Knollmann Friedrich, Ducke Franziska, Krist Lilian, Kertesz Tereza, Meyer Rudolf, Guski Hans, Felix Roland
Department of Radiology, University of Pittsburgh, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
Int J Cardiovasc Imaging. 2008 Mar;24(3):301-10. doi: 10.1007/s10554-007-9262-4. Epub 2007 Sep 12.
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.
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.
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.
尽管多项研究表明，冠状动脉多排螺旋计算机断层扫描（MDCT）能够检测出非钙化动脉粥样硬化斑块，但该方法能否确定易破裂斑块的特征仍未明确。我们旨在将心脏MDCT检测的动脉粥样硬化斑块成分大小与组织学结果进行关联。
选取30例尸检病例，取出心脏，向冠状动脉内注入造影剂，然后使用临床16排探测器CT进行扫描，层厚为0.63mm。重建三条主要冠状动脉的横断面，并与使用光学显微镜的组织病理学切片进行比较。MDCT测量的总斑块面积（r = 0.73，P < 0.0001）和钙化斑块面积（r = 0.83，P < 0.0001）与组织病理学结果相关性良好，而非钙化斑块面积（r = 0.53，P < 0.0001）和脂质核大小（r = 0.43；P < 0.0001）的测量相关性较差。MDCT高估了除脂质核大小（被低估）之外的所有斑块面积。
冠状动脉CT为定量评估总斑块和钙化斑块面积提供了一种准确且可重复的方法。然而，该方法在定量非钙化斑块面积和脂质核大小方面准确性较低，这归因于有限的空间和对比度分辨率。采用当前技术，通过MDCT检测易损斑块仍不确定。
