronary Angiography; Coronary Artery Disease - classification; Coronary Artery Disease - diagnosis; Coronary heart disease; Coronary vessels; Female; Heart; Heart attacks; Heart rate; Humans; Image Enhancement; Image Processing, Computer-Assisted; Lipids; Male; Medical sciences; Middle Aged; Prospective Studies; Sensitivity and Specificity; Software; Tomography, Spiral Computed; Ultrasonic imaging; Ultrasonography, Interventional
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2003.10.059

We evaluated the accuracy of contrast-enhanced multidetector spiral computed tomography (MDCT) for the noninvasive detection and classification of coronary plaques and compared it with intracoronary ultrasound (ICUS). Noninvasive determination of plaque composition and plaque burden may be important to improve risk stratification and to monitor progression of coronary atherosclerosis. We included 46 consecutive patients with a distinctive risk profile, who were investigated by ICUS (Goldvision, 20 MHz, Jomed Inc., Rancho Cordova, California). Due to the inability to slow the heart rate below 65 beats/min (n = 7) and due to renal insufficiency (n = 2), nine of 46 consecutive patients could not be studied by MDCT (Sensation 16, Siemens, Forchheim, Germany). In the remaining 37 patients, 68 vessels were investigated by ICUS, and 58 of these vessels were visualized by MDCT with image quality sufficient for analysis. In these vessels that were divided in 3-mm sections, MDCT correctly classified 62 of 80 (78%) sections containing hypoechoic plaque areas, 87 of 112 (78%) sections containing hyperechoic plaque areas, and 150 of 158 (95%) sections containing calcified plaque tissue. In 484 of 525 (92%) sections, atherosclerotic lesions were correctly excluded. The MDCT-derived density measurements within coronary lesions revealed significantly different values for hypoechoic (49 HU [Hounsfield Units] +/- 22), hyperechoic (91 HU +/- 22), and calcified plaques (391 HU +/- 156, p < 0.02). This study demonstrates that, in the case of diagnostic image quality, contrast-enhanced MDCT permits an accurate identification of coronary plaques and that computed tomography density values measured within plaques reflect echogenity and plaque composition.