Vessel density ratio: A novel approach to identify "culprit" coronary lesion by spiral computed tomography

Area of Science:

• Cardiovascular Imaging
• Radiology
• Interventional Cardiology

Background:

• Acute coronary syndrome (ACS) diagnosis relies on identifying culprit lesions.
• Assessing lesion characteristics with multidetector computed tomography-assisted coronary angiography (MDCTA) can be challenging due to plaque, thrombus, and calcification.
• A standardized, reproducible method is needed to quantify lesion severity.

Purpose of the Study:

• To hypothesize that culprit lesions in ACS exhibit low vessel lumen and plaque density on MDCTA.
• To introduce and test the feasibility of a Vessel Density Ratio (VDR) for identifying culprit lesions.
• To establish VDR as a convenient and standardized approach in ACS diagnosis.

Main Methods:

• Sixty-four patients with varying degrees of coronary artery disease underwent MDCTA within a week of conventional angiography.
• A Vessel Density Ratio (VDR) was calculated by comparing contrast enhancement within a region of interest (including vessel wall, lumen, plaque, and thrombus) to the aortic root density.
• Regions of interest were mapped from maximum intensity projections of diseased segments.

Main Results:

• A total of 174 diseased segments were evaluated.
• Patients with ACS (STEMI, unstable angina/NSTEMI) showed significantly lower mean VDR compared to patients with exertional angina (0.58 vs. 0.66 vs. 0.81; P < 0.001).
• Culprit lesions in ACS patients had the lowest mean VDR compared to non-culprit lesions and lesions in patients without ACS (0.51 vs. 0.68 vs. 0.81; P < 0.001).

Conclusions:

• The Vessel Density Ratio (VDR) is a novel, convenient, and standardized method for identifying culprit lesions in ACS using MDCTA.
• VDR provides a reproducible metric for assessing lesion severity in coronary angiography.
• This technique aids in differentiating critical lesions responsible for ACS events.