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A meta analysis and hierarchical classification of HU-based atherosclerotic plaque characterization criteria

Wisnumurti Kristanto1, Peter M A van Ooijen, Marijke C Jansen-van der Weide

  • 1Department of Radiology, Center for Medical Imaging - North East, Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Plos One
|September 11, 2013
PubMed

Insights

Computed tomography (CT) Hounsfield Unit (HU) criteria for characterizing atherosclerotic plaques vary widely. This study derived a hierarchical classification to establish reliable, local reference CT attenuation values for clinical use.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Medical Imaging Analysis

Background:

  • Lipid-rich atherosclerotic plaques, often rupture-prone, are characterized using computed tomography (CT) Hounsfield Unit (HU) values.
  • Existing HU-based criteria for plaque characterization show considerable variability in published literature.
  • A need exists for standardized, reliable HU criteria for clinical application.

Purpose of the Study:

  • To systematically analyze existing Hounsfield Unit (HU) criteria for characterizing lipid-rich and fibrous atherosclerotic plaques.
  • To empirically derive a hierarchical classification of HU-based criteria for clinical reference.
  • To address the significant variations in reported CT attenuation values.

Main Methods:

  • Conducted a systematic literature search (PubMed, Embase) for studies (1998-2011) using HU criteria for plaque characterization.
  • Analyzed HU criteria based on study characteristics (e.g., examination type, CT vendor, voltage settings).
  • Utilized Student's t-test to assess significant differences and developed a hierarchical classification.

Main Results:

  • No correlation was found between HU criteria and lumen contrast-enhancement.
  • Significant differences in HU criteria were observed based on various study characteristics.
  • The hierarchical classification yielded 21 categories for lipid-rich plaques and 22 for fibrous plaques, with over 50% differing significantly.

Conclusions:

  • Reported CT attenuation values for atherosclerotic plaques vary extensively, making generalized values unreliable for clinical practice.
  • The proposed hierarchical classification provides a framework for determining local, reliable reference CT attenuation values.
  • This classification aids in more consistent and accurate characterization of plaque composition in clinical settings.
Abstract

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