Advertisement

The Many Faces of Atherosclerosis

  • Nandini (Nina) M. MeyersohnEmail author
  • Jan-Erik Scholtz
  • Brian B. Ghoshhajra
Chapter
Part of the Contemporary Medical Imaging book series (CMI)

Abstract

Coronary artery disease spans a wide spectrum of imaging appearances over the course of disease development and progression, and knowledge of this range of variation is crucial for the cardiac imager. Atherosclerotic plaques may be noncalcified, partially calcified, or heavily calcified which can affect image interpretability. A range of degrees of stenoses exists from early nonobstructive plaque to chronic total occlusion. In addition, particular plaque features have been identified that are linked with a higher rate of adverse cardiac events, which are important to recognize due to their potential clinical significance. Such high-risk plaque features include spotty calcification, low attenuation, the “napkin-ring” sign, and positive remodeling. An awareness of the gamut of imaging appearances of atherosclerosis in the coronary arteries is an indispensible foundation when evaluating computed tomography (CT) of the heart.

Keywords

Coronary artery disease Atherosclerosis Coronary angiography High-risk plaque features Low-attenuation plaque Napkin-ring sign Spotty calcium Positive remodeling 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, et al. American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation. 2000;102(1):126–40.CrossRefGoogle Scholar
  2. 2.
    Weigold WG, Abbara S, Achenbach S, Arbab-Zadeh A, Berman D, Carr JJ, et al. Standardized medical terminology for cardiac computed tomography: a report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2011;5(3):136–44.CrossRefGoogle Scholar
  3. 3.
    Rodriguez-Granillo GA, Carrascosa P, Bruining N. Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis? Cardiovasc Diagn Therapy. 2016;6(3):250–8.CrossRefGoogle Scholar
  4. 4.
    Andrew M, John H. The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. Int J Cardiovasc Imaging. 2015;31(Suppl 2):145–57.CrossRefGoogle Scholar
  5. 5.
    Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ, et al. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 2009;3(2):122–36.CrossRefGoogle Scholar
  6. 6.
    Abbara S, Blanke P, Maroules CD, Cheezum M, Choi AD, Han BK, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2016;10(6):435–49.CrossRefGoogle Scholar
  7. 7.
    Diaz-Zamudio M, Bacilio-Perez U, Herrera-Zarza MC, Meave-Gonzalez A, Alexanderson-Rosas E, Zambrana-Balta GF, et al. Coronary artery aneurysms and ectasia: role of coronary CT angiography. Radiographics Rev Publ Radiol Soc North Am Inc. 2009;29(7):1939–54.Google Scholar
  8. 8.
    Virani SS, Mendoza CE, Ferreira AC, de Marchena E. Left main coronary artery stenosis: factors predicting cardiac events in patients awaiting coronary surgery. Tex Heart Inst J. 2006;33(1):23–6.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50(12):1161–70.CrossRefGoogle Scholar
  10. 10.
    Stone GW, Kandzari DE, Mehran R, Colombo A, Schwartz RS, Bailey S, et al. Percutaneous recanalization of chronically occluded coronary arteries. A consensus document: part I. Circulation. 2005;112(15):2364–72.CrossRefGoogle Scholar
  11. 11.
    Alessandrino G, Chevalier B, Lefevre T, Sanguineti F, Garot P, Unterseeh T, et al. A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC Cardiovasc Interv. 2015;8(12):1540–8.CrossRefGoogle Scholar
  12. 12.
    Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54(1):49–57.CrossRefGoogle Scholar
  13. 13.
    Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50(4):319–26.CrossRefGoogle Scholar
  14. 14.
    van Velzen JE, de Graaf FR, de Graaf MA, Schuijf JD, Kroft LJ, de Roos A, et al. Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2011;18(5):893–903.CrossRefGoogle Scholar
  15. 15.
    Kitagawa T, Yamamoto H, Horiguchi J, Ohhashi N, Tadehara F, Shokawa T, et al. Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. J Am Coll Cardiol Img. 2009;2(2):153–60.CrossRefGoogle Scholar
  16. 16.
    Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, et al. Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. J Am Coll Cardiol Img. 2009;2(12):1412–9.CrossRefGoogle Scholar
  17. 17.
    Gauss S, Achenbach S, Pflederer T, Schuhback A, Daniel WG, Marwan M. Assessment of coronary artery remodelling by dual-source CT: a head-to-head comparison with intravascular ultrasound. Heart. 2011;97(12):991–7.CrossRefGoogle Scholar
  18. 18.
    Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, et al. Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol. 2006;47(8):1655–62.CrossRefGoogle Scholar
  19. 19.
    Ito T, Terashima M, Kaneda H, Nasu K, Matsuo H, Ehara M, et al. Comparison of in vivo assessment of vulnerable plaque by 64-slice multislice computed tomography versus optical coherence tomography. Am J Cardiol. 2011;107(9):1270–7.CrossRefGoogle Scholar
  20. 20.
    Otsuka K, Fukuda S, Tanaka A, Nakanishi K, Taguchi H, Yoshikawa J, et al. Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. J Am Coll Cardiol Img. 2013;6(4):448–57.CrossRefGoogle Scholar
  21. 21.
    Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, Alkadhi H. The napkin-ring sign: CT signature of high-risk coronary plaques? J Am Coll Cardiol Img. 2010;3(4):440–4.CrossRefGoogle Scholar
  22. 22.
    Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005;46(6):937–54.CrossRefGoogle Scholar
  23. 23.
    Laine P, Kaartinen M, Penttila A, Panula P, Paavonen T, Kovanen PT. Association between myocardial infarction and the mast cells in the adventitia of the infarct-related coronary artery. Circulation. 1999;99(3):361–9.CrossRefGoogle Scholar
  24. 24.
    Andreini D, Pontone G, Mushtaq S, Bartorelli AL, Bertella E, Trabattoni D, et al. Coronary in-stent restenosis: assessment with CT coronary angiography. Radiology. 2012;265(2):410–7.CrossRefGoogle Scholar

Copyright information

© Humana Press 2019

Authors and Affiliations

  • Nandini (Nina) M. Meyersohn
    • 1
    • 2
    Email author
  • Jan-Erik Scholtz
    • 2
  • Brian B. Ghoshhajra
    • 1
    • 2
  1. 1.Division of Cardiovascular Imaging, Department of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  2. 2.Cardiac MR PET CT ProgramMassachusetts General HospitalBostonUSA

Personalised recommendations