冠状动脉 CT 血管造影术能多早检测到动脉粥样硬化？PARADIGM 试验中连续扫描的定量 CT 分析的见解。

How early can atherosclerosis be detected by coronary CT angiography? Insights from quantitative CT analysis of serial scans in the PARADIGM trial.

机构信息

Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.

出版信息

J Cardiovasc Comput Tomogr. 2023 Nov-Dec;17(6):407-412. doi: 10.1016/j.jcct.2023.08.012. Epub 2023 Oct 3.

DOI:10.1016/j.jcct.2023.08.012

PMID:37798157

Abstract

BACKGROUND

Non-obstructing small coronary plaques may not be well recognized by expert readers during coronary computed tomography angiography (CCTA) evaluation. Recent developments in atherosclerosis imaging quantitative computed tomography (AI-QCT) enabled by machine learning allow for whole-heart coronary phenotyping of atherosclerosis, but its diagnostic role for detection of small plaques on CCTA is unknown.

METHODS

We performed AI-QCT in patients who underwent serial CCTA in the multinational PARADIGM study. AI-QCT results were verified by a level III experienced reader, who was blinded to baseline and follow-up status of CCTA. This retrospective analysis aimed to characterize small plaques on baseline CCTA and evaluate their serial changes on follow-up imaging. Small plaques were defined as a total plaque volume <50 mm.

RESULTS

A total of 99 patients with 502 small plaques were included. The median total plaque volume was 6.8 mm (IQR 3.5-13.9 mm), most of which was non-calcified (median 6.2 mm; 2.9-12.3 mm). The median age at the time of baseline CCTA was 61 years old and 63% were male. The mean interscan period was 3.8 ± 1.6 years. On follow-up CCTA, 437 (87%) plaques were present at the same location as small plaques on baseline CCTA; 72% were larger and 15% decreased in volume. The median total plaque volume and non-calcified plaque volume increased to 18.9 mm (IQR 8.3-45.2 mm) and 13.8 mm (IQR 5.7-33.4 mm), respectively, among plaques that persisted on follow-up CCTA. Small plaques no longer visualized on follow-up CCTA were significantly more likely to be of lower volume, shorter in length, non-calcified, and more distal in the coronary artery, as compared with plaques that persisted at follow-up.

CONCLUSION

In this retrospective analysis from the PARADIGM study, small plaques (<50 mm) identified by AI-QCT persisted at the same location and were often larger on follow-up CCTA.

摘要

背景

在冠状动脉计算机断层扫描血管造影（CCTA）评估中，非阻塞性小冠状动脉斑块可能无法被专家读者很好地识别。基于机器学习的动脉粥样硬化成像定量计算机断层扫描（AI-QCT）的最新发展使得能够对冠状动脉粥样硬化进行全心脏表型分析，但它在检测 CCTA 上的小斑块方面的诊断作用尚不清楚。

方法

我们在多国 PARADIGM 研究中进行了接受连续 CCTA 检查的患者的 AI-QCT。AI-QCT 结果由一位具有 III 级经验的读者进行验证，该读者对 CCTA 的基线和随访状态不知情。这项回顾性分析旨在描述基线 CCTA 上的小斑块，并评估其在随访成像上的连续变化。小斑块定义为总斑块体积<50mm。

结果

共纳入 99 例患者的 502 个小斑块。总斑块体积中位数为 6.8mm（IQR 3.5-13.9mm），其中大部分为非钙化斑块（中位数 6.2mm；2.9-12.3mm）。基线 CCTA 时的中位年龄为 61 岁，63%为男性。平均两次扫描间隔为 3.8±1.6 年。在随访 CCTA 中，437（87%）个斑块位于基线 CCTA 中小斑块的相同位置；72%的斑块较大，15%的斑块体积减小。在随访 CCTA 中持续存在的斑块中，总斑块体积和非钙化斑块体积中位数分别增加至 18.9mm（IQR 8.3-45.2mm）和 13.8mm（IQR 5.7-33.4mm）。在随访 CCTA 中不再可见的小斑块体积较小、长度较短、非钙化且位于冠状动脉的更远端的可能性显著更高。