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CT-pathologic correlation of non-calcified atherosclerotic arterial plaques: a study using carotid endarterectomy
Masahiro Higashi1,2, Naoaki Yamada2, Satoshi Imakita3
1Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Insights
CT values can distinguish between lipid-rich necrotic cores and fibrous tissue in atherosclerotic plaques. Dual-phase contrast-enhanced CT scans improve the accuracy of differentiating these vulnerable plaque components.
Area of Science:
- Radiology and Imaging Science
- Cardiovascular Pathology
- Medical Image Analysis
Background:
- Pathologic features of atherosclerotic plaques on computed tomography (CT) are not well-established.
- Accurate characterization of plaque components is crucial for assessing cardiovascular risk.
- Distinguishing between lipid-rich necrotic cores and fibrous tissue is key to identifying vulnerable plaques.
Purpose of the Study:
- To compare CT values of pathologically confirmed atherosclerotic plaque constituents.
- To evaluate the ability of CT imaging to differentiate between lipid-rich necrotic cores and fibrous tissue.
- To establish the diagnostic performance of different CT phases in plaque characterization.
Main Methods:
- Analysis of 50 carotid endarterectomy samples with corresponding pre-operative CT scans (pre-contrast, early post-contrast, delayed post-contrast).
- Comparison of CT values (Hounsfield units) for lipid-rich necrotic core (NC) and fibrous tissue (F) with histopathological findings.
- Utilized discrimination techniques to assess the ability of CT features to differentiate plaque components.
Main Results:
- CT values were significantly lower for lipid-rich necrotic cores (NC) compared to fibrous tissue (F) across all CT phases (p < 0.01 for pre-contrast, p < 0.0001 for post-contrast).
- Dual-phase contrast-enhanced CT (CT-E and CT-D) demonstrated higher accuracy (85-84%) and sensitivity (85-92%) in differentiating NC from F compared to pre-contrast CT (CT-P) (68% accuracy, 74% sensitivity).
- Linear discrimination analysis using CT-E and CT-D achieved 90-91% sensitivity and accuracy.
Conclusions:
- CT values are consistently lower in lipid-rich necrotic cores than in fibrous tissue, even with overlapping values.
- The use of two-phase post-contrast CT significantly improves the discrimination ability between these critical plaque components.
- Findings support the potential for computer-aided diagnosis of vulnerable atherosclerotic plaques using CT imaging.
Objective:
Pathologic features of atherosclerotic plaques on CT are not established. We compared CT values among pathologically confirmed plaque constituents and evaluated their ability to distinguish plaque constituents.
Methods:
50 histopathological images of carotid endarterectomy samples from 10 males and 2 females (age 54-74 years, average 65.9 years) were examined. We compared pre-operative CT [pre-contrast (CT-P), early post-contrast phase (CT-E), delayed post-contrast phase (CT-D)] of lipid-rich necrotic core (NC) and fibrous tissue (F) plaque components with pathological images. The ability of features to differentiate plaque components using several discrimination techniques were compared.
Results:
CT values of NC and F were 36 ± 13, 45 ± 11 (mean ± standard deviation, Hounsfield unit, HU), 41 ± 17, 69 ± 18, and 44 ± 16, 70 ± 13 in CT-P (p < 0.01), CT-E (p < 0.0001), and CT-D (p < 0.0001), respectively. The threshold, sensitivity, and accuracy for distinguishing NC from F were 44 HU, 74%, and 68%; 55 HU, 85%, and 85%; and 63 HU, 92%, and 84% in CTP, CT-E, and CT-D, respectively. CT-P had lower accuracy than CT-E and CT-D (both p < 0.05), but CT-E and CT-D were similar. CT-E and CT-D yielded 90 and 91% sensitivity and accuracy, respectively in linear discrimination analysis.
Conclusion:
In both pre- and post-contrast CT, CT values were lower in NC than F. Although values overlapped, using two-phase post-contrast CTs improved discrimination ability.
Advances In Knowledge:
Our findings may help to establish computer-aided diagnosis of vulnerable atherosclerotic plaques in future.
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