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Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT
Christoph R Becker1, Konstantin Nikolaou, Michael Muders
1Department of Clinical Radiology, University of Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. christoph.becker@ikra.med.uni-muenchen.de
Insights
Multi-detector-row CT angiography (CTA) can non-invasively assess coronary atherosclerosis morphology. CTA accurately detects various plaque types and plaque tissue attenuation may indicate lipid-rich or fibrous composition.
Area of Science:
- Cardiovascular Imaging
- Medical Imaging Technology
- Pathology
Background:
- Coronary atherosclerosis assessment is crucial for cardiovascular disease management.
- Multi-detector-row CT angiography (CTA) offers non-invasive visualization of coronary arteries.
- The correlation between CTA-based plaque morphology and histopathology remains largely uncharacterized.
Purpose of the Study:
- To evaluate the relationship between atherosclerotic plaque morphology determined by CTA and histopathological findings.
- To assess the sensitivity of CTA in detecting different types of coronary atherosclerotic lesions.
- To determine if CT attenuation values can differentiate plaque composition.
Main Methods:
- Human cadaver heart specimens (n=11) underwent CTA after coronary artery contrast injection.
- Atherosclerotic lesions were analyzed on CTA images for morphology and tissue attenuation.
- Histopathological analysis using American Heart Association criteria was performed on macroscopically identified lesions.
- Direct comparison between CTA findings and histopathology for 33 lesions.
Main Results:
- CTA demonstrated varying sensitivity for different lesion types: atheromas (73%), fibroatheromas (70%), fibrocalcified (86%), and calcified (100%).
- Significant differences in CT attenuation were observed between lipid-rich (47±9 HU) and fibrous-rich (104±28 HU) non-calcified plaques (p<0.01).
- CTA identified 40 lesions, while macroscopic examination revealed 50 lesions.
Conclusions:
- CTA can detect various stages of coronary atherosclerosis, correlating with histopathological findings.
- The tissue attenuation of non-calcified plaques on CTA may provide insights into their predominant composition.
- CTA shows promise as a non-invasive tool for characterizing coronary atherosclerotic plaques.
Abstract:
Multi-detector-row CT angiography (CTA) is a new technology that allows for non-invasive investigation of coronary atherosclerosis in patients. The relation between the morphology of atherosclerotic plaques assessed by CTA and histopathology is unknown. We investigated 11 human cadaver heart specimens. A mixture of methylcellulose and CT contrast media was injected into the coronary arteries to achieve in-vivo-like contrast enhancement within the coronary artery lumen. The morphologic pattern of atherosclerotic lesions found on CTA images and the tissue attenuation of non-calcified plaques were determined. After CTA imaging, atherosclerotic lesions in the coronary arteries were macroscopically identified and characterized histopathologically according to American Heart Association criteria. A total of 50 and 40 lesions were found macroscopically and by CTA, respectively. Thirty-three lesions could have been compared directly. The sensitivity of CTA compared with macroscopic detection of atheromas, fibroatheromas, fibrocalcified, and calcified lesions was 73, 70, 86, and 100%, respectively. The mean CT attenuation of predominantly lipid-rich and fibrous-rich plaques was significantly different (47+/-9 and 104+/-28 HU, respectively; p<0.01). Atherosclerotic coronary plaques detected by CTA may represent different stages of coronary atherosclerosis. The tissue attenuation of non-calcified plaques may allow for assessment of their predominant component.