Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
J Cardiovasc Comput Tomogr. 2010 Sep-Oct;4(5):301-8. doi: 10.1016/j.jcct.2010.05.016. Epub 2010 Jun 8.
Identification and differentiation of coronary atherosclerotic plaques may improve risk stratification for incident coronary events.
We investigated the ability of dual-source computed tomography (CT) to depict and characterize atherosclerotic coronary plaques.
Contrast-enhanced CT was performed in 25 human heart specimens with a total of 322 histologically determined plaques. Coronary plaques were classified on CT as (1) noncalcified, mixed, or calcified and (2) by CT attenuation values. Atherosclerotic plaques were histopathologically characterized according to the Stary classification.
CT detected 79% (245/322) of all plaques. Lesions missed by CT were generally early lesions, type I (n = 31), type II (n = 38), or type III (n = 8), according to Stary. CT detected 29% of early (Stary I-III) and 100% of advanced (Stary IV-VIII) plaques. Plaque classification as noncalcified was sensitive (100%) and specific (72%) for early, whereas classification as mixed/calcified was sensitive (92%, 89%) and specific (100%) for advanced plaques. Calcified plaques on CT were detected with high sensitivity (80%) and specificity (95%). Other subtypes were not distinguishable with CT according to the presence or absence of calcification. CT density was significantly higher for advanced (306 ± 470 HU) than for early (42 ± 14 HU; P < 0.01) plaques. The mean CT density value of type VII plaques (512 ± 349 HU) was significantly higher than those of other plaques (34-101 HU; P < 0.001).
CT reliably depicts advanced coronary plaques and allows for the differentiation between early and advanced plaques.
识别和区分冠状动脉粥样硬化斑块可改善新发冠状动脉事件的风险分层。
本研究旨在探讨双源 CT 对粥样硬化冠状动脉斑块的显示和特征描述能力。
对 25 个人体心脏标本（共计 322 个经组织学确定的斑块）进行增强 CT 检查。根据 CT 衰减值将冠状动脉斑块分为（1）非钙化、混合或钙化斑块和（2）非钙化、混合或钙化斑块。根据 Stary 分类法对粥样硬化斑块进行组织病理学特征描述。
CT 检出了 322 个斑块中的 79%（245/322）。CT 漏诊的病变一般为早期病变，根据 Stary 分类，Ⅰ型（n = 31）、Ⅱ型（n = 38）或Ⅲ型（n = 8）。CT 检出了 29%的早期（Stary I-III）和 100%的晚期（Stary IV-VIII）斑块。非钙化斑块的 CT 分类对早期病变具有高度的敏感性（100%）和特异性（72%），而混合/钙化斑块的 CT 分类对晚期病变具有高度的敏感性（92%，89%）和特异性（100%）。CT 对钙化斑块的检出具有较高的敏感性（80%）和特异性（95%）。根据有无钙化，其他亚型在 CT 上无法区分。晚期斑块的 CT 密度（306 ± 470 HU）显著高于早期斑块（42 ± 14 HU；P < 0.01）。VII 型斑块的平均 CT 密度值（512 ± 349 HU）显著高于其他斑块（34-101 HU；P < 0.001）。
CT 能可靠地显示晚期冠状动脉斑块，并能区分早期和晚期斑块。
