Quantification of atherosclerotic coronary plaque components by submillimeter computed tomography

  • Friedrich Knollmann
  • Franziska Ducke
  • Lilian Krist
  • Tereza Kertesz
  • Rudolf Meyer
  • Hans Guski
  • Roland Felix
Original Paper


Background: Although several investigations have shown that multi-detecor row computed tomography (MDCT) of the coronary arteries can detect noncalcified atherosclerotic plaque, it has remained unresolved if the method also determines features of a rupture-prone plaque. We set out to correlate the size of atherosclerotic plaque components with cardiac MDCT with histology. Methods and results: In 30 autopsy cases, hearts were isolated, coronary arteries filled with contrast agent, and depicted with a clinical 16-row detector CT with a slice thickness of 0.63 mm. Transections of the three main coronary arteries were reconstructed and compared with histopathologic sections using light microscopy. MDCT measurements of total plaque area (r = 0.73, P < 0.0001) and calcified plaque area (r = 0.83, P < 0.0001) correlated well with histopathology, while measurements of non-calcified plaque area (r = 0.53, P < 0.0001) and lipid core size (r = 0.43; P < 0.0001) correlated less well. MDCT overestimated all plaque areas except lipid core size, which was underestimated. Conclusions: Coronary CT provides an accurate and reproducible method for the quantitative assessment of total plaque and calcified plaque areas. However, the method is less accurate for the quantification of non-calcified plaque area and lipid core size, which is ascribed to limited spatial and contrast resolution. With the present technique, the detection of vulnerable plaques by MDCT remains uncertain.


