Department of Cardiology, Chubu Rosai Hospital, and Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Int J Cardiol. 2011 May 19;149(1):95-101. doi: 10.1016/j.ijcard.2010.04.002. Epub 2010 May 2.
Noninvasive assessment of coronary plaque is important for coronary risk stratification. Whereas integrated backscatter intravascular ultrasound (IB-IVUS) has proven effective for analysis of the tissue components of coronary plaque, plaque assessment by 64-slice multidetector computed tomography (MDCT) has not been established. We therefore evaluated the accuracy of MDCT compared with IB-IVUS for identification of coronary plaque components and determination of plaque volume.
Thirty-one sites in 17 coronary vessels (7 left anterior descending, 5 left circumflex, and 5 right coronary arteries) with substantial stenosis were visualized by both 64-slice MDCT and IB-IVUS. Coronary plaque was evaluated by MDCT and the findings were compared with those of IB-IVUS at the same sites and for the same vessel lengths. Plaque was classified as low-attenuated, fibrous, or calcified, and the volume of each plaque component and total plaque volume were calculated.
Total plaque volume per vessel determined by MDCT was significantly correlated with that determined by IB-IVUS (r=0.704, P<0.05, n=17). However, the volumes of individual plaque components determined by the two approaches were not correlated. The predominant plaque morphology as determined by the two approaches was consistent in 12 of the 17 vessels (70.6%), whereas calcified and low-attenuated plaques were overestimated by MDCT in the remaining vessels.
MDCT is a promising approach for noninvasive detection of different types of coronary plaque and may therefore contribute to coronary risk stratification. The ability of MDCT to determine the volume of individual plaque components, however, is limited.
非侵入性评估冠状动脉斑块对于冠状动脉风险分层很重要。虽然血管内超声（IB-IVUS）的综合背向散射已被证明对冠状动脉斑块的组织成分分析有效，但 64 层多排 CT（MDCT）的斑块评估尚未确立。因此，我们评估了 MDCT 与 IB-IVUS 相比在识别冠状动脉斑块成分和确定斑块体积方面的准确性。
通过 64 层 MDCT 和 IB-IVUS 可视化了 17 个冠状动脉（7 个左前降支，5 个左回旋支和 5 个右冠状动脉）的 31 个部位，存在明显狭窄。通过 MDCT 评估冠状动脉斑块，将发现与相同部位和相同血管长度的 IB-IVUS 进行比较。将斑块分为低衰减、纤维状或钙化，并计算每个斑块成分和总斑块体积。
MDCT 确定的每个血管的总斑块体积与 IB-IVUS 确定的总斑块体积显著相关（r=0.704，P<0.05，n=17）。然而，两种方法确定的各个斑块成分的体积没有相关性。两种方法确定的主要斑块形态在 17 个血管中的 12 个（70.6%）中是一致的，而在其余的血管中，MDCT 高估了钙化和低衰减斑块。
MDCT 是一种有前途的非侵入性检测不同类型冠状动脉斑块的方法，因此可能有助于冠状动脉风险分层。然而，MDCT 确定单个斑块成分体积的能力是有限的。
