Fujimoto Shinichiro, Kondo Takeshi, Kodama Takahide, Fujisawa Yasuko, Groarke John, Kumamaru Kanako K, Takamura Kazuhisa, Matsunaga Eriko, Miyauchi Katsumi, Daida Hiroyuki, Rybicki Frank J
Department of Cardiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan,
Int J Cardiovasc Imaging. 2014 Oct;30(7):1373-82. doi: 10.1007/s10554-014-0461-5. Epub 2014 Jun 4.
Coronary computed tomography angiography (CCTA) plaque morphology based on conventional Hounsfield units relies on absolute CT numbers is influenced by imaging and anatomical variables. The project describes and tests a novel alternative method, termed the "labeling method", which uses relative CT numbers and 3-dimensional plaque structure. Using virtual histology intravascular ultrasound (VH-IVUS) as the reference standard, this study compares the labeling method to a conventional CT-number based method to determine coronary plaque morphology. Thirty-seven high-risk, non-calcified atherosclerotic coronary lesions were prospectively evaluated in 33 consecutive patients who underwent CCTA followed by VH-IVUS (mean interval 8.6 ± 13.3 days). CCTA-derived vessel and minimum lumen areas were compared to VH-IVUS measures. Fibrotic and necrotic core areas were calculated by both the labeling method to the CT-number based method; both were tested for agreement with reference standard VH-IVUS. Inter- and intra-observer correlations were assessed. CCTA significantly underestimated minimum lumen area when compared to VH-IVUS (mean difference -1.4 ± 0.9 mm(2), p < 0.0001). Necrotic core and fibrous areas quantified using the labeling method demonstrated superior correlation with VH-IVUS compared to those quantified using the CT-number based method, Pearson's r = 0.75 versus 0.42 and r = 0.80 and 0.59, respectively. Compared to VH-IVUS, limits of agreement for the labeling method-derived necrotic core (-2.0 to 2.5 mm(2)) and fibrous areas (0.6-8.0 mm(2)) were more narrow than those determined using the CT-number based method (-3.7 to 7.3 and -4.0 to 8.9 mm(2), respectively). Inter- and intraobserver correlations were excellent for all CCTA derived measures (r = 0.85-0.98). A novel CCTA-based labeling method offers an alternative to conventional CT-number based analyses for plaque morphology. The labeling method demonstrates superior correlation to VH-IVUS for measures of fibrotic and necrotic core areas within non-calcified coronary atherosclerotic plaques.
基于传统亨氏单位的冠状动脉计算机断层扫描血管造影（CCTA）斑块形态学依赖于绝对CT值，会受到成像和解剖学变量的影响。该项目描述并测试了一种名为“标记法”的新型替代方法，该方法使用相对CT值和三维斑块结构。本研究以虚拟组织学血管内超声（VH-IVUS）作为参考标准，将标记法与传统的基于CT值的方法进行比较，以确定冠状动脉斑块形态。对33例连续接受CCTA检查并随后接受VH-IVUS检查（平均间隔8.6±13.3天）的高危、非钙化动脉粥样硬化性冠状动脉病变患者进行了前瞻性评估。将CCTA得出的血管和最小管腔面积与VH-IVUS测量值进行比较。通过标记法和基于CT值的方法计算纤维化和坏死核心面积；两者均与参考标准VH-IVUS进行一致性测试。评估了观察者间和观察者内的相关性。与VH-IVUS相比，CCTA显著低估了最小管腔面积（平均差异-1.4±0.9mm²，p<0.0001）。与基于CT值的方法相比，使用标记法量化的坏死核心和纤维化面积与VH-IVUS的相关性更好，皮尔逊相关系数分别为0.75对0.42以及0.80对0.59。与VH-IVUS相比，标记法得出的坏死核心（-2.0至2.5mm²）和纤维化面积（0.6 - 8.0mm²）的一致性界限比基于CT值的方法（分别为-3.7至7.3和-4.0至8.9mm²）更窄。对于所有CCTA得出的测量值，观察者间和观察者内的相关性都非常好（r = 0.85 - 0.98）。一种基于CCTA的新型标记法为传统的基于CT值的斑块形态分析提供了一种替代方法。对于非钙化冠状动脉粥样硬化斑块内的纤维化和坏死核心面积测量，标记法与VH-IVUS的相关性更好。
