Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
J Cardiol. 2013 Jun;61(6):399-403. doi: 10.1016/j.jjcc.2013.01.004. Epub 2013 Feb 26.
Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). Plaques showing the napkin-ring sign in multidetector computed tomography (MDCT) have been reported as thin-cap fibroatheroma that is recognized as a precursor lesion for plaque rupture. The purpose of this study was to investigate distribution and frequency of napkin-ring sign and its relationship to features indicating coronary plaque vulnerability on MDCT in patients with coronary artery disease.
We enrolled 273 patients with ACS (n=61) or stable angina pectoris (SAP, n=212) who were assessed by MDCT. The definition of the napkin-ring sign was the presence of a ring of high attenuation and the CT attenuation of a ring presenting higher than those of the adjacent plaque and no greater than 130HU.
The culprit plaques with the napkin-ring sign show higher remodeling index and lower CT attenuation (1.15±0.12 vs. 1.02±0.12, p<0.01 and 39.9±22.8 vs. 72.7±26.6, p<0.01, respectively). Napkin-ring sign at culprit lesions was more frequent in patients with ACS than those with SAP (49.0% vs. 11.2%, p<0.01). Moreover, napkin-ring sign at non-culprit lesions was more frequently observed in ACS patients compared with SAP patients (12.7% vs. 2.8%, p<0.01). The distribution of the napkin-ring sign in the right coronary arteries and left circumflex arteries of our population was relatively even, whereas the napkin-ring sign in the left anterior descending artery was common in the proximal sites (p<0.01).
The napkin-ring sign assessed by MDCT represents similar clinical features of fibroatheroma. MDCT could contribute to the search for fibroatheroma.
斑块破裂和继发性血栓形成在急性冠状动脉综合征（ACS）的发病机制中起着关键作用。多排螺旋 CT（MDCT）显示的“餐巾环征”斑块被认为是易损斑块破裂的前期病变。本研究旨在探讨 MDCT 上冠状动脉疾病患者餐巾环征的分布和频率及其与提示斑块易损性特征的关系。
我们纳入了 273 例 ACS 患者（ACS 组，n=61）或稳定型心绞痛患者（SAP 组，n=212），并对其进行 MDCT 评估。餐巾环征的定义为存在高衰减环，且环的 CT 衰减值高于相邻斑块，且不超过 130HU。
带有餐巾环征的罪犯斑块表现出更高的重构指数和更低的 CT 衰减（1.15±0.12 比 1.02±0.12，p<0.01 和 39.9±22.8 比 72.7±26.6，p<0.01）。ACS 患者的罪犯斑块中出现餐巾环征的比例高于 SAP 患者（49.0%比 11.2%，p<0.01）。此外，ACS 患者非罪犯斑块中出现餐巾环征的比例高于 SAP 患者（12.7%比 2.8%，p<0.01）。在我们的人群中，右冠状动脉和左回旋支的餐巾环征分布相对均匀，而左前降支的餐巾环征则常见于近端（p<0.01）。
MDCT 评估的餐巾环征代表纤维粥样瘤的相似临床特征。MDCT 有助于寻找纤维粥样瘤。
