Department of Radiology, 6915Mayo Clinic, USA.
Department of Cardiovascular Medicine, 6915Mayo Clinic, USA.
Interv Neuroradiol. 2022 Jun;28(3):332-337. doi: 10.1177/15910199211031093. Epub 2021 Aug 16.
Using computed tomography angiography to differentiate between components of carotid atherosclerotic lesions remains largely elusive. This study sought to validate a semi-automated software for computed tomography angiography plaque analysis using histologic comparisons.
A retrospective review was performed of consecutive patients that underwent a carotid endarterectomy, with pre-procedural computed tomography angiography imaging of the cervical arterial vasculature available for review. Images were evaluated using a commercially-available software package, which produced segmented analyses of intraplaque components (e.g. intraplaque hemorrhage, lipid-rich necrotic core, and calcifications). On imaging, each component was assessed in terms of its (1) presence or absence, and (2) both volume and proportion of the total plaque volume (if present). On histological evaluation of carotid endarterectomy specimens, each component was evaluated as an estimated proportion of total plaque volume.
Of 80 included patients, 30 (37.5%) were female. The average age was 69.7 years (SD = 9.1). Based on imaging, intraplaque hemorrhage was the smallest contributor to plaque composition (1.2% of volumes on average). Statistically significant linear associations were noted between the proportion of intraplaque hemorrhage, lipid-rich necrotic core, and calcifications on histology and the volume of each component on imaging ( values ranged from 0.0008 to 0.01). Area under curve were poor for intraplaque hemorrhage and lipid-rich necrotic core (0.59 and 0.61, respectively) and acceptable for calcifications (0.73).
Semi-automated analyses of computed tomography angiography have limited diagnostic accuracy in the detection of intraplaque hemorrhage and lipid-rich necrotic core in carotid artery plaques. However, volumetric imaging measurements of different components corresponded with histologic analysis.
利用计算机断层血管造影术区分颈动脉粥样硬化斑块的成分在很大程度上仍然难以实现。本研究旨在通过与组织学比较验证一种用于计算机断层血管造影斑块分析的半自动软件。
对连续接受颈动脉内膜切除术的患者进行回顾性分析，这些患者的颈总动脉血管术前均有计算机断层血管造影成像可供评估。使用商业上可用的软件包评估图像，该软件包对斑块内成分（如斑块内出血、富含脂质的坏死核心和钙化）进行分段分析。在影像学上，根据斑块内成分的存在与否以及其（1）体积和（2）在总斑块体积中的比例来评估每个成分（如果存在的话）。在颈动脉内膜切除标本的组织学评估中，每个成分均作为总斑块体积的估计比例进行评估。
在 80 名纳入的患者中，有 30 名（37.5%）为女性。平均年龄为 69.7 岁（标准差=9.1）。根据影像学，斑块内出血是斑块成分中最小的成分（平均体积占比为 1.2%）。在组织学上，斑块内出血、富含脂质的坏死核心和钙化的比例与影像学上每个成分的体积之间存在显著的线性关联（ 值范围从 0.0008 到 0.01）。斑块内出血和富含脂质的坏死核心的曲线下面积较差（分别为 0.59 和 0.61），而钙化的曲线下面积为可接受（0.73）。
计算机断层血管造影半自动分析在检测颈动脉斑块内出血和富含脂质的坏死核心方面的诊断准确性有限。然而，不同成分的体积成像测量与组织学分析相对应。
