Coronary artery disease
Comparison of 64-Slice Multidetector Computed Tomography With Spectral Analysis of Intravascular Ultrasound Backscatter Signals for Characterizations of Noncalcified Coronary Arterial Plaques

https://doi.org/10.1016/j.amjcard.2008.05.060Get rights and content

In vivo identification of plaque composition may allow the detection of vulnerable plaques before rupture. However, the clinical relevance of multidetector computed tomography (MDCT) in characterizing coronary plaques is currently a subject of debate. We compared 64-slice MDCT with virtual histology to investigate the potential role of 64-slice MDCT in the differentiation of composition of noncalcified coronary plaques. Fifty-nine consecutive patients (stable/unstable angina 34/21) were enrolled. Mean computed tomographic (CT) density (Hounsfield units) of noncalcified coronary plaques (n = 80) was compared with a relative volume of each plaque component (fibrous, fibrofatty, calcium, and necrotic core) analyzed by virtual histology. Mean heart rate during MDCT was 58 ± 9 beats/min. There was a negative correlation between mean CT density and the necrotic core (r = −0.539, p <0.001) and a positive correlation between mean CT density and the fibrotic tissue component (r = 0.571, p <0.001). Mean CT density of the plaques with a <10% necrotic core was significantly higher than that of a ≥10% necrotic core (93.1 ± 37.5 vs 41.3 ± 26.4 HU, p <0.001). However, overlapping of mean CT densities between plaques with a <10% necrotic core and those with a ≥10% necrotic core was found. In conclusion, mean CT density of noncalcified coronary plaques measured by 64-slice MDCT may depend on the relative volumes of the necrotic core and fibrotic component. Sixty-four–slice MDCT may have the potential for determining composition of noncalcified coronary plaques, which needs further studies for clinical application.

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Methods

Fifty-nine consecutive patients (stable/unstable angina 34/21, mean age 62 ± 18 years) who were referred for invasive coronary angiography were enrolled. In all patients who had no exclusion criteria, 64-slice MDCT was performed as part of research protocols within 7 days before coronary angiography. In each patient who had >1 clearly identifiable coronary plaque on multidetector computed tomogram, virtual histologic study was performed before coronary intervention. Patients with possible acute

Results

Sixty-four–slice multidetector computed tomographic scanning was performed without any complications in all 59 patients (mean age 62 ± 18 years) who were scheduled for conventional invasive coronary angiography. Beta blockers were administered in 51 patients to decrease their heart rate. Mean heart rate during MDCT was 58 ± 9 beats/min. Forty-six patients (84%) had a heart rate <60 beats/min. Baseline characteristics of patients are presented in Table 1.

Four of 59 patients had CT angiograms

Discussion

The present study was different from previous studies that compared 4- or 16-slice MDCT with IVUS. The present study used the scanning technology that improved the material used in previous studies. Compared with 4- or 16-slice CT investigations, 64-slice MDCT provides improved temporal and spatial resolution.6 With faster tube rotation and simultaneous acquisition of 64 slices per rotation, the technique achieved a higher temporal resolution in the center of the field of the view, and with a

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