Coronary disease Atherosclerosis Imaging Tomography 


  1. 1.
    Nieman K, Oudkerk M, Rensing BJ, van Ooijen P, Munne A, van Geuns R-J, de Feyter PJ (2001) Coronary angiography with multi-slice computed tomography. Lancet 357:599–603PubMedCrossRefGoogle Scholar
  2. 2.
    Achenbach S, Giesler T, Ropers D, Ulzheimer S, Derlien H, Schulte C, Wenkel E, Moshage W, Bautz W, Daniel WG, Kalender WA, Baum U (2001) Detection of coronary artery stenosis by contrast-enhanced, retrospectively electrocardiographically-gated, multislcie spiral computed tomography. Circulation 103:2353–2358Google Scholar
  3. 3.
    Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, Schlundt C, Bautz W, Daniel WG, Achenbach S (2003) Detection of coronary artery stenosis with thin-slice multi-detector row spiral computed tomography and multiplanar reconstructions. Circulation 107:664–666PubMedCrossRefGoogle Scholar
  4. 4.
    Leber AW, Knez A, Becker A, Becker C, Reiser M, Steinbeck G, Boeksteger P (2005) Visualizing noncalcified coronary plaques by CT. Int J Cardiovasc Imaging 21:55–61PubMedCrossRefGoogle Scholar
  5. 5.
    Kopp AF, Schroeder S, Baumbach A, Kuettner A, Georg C, Ohnesorge B, Heuschmid M, Kuzo R, Claussen CD (2001) Non-invasive characterization of coronary lesion morphology and composition by multislcie CT: first results in comparison with intracoronary ultrasound. Eur Radiol 11:1607–1611PubMedCrossRefGoogle Scholar
  6. 6.
    Achenbach S, Moselewski F, Ropers D, Ferencik M, Hoffmann U, MacNeill B, Pohle K, Baum U, Anders K, Jang IK, Daniel WG, Brady TJ (2004) Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multisdetector spiral computed tomography. Circulation 109:14–17PubMedCrossRefGoogle Scholar
  7. 7.
    Moselewski F, Ropers D, Pohle K, Hoffmann U, Ferencik M, Chan RC, Cury RC, Abbara S, Jang IK, Brady TJ, Daniel WG, Achenbach S (2004) Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice multidetector computed tomography versus intravascular ultrasound. Am J Cardiol 94:1294–1297PubMedCrossRefGoogle Scholar
  8. 8.
    Carracosa PM, Capunay CM, Garcia-Merletti P, Carrascosa J, Garcia MJ (2006) Characterization of coronary atherosclerotic plaques by multidetector computed tomography. Am J Cardiol 97:598–602CrossRefGoogle Scholar
  9. 9.
    Becker CR, Nikolaou K, Muders M, Babaryka G, Crispin A, Schoepf UJ, Loehrs U, Reiser M (2003) Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT. Eur Radiol 13:2094–2098PubMedCrossRefGoogle Scholar
  10. 10.
    Nikolaou K, Becker CR, Muders M, Babaryka G, Scheidler J, Flohr T, Loehrs U, Reiser MF, Fayad ZA (2004) Multidetector-row computed tomography and magnetic resonance imaging of atherosclerotic lesions in human ex vivo coronary arteries. Atherosclerosis 174:243–252PubMedGoogle Scholar
  11. 11.
    Schroeder S, Kuettner A, Leitritz M, Janzen J, Kopp AF, Herdeg C, Heuschmid M, Burgstahler C, Baumbach A, Wehrmann M, Claussen CD (2004) Relability of differentiating human coronary plaque morphology using contrast-enhanced multislice spiral computed tomography. J Comput Assist Tomogr 28:449–454PubMedCrossRefGoogle Scholar
  12. 12.
    Burke AP, Farb A, Malcolm GT, Lang Y-H, Smialek, Virmani R (1997) Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 336:1276–1282PubMedCrossRefGoogle Scholar
  13. 13.
    Davies MJ (1997) The composition of coronary artery plaques. N Engl J Med 336:1312–1314PubMedCrossRefGoogle Scholar
  14. 14.
    Virmani R, Burke AP, Farb A, Kolodgie FD (2006) Pathology of the vulnerable plaque. J Am Coll Cardiol 47:C13–C18PubMedCrossRefGoogle Scholar
  15. 15.
    Austen WG, Edwards JE, Frye RL,Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Circulation 51:5–40PubMedGoogle Scholar
  16. 16.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedGoogle Scholar
  17. 17.
    Langheinrich AC, Bohle RM, Greschus S, Hackstein N, Walker G, von Gerlach S, Rau WS, Holschermann H (2004) Atherosclerotic lesions at micro CT: Feasibiliy for analysis of coronary artery wall in autopsy specimens. Radiology 231:675–681PubMedCrossRefGoogle Scholar
  18. 18.
    Ferencik M, Chan RC, Achenbach S, Lisauskas JB, Houser SL, Hoffmann U, Abbara S, Cury RC, Bouma BE, Tearney GJ, Brady TJ (2006) Arterial wall imaging: evaluation with 16-section multidetector CT in blood vessel phantoms and ex vivo coronary arteries. Radiology 240:708–716PubMedCrossRefGoogle Scholar
  19. 19.
    Leber AW, Knez A, von Ziegler, Becker A, Nikolaou K, Paul S, Wintersperger B, Reiser M, Becker CR, Steinbeck G, Boekstegers P (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography. J Am Coll Cardiol 46:147–154PubMedCrossRefGoogle Scholar
  20. 20.
    Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG (2001) American college of cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS). J Am Coll Cardiol 37:1478–1492PubMedCrossRefGoogle Scholar
  21. 21.
    Birgelen C, vd Lugt A, Nicosia A, Mintz GS, Gussenhoven EJ, de Vrey E, Mallus MT, Roelandt JR, Serruys PW, de Feyter PJ (1996) Computerized assessment of coronary lumen and atherosclerotic plaque dimensions in three-dimensional intravascular ultrasound correlated with histomorphometry. Am J Cardiol 78:1202–1209CrossRefGoogle Scholar
  22. 22.
    Mautner GC, Mautner SL, Froehlich J, Feuerstein IM, Proschan MA, Roberts WC, Doppman JL (1994) Coronary artery calcification: Assessement with electron beam CT and histomorphometric correlation. Radiology 192:619–623PubMedGoogle Scholar
  23. 23.
    Rumberger JA, Simons B, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. Circulation 92:2157–2162PubMedGoogle Scholar
  24. 24.
    de Wert TT, Ouhlous M, Zondervan PE, Hendriks JM, Dippel DWJ, van Sambeek MRHM, vd Lugt A (2005) In vitro characterization of atherosclerotic carotid plaque with multidetector computed tomography and histopathological correlation. Eur Radiol 15:1906–1914CrossRefGoogle Scholar
  25. 25.
    Hausleitner J, Meyer T, Hadamitzky M, Kastrati A, Martinoff S, Schömig A (2006) Prevalence of noncalcified plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease. J Am Coll Cardiol 48:312–318CrossRefGoogle Scholar
  26. 26.
    Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, Cury RC, Abbara S, Joneidi-Jafari H, Achenbach S, Brady TJ (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesins in stable angina by multidetector computed tomography. J Am Coll Cardiol 47:1655–1662PubMedCrossRefGoogle Scholar
  27. 27.
    Rioufol G, Finet G, Ginon I, Andre-Fouet X, Rossi R, Vialle E, Desjoyaux E, Convert G, Huret JF, Tabib A (2002) Multiple atherosclerotic plaque rupture in acute coronary syndrome. Circulation 106:804–808PubMedCrossRefGoogle Scholar
  28. 28.
    Schoenhagen P, Tuzcu M, Ellis SG (2002) Plaque vulnerability, plaque rupture, and acute coronary syndromes. Circulation 106:760–762PubMedCrossRefGoogle Scholar
  29. 29.
    Morin RL, McCollough CH (2003) Radiation dose in computed tomography of the heart. Circulation 107:917–922PubMedCrossRefGoogle Scholar
  30. 30.
    Halliburton SS, Schoenhagen P, Nair A, Stillman AE, Lieber ML, Tuzcu EM, Vince GD, White RD (2006) Contrast enhancement of coronary atherosclerotic plaque: a high-resolution, multidetector-row computed tomography study of pressure-perfused, human ex-vivo coronary arteries. Coron Artery Dis 17:553–560PubMedCrossRefGoogle Scholar
  31. 31.
    Cademartiri F, Mollet NR, Runza G, Bruining N, Hamers R, Somers P, Knaapen M, Verheye S, Midiri M, Krestin GP, de Feyter PJ (2005) Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observation in an ex vivo model of coronary computed tomography angiography. Eur Radiol 15:1426–1431PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Friedrich Knollmann
    • 1
  • Franziska Ducke
    • 2
  • Lilian Krist
    • 2
  • Tereza Kertesz
    • 2
  • Rudolf Meyer
    • 3
  • Hans Guski
    • 4
  • Roland Felix
    • 2
  1. 1.Department of RadiologyUniversity of PittsburghPittsburghUSA
  2. 2.Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-KlinikumBerlinGermany
  3. 3.Arbeitsbereich Pathologie, Deutsches Herzzentrum BerlinBerlinGermany
  4. 4.Institut fuer Pathologie, Charite Campus MitteBerlinGermany

Personalised recommendations