First Department of Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
Int J Cardiol. 2011 May 5;148(3):313-8. doi: 10.1016/j.ijcard.2009.11.019. Epub 2009 Dec 11.
Dual-source computed tomography (DSCT) has enabled us to non-invasively visualize coronary artery stenosis, but its ability to characterize coronary atherosclerotic plaques (ASPs) has not been evaluated. Intravascular optical coherence tomography (OCT) provides tissue images of coronary artery wall that are validated by pathohistological studies. We studied the diagnostic accuracy of DSCT in the characterization of coronary ASPs, especially lipid-rich ASP with thin fibrous cap (TCFA), in comparison with OCT.
DSCT and OCT were used to image non-stenotic ASPs in non-culprit coronary arteries of 17 acute coronary syndrome (ACS) patients, and 162 coronary regions were enrolled.
The mean CT values of fibrous ASP, ASP with lipid core, and ASP with calcium deposit were 77.5, 28.9, and 515.9 HU, respectively (P<0.0001). ASP with calcium deposit was detected with a sensitivity of 88.9% and a specificity of 98.6%, while ASP with lipid core was detected by DSCT with a relatively low sensitivity of 73.1% and a high specificity of 94.0%. In TCFA, cross-sectional areas of both ASP and lipid core were significantly larger, mean CT value of ASP was significantly lower, and concomitant calcification was more frequently observed compared with lipid-rich ASP with thick fibrous cap (ThCFA). The combination of these CT parameters seems to be a useful index for the differentiation of TCFA from ThCFA.
DSCT is useful for non-invasive evaluation of calcified and fibro-fatty tissue characters in coronary artery plaque, but it is still not able to differentiate TCFA, one of the features of vulnerable plaque.
双源计算机断层扫描（DSCT）使我们能够无创性地观察冠状动脉狭窄，但尚未评估其对冠状动脉粥样硬化斑块（ASPs）的特征描述能力。血管内光学相干断层扫描（OCT）提供了经病理组织学研究验证的冠状动脉壁组织图像。我们研究了 DSCT 对冠状动脉 AS 的特征描述的诊断准确性，特别是富含脂质的薄纤维帽易损斑块（TCFA），并与 OCT 进行了比较。
对 17 例急性冠状动脉综合征（ACS）患者非罪犯冠状动脉的非狭窄性 ASP 进行了 DSCT 和 OCT 成像，共纳入 162 个冠状动脉区域。
纤维性 ASP、含脂核心 ASP 和含钙沉积 ASP 的平均 CT 值分别为 77.5、28.9 和 515.9 HU（P<0.0001）。钙沉积 ASP 的检测灵敏度为 88.9%，特异性为 98.6%，而含脂核心 ASP 的检测灵敏度相对较低，为 73.1%，特异性为 94.0%。在 TCFA 中，ASP 和脂质核心的横截面积均明显增大，ASP 的平均 CT 值明显降低，且与富含脂质的厚纤维帽易损斑块（ThCFA）相比，更常伴有钙化。这些 CT 参数的组合似乎是区分 TCFA 和 ThCFA 的有用指标。
DSCT 可用于非侵入性评估冠状动脉斑块中钙化和纤维脂肪组织特征，但仍无法区分 TCFA，这是易损斑块的特征之一。
