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How reliable are 40 MHz IVUS and 64-slice MDCT in characterizing coronary plaque composition? An ex vivo study with

Romain Chopard1, Loic Boussel, Pascal Motreff

  • 1Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University, INSERM Research Unit 886 and CREATIS Research Unit associated to CNRS (UMR 5515), B.P Lyon-Monchat, 69394, Lyon Cedex 03, France.

The International Journal of Cardiovascular Imaging
|January 7, 2010
PubMed

Insights

Intravascular ultrasound (IVUS) and multi-detector computed tomography (MDCT) both struggle to accurately characterize coronary artery plaque composition. Histological analysis revealed limitations in both imaging modalities for reliable plaque assessment.

Area of Science:

  • Cardiovascular Imaging
  • Medical Device Technology
  • Pathology

Background:

  • Accurate characterization of coronary artery plaque composition is crucial for assessing cardiovascular risk.
  • Intravascular ultrasound (IVUS) and multi-detector computed tomography (MDCT) are advanced imaging techniques used for coronary plaque evaluation.
  • Histological analysis serves as the gold standard for determining plaque composition.

Purpose of the Study:

  • To evaluate the reliability of IVUS and MDCT in characterizing coronary plaque composition compared to histological analysis.
  • To determine if IVUS can serve as a valid reference for validating MDCT plaque characterization.
  • To assess the accuracy of both imaging modalities in identifying calcified, fibrous, and lipid-rich plaques.

Main Methods:

  • Postmortem human coronary artery specimens (n=21) were imaged using 40 MHz IVUS and 64-slice MDCT.
  • Coronary cross-sections were histologically analyzed to classify plaque types.
  • Plaque composition was assessed visually, and MDCT attenuation values (Hounsfield Units) were measured.

Main Results:

  • Histology identified 83 atherosclerotic plaques.
  • IVUS showed limitations in characterizing calcified plaque (75% positive predictive value) and lipid-rich plaque (60% positive predictive value).
  • MDCT demonstrated higher accuracy for calcified plaque (100% positive predictive value) but similar limitations for lipid-rich plaque (68% positive predictive value).
  • MDCT attenuation values differed significantly for calcified plaque (966 HU) compared to fibrous (83 HU) and lipid-rich plaques (71 HU), but not between fibrous and lipid-rich plaques.

Conclusions:

  • Neither 40 MHz IVUS nor 64-slice MDCT are reliable for accurate in vivo coronary plaque characterization when validated against histology.
  • IVUS exhibits acoustic ambiguities affecting plaque composition analysis.
  • MDCT struggles with accurate differentiation of plaque components, particularly lipid-rich versus fibrous plaque.

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