Head-to-head comparison of coronary plaque evaluation between multislice computed tomography and intravascular...

The purpose of this study was to perform a head-to-head comparison of plaque observations with multislice computed tomography (MSCT) to virtual histology intravascular ultrasound (VH IVUS).

The VH IVUS allows in vivo coronary plaque characterization with high spatial resolution. Noninvasively, plaques may be evaluated with MSCT, but limited data are available.

A total of 50 patients underwent 64-slice MSCT followed by VH IVUS. The Agatston score was evaluated on MSCT in coronary segments where IVUS was performed. Plaques were classified on MSCT as noncalcified, mixed, and calcified. Four plaque components (fibrotic, fibro-fatty, and necrotic core tissues and dense calcium) were identified on VH IVUS, and the presence of thin-cap fibroatheroma was evaluated.

A moderate correlation was observed between the Agatston score and calcium volume on VH IVUS (r = 0.69, p < 0.0001). In total, 168 coronary plaques were evaluated (48 [29%] noncalcified, 71 [42%] mixed, 49 [29%] calcified). As compared with calcified plaques, noncalcified plaques contained more fibrotic (60.90 +/- 9.21% vs. 54.60 +/- 8.33%, p = 0.001) and fibro-fatty tissues (28.11 +/- 13.03% vs. 21.37 +/- 9.75%, p = 0.006) on VH IVUS. Mixed and calcified plaques contained more dense calcium (7.61 +/- 8.94% vs. 2.68 +/- 3.01%, p = 0.001; 10.18 +/- 6.71% vs. 2.68 +/- 3.01%, p < 0.0001, respectively). Thin-cap fibroatheromas were most frequently observed in mixed plaques as compared with noncalcified and calcified plaques (32%, 13%, 8%, p = 0.002, respectively).

A good correlation was observed between calcium quantification on MSCT and VH IVUS. In addition, plaque classification on MSCT paralleled relative plaque composition on VH IVUS, although VH IVUS provided more precise plaque characterization. Mixed plaques on MSCT were associated with high-risk features on VH IVUS.