Kolossváry Márton, Szilveszter Bálint, Merkely Béla, Maurovich-Horvat Pál
MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Cardiovasc Diagn Ther. 2017 Oct;7(5):489-506. doi: 10.21037/cdt.2016.11.06.
CT based technologies have evolved considerably in recent years. Coronary CT angiography (CTA) provides robust assessment of coronary artery disease (CAD). Early coronary CTA imaging-as a gate-keeper of invasive angiography-has focused on the presence of obstructive stenosis. Coronary CTA is currently the only non-invasive imaging modality for the evaluation of non-obstructive CAD, which has been shown to contribute to adverse cardiac events. Importantly, improved spatial resolution of CT scanners and novel image reconstruction algorithms enable the quantification and characterization of atherosclerotic plaques. State-of-the-art CT imaging can therefore reliably assess the extent of CAD and differentiate between various plaque features. Recent studies have demonstrated the incremental prognostic value of adverse plaque features over luminal stenosis. Comprehensive coronary plaque assessment holds potential to significantly improve individual risk assessment incorporating adverse plaque characteristics, the extent and severity of atherosclerotic plaque burden. As a result, several coronary CTA based composite risk scores have been proposed recently to determine patients at high risk for adverse events. Coronary CTA became a promising modality for the evaluation of functional significance of coronary lesions using CT derived fractional flow reserve (FFR-CT) and/or rest/dynamic myocardial CT perfusion. This could lead to substantial reduction in unnecessary invasive catheterization procedures and provide information on ischemic burden of CAD. Discordance between the degree of stenosis and ischemia has been recognized in clinical landmark trials using invasive FFR. Both lesion stenosis and composition are possibly related to myocardial ischemia. The evaluation of lesion-specific ischemia using combined functional and morphological plaque information could ultimately improve the diagnostic performance of CTA and thus patient care. In this review we aimed to summarize current evidence on comprehensive coronary artery plaque assessment using coronary CTA.
近年来，基于CT的技术有了长足的发展。冠状动脉CT血管造影（CTA）能对冠状动脉疾病（CAD）进行有力评估。早期的冠状动脉CTA成像作为侵入性血管造影的把关手段，主要关注阻塞性狭窄的存在。冠状动脉CTA目前是评估非阻塞性CAD的唯一非侵入性成像方式，已证明其与不良心脏事件有关。重要的是，CT扫描仪空间分辨率的提高和新型图像重建算法使动脉粥样硬化斑块的量化和特征分析成为可能。因此，先进的CT成像能够可靠地评估CAD的范围，并区分各种斑块特征。最近的研究表明，不良斑块特征在预测预后方面比管腔狭窄更具价值。综合冠状动脉斑块评估有可能显著改善结合不良斑块特征、动脉粥样硬化斑块负荷程度和严重性的个体风险评估。因此，最近提出了几种基于冠状动脉CTA的综合风险评分，以确定发生不良事件高风险的患者。冠状动脉CTA通过CT衍生的血流储备分数（FFR-CT）和/或静息/动态心肌CT灌注，成为评估冠状动脉病变功能意义的一种有前景的方式。这可能会大幅减少不必要的侵入性导管检查程序，并提供有关CAD缺血负担的信息。在使用侵入性FFR的临床标志性试验中，已认识到狭窄程度与缺血之间的不一致。病变狭窄和成分都可能与心肌缺血有关。结合功能和形态学斑块信息评估病变特异性缺血最终可能提高CTA的诊断性能，从而改善患者护理。在本综述中，我们旨在总结目前关于使用冠状动脉CTA进行综合冠状动脉斑块评估的证据。
