冠状动脉计算机断层血管造影成像识别体内富含脂质的动脉粥样硬化斑块的可行性和局限性：近红外光谱分析的研究结果。
The feasibility and limitation of coronary computed tomographic angiography imaging to identify coronary lipid-rich atheroma in vivo: Findings from near-infrared spectroscopy analysis.
机构信息
Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Osaka, Japan.
出版信息
Atherosclerosis. 2021 Apr;322:1-7. doi: 10.1016/j.atherosclerosis.2021.02.019. Epub 2021 Feb 24.
BACKGROUND
Coronary computed tomography angiography (CCTA) non-invasively visualizes lipid-rich plaque. However, this ability is not fully validated in vivo. The current study aimed to elucidate the association of CCTA features with near-infrared spectroscopy-derived lipidic plaque measure in patients with coronary artery disease.
METHODS
95 coronary lesions (culprit/non-culprit = 51/44) in 35 CAD subjects were evaluated by CCTA and NIRS imaging. CT density, positive remodeling, spotty calcification, napkin-ring sign and NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI) were analyzed by two independent physicians. The association of CCTA-derived plaque features with maxLCBI ≥ 400 was evaluated.
RESULTS
The median CT density and maxLCBI were 57.7 Hounsfield units (HU) and 304, respectively. CT density (r = -0.75, p < 0.001) and remodeling index (RI) (r = 0.58, p < 0.001) were significantly associated with maxLCBI, respectively. Although napkin-ring sign (p < 0.001) showed higher prevalence of maxLCBI ≥ 400 than those without it, spotty calcification did not (p = 0.13). On multivariable analysis, CT density [odds ratio (OR) = 0.95, 95% confidence interval (CI) = 0.93-0.97; p < 0.001] and positive remodeling [OR = 7.71, 95%CI = 1.37-43.41, p = 0.02] independently predicted maxLCBI ≥ 400. Receiver operating characteristic curve analysis demonstrated CT density <32.9 HU (AUC = 0.92, sensitivity = 85.7%, specificity = 91.7%) and RI ≥ 1.08 (AUC = 0.83, sensitivity = 74.3%, specificity = 85.0%) as optimal cut-off values of maxLCBI ≥ 400. Of note, only 52.6% at lesions with one of these plaque features exhibited maxLCBI ≥ 400, whereas the frequency of maxLCBI ≥ 400 was highest at those with both features (88.5%, p < 0.001 for trend).
CONCLUSIONS
CT density <32.9 HU and RI ≥ 1.08 were associated with lipid-rich plaque on NIRS imaging. Our findings underscore the synergistic value of CT density and positive remodeling to detect lipid-rich plaque by CCTA.
背景
冠状动脉计算机断层扫描血管造影术（CCTA）可无创性地显示富含脂质的斑块。然而，这种能力在体内尚未得到充分验证。本研究旨在阐明冠心病患者 CCTA 特征与近红外光谱（NIRS）检测到的脂质斑块指标之间的相关性。
方法
35 例 CAD 患者的 95 个冠状动脉病变（罪犯/非罪犯病变=51/44）分别接受 CCTA 和 NIRS 成像检查。由两位独立的医师分析 CT 密度、阳性重构、点状钙化、餐巾环征和 NIRS 检测到的最大 4mm 脂质核心负荷指数（maxLCBI）。评估 CCTA 衍生的斑块特征与 maxLCBI≥400 的相关性。
结果
中位 CT 密度和 maxLCBI 分别为 57.7 HU 和 304。CT 密度（r=-0.75，p<0.001）和重构指数（RI）（r=0.58，p<0.001）与 maxLCBI 显著相关。尽管餐巾环征（p<0.001）在 maxLCBI≥400 的病变中更为常见，但点状钙化无此特征（p=0.13）。多变量分析显示，CT 密度[比值比（OR）=0.95，95%置信区间（CI）=0.93-0.97；p<0.001]和阳性重构（OR=7.71，95%CI=1.37-43.41，p=0.02）独立预测 maxLCBI≥400。受试者工作特征曲线分析表明，CT 密度<32.9 HU（AUC=0.92，敏感性=85.7%，特异性=91.7%）和 RI≥1.08（AUC=0.83，敏感性=74.3%，特异性=85.0%）是 maxLCBI≥400 的最佳截断值。值得注意的是，只有 52.6%的病变具有其中一种斑块特征时 maxLCBI≥400，而具有两种特征时 maxLCBI≥400 的频率最高（趋势性 p<0.001）。
结论
CT 密度<32.9 HU 和 RI≥1.08 与 NIRS 成像上的富含脂质斑块相关。我们的研究结果强调了 CT 密度和阳性重构联合应用于 CCTA 检测富含脂质斑块的协同价值。
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