双源 CT 对急性非 ST 段抬高型心肌梗死与稳定性冠心病患者冠状动脉斑块成分的定量分析与虚拟组织学血管内超声的相关性。
Quantitative analysis of coronary plaque composition by dual-source CT in patients with acute non-ST-elevation myocardial infarction compared to patients with stable coronary artery disease correlated with virtual histology intravascular ultrasound.
机构信息
Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
出版信息
Acad Radiol. 2013 Aug;20(8):995-1003. doi: 10.1016/j.acra.2013.03.013.
RATIONALE AND OBJECTIVES
To quantitatively assess coronary atherosclerotic plaque composition in patients with acute non-ST elevation myocardial infarction (NSTEMI) and patients with stable coronary artery disease (CAD) by coronary computed tomography angiography (cCTA) correlated with virtual histology intravascular ultrasound (VH-IVUS).
MATERIALS AND METHODS
Sixty patients (35 with NSTEMI) were included. Corresponding plaques were assessed by dual-source cCTA and VH-IVUS regarding volumes and percentages of fatty, fibrous, and calcified component; overall plaque burden; and maximal percent area stenosis. Possible differences between patient groups were investigated. Concordance between cCTA and VH-IVUS measurements was validated by Bland-Altman analysis.
RESULTS
Forty corresponding plaques (22 of patients with NSTEMI) were finally analyzed by cCTA and VH-IVUS. cCTA plaque analysis revealed no significant differences between plaques of patients with NSTEMI and stable CAD regarding absolute and relative amounts of any plaque component (fatty: 20 mm³/13% versus 17 mm³/14%; fibrous: 81 mm³/63% versus 80 mm³/53%; calcified: 16 mm³/14% versus 26 mm³/26%; all P > .05) or overall plaque burden (153 mm³ versus 165 mm³; P > .05), nor did VH-IVUS plaque analysis. VH-IVUS measured a higher area stenosis in patients with NSTEMI compared to patients with stable CAD (76% versus 68%, P = .01; in cCTA 69% versus 65%, P = .2). Volumes of fatty component were measured systematically lower in cCTA, whereas calcified and fibrous volumes were higher. No significant bias was observed comparing volumes of overall noncalcified component and overall plaque burden.
CONCLUSION
Plaques of patients with acute NSTEMI and of patients with stable CAD cannot be differentiated by quantification of plaque components. cCTA and VH-IVUS differ in plaque component analysis.
背景与目的
通过冠状动脉计算机断层血管造影术（cCTA）与虚拟组织学血管内超声（VH-IVUS）相关联，定量评估急性非 ST 段抬高型心肌梗死（NSTEMI）患者和稳定型冠状动脉疾病（CAD）患者的冠状动脉粥样硬化斑块成分。
材料与方法
共纳入 60 例患者（35 例为 NSTEMI 患者）。通过双源 cCTA 和 VH-IVUS 评估相应斑块的脂肪、纤维和钙化成分的体积和百分比；总体斑块负担；以及最大面积狭窄百分比。研究了患者组之间可能存在的差异。通过 Bland-Altman 分析验证 cCTA 和 VH-IVUS 测量值之间的一致性。
结果
最终通过 cCTA 和 VH-IVUS 对 40 个对应斑块（NSTEMI 患者 22 个）进行了分析。cCTA 斑块分析显示，NSTEMI 患者和稳定型 CAD 患者的斑块在任何斑块成分的绝对和相对量方面（脂肪：20mm³/13%比 17mm³/14%；纤维：81mm³/63%比 80mm³/53%；钙化：16mm³/14%比 26mm³/26%；均 P＞0.05）或总体斑块负担（153mm³比 165mm³；P＞0.05）方面均无显著差异，VH-IVUS 斑块分析也无显著差异。与稳定型 CAD 患者相比，NSTEMI 患者的 VH-IVUS 测量的狭窄程度更高（76%比 68%，P=0.01；cCTA 为 69%比 65%，P=0.2）。在 cCTA 中，脂肪成分的体积系统地测量较低，而钙化和纤维体积较高。比较非钙化总体成分和总体斑块负担的体积时，未观察到显著偏差。
结论
通过斑块成分的定量评估，无法区分急性 NSTEMI 患者和稳定型 CAD 患者的斑块。cCTA 和 VH-IVUS 在斑块成分分析方面存在差异。
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