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Classification of noncalcified coronary atherosclerotic plaque components on CT coronary angiography: impact of vascular attenuation and density thresholds

Classificazione delle componenti aterosclerotiche non calcifiche delle placche coronariche mediante angiografia coronarica TC: impatto dell’attenuazione vascolare e delle soglie di densità

  • Cardiac Radiology / Cardioradiologia
  • Published:
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Abstract

Purpose

The authors assessed the effect of vascular attenuation and density thresholds on the classification of noncalcified plaque by computed tomography coronary angiography (CTCA).

Materials and methods

Thirty patients (men 25; age 59±8 years) with stable angina underwent arterial and delayed CTCA. At sites of atherosclerotic plaque, attenuation values (HU) were measured within the coronary lumen, noncalcified and calcified plaque material and the surrounding epicardial fat. Based on the measured CT attenuation values, coronary plaques were classified as lipid rich (attenuation value below the threshold) or fibrous (attenuation value above the threshold) using 30-HU, 50-HU and 70-HU density thresholds.

Results

One hundred and sixty-seven plaques (117 mixed and 50 noncalcified) were detected and assessed. The attenuation values of mixed plaques were higher than those of exclusively noncalcified plaques in both the arterial (148.3±73.1 HU vs. 106.2±57.9 HU) and delayed (111.4±50.5 HU vs. 64.4±43.4 HU) phases (p<0.01). Using a 50-HU threshold, 12 (7.2%) plaques would be classified as lipid rich on arterial scan compared with 28 (17%) on the delayed-phase scan. Reclassification of these 16 (9.6%) plaques from fibrous to lipid rich involved 4/30 (13%) patients.

Conclusions

Classification of coronary plaques as lipid rich or fibrous based on absolute CT attenuation values is significantly affected by vascular attenuation and density thresholds used for the definition.

Riassunto

Obiettivo

Scopo del presente lavoro è valutare l’effetto dell’attenuazione vascolare e delle soglie di densità sulla classificazione delle placche aterosclerotiche coronariche non calcifiche mediante angiografia coronarica con tomografia computerizzata (CTCA).

Materiali e metodi

Trenta pazienti (maschi 25; età 59±8 anni) con angina stabile sono stati sottoposti a CTCA in fase arteriosa e tardiva. Nei segmenti con aterosclerosi coronarica, è stata misurata l’attenuazione (HU) del lume coronarico, delle componenti calcifica e non calcifica delle placche aterosclerotiche e del tessuto adiposo epicardico adiacente. Sulla base delle attenuazioni misurate, le placche sono state classificate come lipidiche (valori di attenuazione al di sotto della soglia) o fibrose (valori di attenuazione al di sopra della soglia) utilizzando 30 HU, 50 HU e 70 HU come soglie di densità.

Risultati

Sono state rilevate e valutate 167 placche (117 miste e 50 non calcifiche). I valori di attenuazione della placche miste è risultato maggiore di quello delle placche esclusivamente non calcifiche, sia in fase arteriosa (148,3±73,1 HU vs. 106,2±57,9 HU) che in fase tardiva (111,4±50,5 HU vs. 64,4±43,4 HU; p<0,01). Utilizzando una soglia di 50 HU, 12 (7,2%) placche sarebbero state classificate come lipidiche nella fase arteriosa, contro 28 (17%) nella fase tardiva. La riclassificazione di queste 16 (9,6%) placche da fibrose a lipidiche è avvenuta in 4/30 (13%) pazienti.

Conclusioni

La classificazione delle placche coronariche come lipidiche o fibrose sulla base dei valori assoluti di attenuazione è significativamente influenzata dall’attenuazione vascolare e dalle soglie di densità utilizzate per la definizione.

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Authors and Affiliations

  1. Cardiovascular Imaging, Giovanni XXIII Clinic, Monastier (TV), Italy

    E. Maffei, C. Martini, S. Seitun, T. Arcadi, N. R. Mollet & F. Cademartiri

  2. Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands

    K. Nieman, C. Martini, A. Rossi & F. Cademartiri

  3. SDN Foundation — IRCCS, Naples, Italy

    O. Catalano

  4. Department of Radiology, University of Verona, Verona, Italy

    R. Malagò

  5. Department of Radiology, University of Ferrara, Ferrara, Italy

    A. Clemente

  6. Cardiovascular Imaging, Giovanni XXIII Clinic, Via Giovanni XXIII 7, 31050, Monastier (TV), Italy

    F. Cademartiri

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  1. E. Maffei
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  2. K. Nieman
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  3. C. Martini
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  8. A. Rossi
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  9. A. Clemente
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  10. N. R. Mollet
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  11. F. Cademartiri
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Correspondence to F. Cademartiri.

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Maffei, E., Nieman, K., Martini, C. et al. Classification of noncalcified coronary atherosclerotic plaque components on CT coronary angiography: impact of vascular attenuation and density thresholds. Radiol med 117, 230–241 (2012). https://doi.org/10.1007/s11547-011-0744-z

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  • DOI: https://doi.org/10.1007/s11547-011-0744-z

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