Kuntz Salomé H, Jinnouchi Hiroyuki, Kutyna Matthew, Torii Sho, Cornelissen Anne, Sakamoto Atsushi, Sato Yu, Fuller Daniela T, Schwein Adeline, Ohana Mickael, Gangloff Hugo, Lejay Anne, Finn Aloke V, Chakfé Nabil, Virmani Renu
CVPath Institute, Gaithersburg, MD, USA; University Hospital of Strasbourg, Department of Vascular Surgery and Kidney Transplantation, Strasbourg, France; GEPROVAS, Strasbourg, France.
CVPath Institute, Gaithersburg, MD, USA.
Eur J Vasc Endovasc Surg. 2021 Jan;61(1):146-154. doi: 10.1016/j.ejvs.2020.08.037. Epub 2020 Nov 10.
To co-register conventional computed tomography angiography (CTA), with ex vivo micro-computed tomography (microCT) and histology of popliteal atherosclerotic plaques. Improving the non-invasive imaging capabilities may be valuable to advance patient care with peripheral arterial obstructive disease towards lesion and individual based treatment.
In this prospective observational study, 12 popliteal arteries from 11 symptomatic patients who had undergone transfemoral amputations for chronic limb threatening ischaemia and who had pre-operative CTA, were analysed ex vivo by microCT and histology. A total of 353 histological cross sections were co-registered with microCT and CTA, and classified as: lipid rich (LP, n = 26), fibrous (FP, n = 80), or calcific (CP, n = 247) plaques. CTA and microCT plaque density was calculated in 791 regions of interest as Hounsfield units (HU).
CTA and microCT could identify plaque components that were confirmed by histology such as fibrous tissue (FP), lipid pool/core (LP), and calcification (CP). MicroCT densities were 77.8 HU for FP (IQR 52.8, 129.5 HU), -28.4 HU for LP (IQR -87.1, 13.2 HU), and 3826.0 HU for CP (IQR 2989.0, 4501.0 HU). CTA densities of the three components of the plaque were: 78.0 HU for FP (IQR 59.5, 119.8 HU), 32.5 HU for LP (IQR 15.0, 42 HU), and 641.5 HU for CP (IQR 425.8, 1135 HU). The differences were statistically significant between the HU densitometric characteristics among the three groups (p < .0001) for both imaging modalities. Overall, microCT performed better diagnostically than conventional CTA for the three types of plaques: areas under the receiving operator characteristics curve were greater for microCT than CTA for FP (0.97 vs. 0.90), for LP (0.88 vs. 0.67), and for CP (0.97 vs. 0.90).
CTA and microCT can be used to identify histological atherosclerotic plaque components, with better diagnostic performance for microCT. This study demonstrates the feasibility of using microCT to assess plaque morphology lesions in a manner that approaches histology thus becoming a useful tool for ex vivo assessment of atherosclerosis and towards lesion based treatment.
将传统计算机断层扫描血管造影（CTA）与腘动脉粥样硬化斑块的离体微计算机断层扫描（microCT）及组织学进行共同配准。提高无创成像能力对于推动外周动脉闭塞性疾病患者的个体化治疗可能具有重要价值。
在这项前瞻性观察性研究中，对11例因慢性肢体威胁性缺血接受经股截肢手术且术前行CTA检查的有症状患者的12条腘动脉进行了离体microCT和组织学分析。共353个组织学横截面与microCT和CTA进行了共同配准，并分类为：富含脂质斑块（LP，n = 26）、纤维斑块（FP，n = 80）或钙化斑块（CP，n = 247）。在791个感兴趣区域计算CTA和microCT斑块密度，以亨氏单位（HU）表示。
CTA和microCT能够识别经组织学证实的斑块成分，如纤维组织（FP）、脂质池/核心（LP）和钙化（CP）。FP的microCT密度为77.8 HU（四分位间距52.8，129.5 HU），LP为 - 28.4 HU（四分位间距 - 87.1，13.2 HU），CP为3826.0 HU（四分位间距2989.0，4501.0 HU）。斑块三种成分的CTA密度分别为：FP为78.0 HU（四分位间距59.5，119.8 HU），LP为32.5 HU（四分位间距15.0，42 HU），CP为641.5 HU（四分位间距425.8，1135 HU）。两种成像方式下，三组之间的HU密度特征差异均具有统计学意义（p < .0001）。总体而言，对于三种类型的斑块，microCT在诊断方面比传统CTA表现更好：在接受者操作特征曲线下的面积，microCT对于FP（0.97对0.90）、LP（0.88对0.67）和CP（0.97对0.90）均大于CTA。
CTA和microCT可用于识别组织学动脉粥样硬化斑块成分，其中microCT具有更好的诊断性能。本研究证明了使用microCT以接近组织学的方式评估斑块形态病变的可行性，从而成为离体评估动脉粥样硬化和基于病变治疗的有用工具。
