JACC Cardiovasc Imaging. 2009 Dec;2(12):1412-9. doi: 10.1016/j.jcmg.2009.09.012.
OBJECTIVES: The purpose of this study was to investigate whether multidetector computed tomography (MDCT) can noninvasively help assess thin-cap fibroatheroma (TCFA). BACKGROUND: Plaque rupture and thrombus formation play key roles in the onset of acute coronary syndrome. TCFA is recognized as a precursor lesion for plaque rupture, and MDCT angiography can potentially help identify plaques prone to rupture. METHODS: We enrolled 105 patients with coronary artery disease (acute coronary syndromes, n = 31; stable angina pectoris, n = 74). Culprit lesions were assessed by both MDCT and optical coherence tomography (OCT). Patients were divided into a TCFA and a non-TCFA group according to OCT findings; clinical and MDCT observations were compared for 2 groups. RESULTS: There were no differences in patients' characteristics between the 2 groups. OCT revealed 25 TCFAs at the culprit site in 105 patients. Acute coronary syndrome was more frequent in the TCFA group than in the non-TCFA group (52% vs. 23%, p = 0.01). High-sensitive C-reactive protein was higher in the TCFA group (0.32 +/- 0.32 mg/dl vs. 0.17 +/- 0.16 mg/dl, p < 0.001). Positive remodeling identified by MDCT was observed more frequently in the TCFA group than in the non-TCFA group (76% vs. 31%, p < 0.001). Computed tomography attenuation value of the culprit plaque in the TCFA group was lower than that in the non-TCFA group (35.1 +/- 32.3 HU vs. 62.0 +/- 33.6 HU, p < 0.001). The frequency of ring-like enhancement in the TCFA group was higher than in the non-TCFA group (44% vs. 4%, p < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of ring-like enhancement for detecting TCFA are 44%, 96%, 79%, and 85%, respectively. By stepwise regression, the ring-like enhancement, high-sensitive C-reactive protein, and diagnosis of acute events were associated with the presence of TCFA at the culprit site. CONCLUSIONS: MDCT can identify differences in plaque morphologies between TCFA and non-TCFA. From our results, MDCT may provide for the noninvasive assessment of vulnerable plaque.
目的：本研究旨在探讨多层螺旋 CT（MDCT）能否无创性帮助评估薄帽纤维粥样斑块（TCFA）。
背景：斑块破裂和血栓形成在急性冠脉综合征的发病中起关键作用。TCFA 被认为是斑块破裂的前驱病变，MDCT 血管造影术可能有助于识别易破裂的斑块。
方法：我们纳入了 105 例冠心病患者（急性冠脉综合征组，n=31；稳定型心绞痛组，n=74）。根据 MDCT 和光学相干断层扫描（OCT）评估罪犯病变。根据 OCT 结果，将患者分为 TCFA 组和非 TCFA 组；比较两组的临床和 MDCT 观察结果。
结果：两组患者的特征无差异。OCT 在 105 例患者的罪犯部位发现 25 个 TCFA。TCFA 组急性冠脉综合征的发生率高于非 TCFA 组（52% vs. 23%，p=0.01）。TCFA 组高敏 C 反应蛋白水平较高（0.32±0.32mg/dl vs. 0.17±0.16mg/dl，p<0.001）。MDCT 识别的正性重构在 TCFA 组更为常见（76% vs. 31%，p<0.001）。TCFA 组罪犯斑块的 CT 衰减值低于非 TCFA 组（35.1±32.3HU vs. 62.0±33.6HU，p<0.001）。TCFA 组环形强化的发生率高于非 TCFA 组（44% vs. 4%，p<0.0001）。环形强化检测 TCFA 的灵敏度、特异度、阳性预测值和阴性预测值分别为 44%、96%、79%和 85%。逐步回归分析显示，环形强化、高敏 C 反应蛋白和急性事件诊断与罪犯部位 TCFA 的存在相关。
结论：MDCT 可识别 TCFA 与非 TCFA 斑块形态的差异。根据我们的结果，MDCT 可能为易损斑块的无创评估提供依据。
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