Zhou Tao, Li Ying, Sun Nannan, Hua Bing, Zhang Min, Ma Zhuangfei, Li Min, Jia Shouqiang
Department of Radiology, People's Hospital Affiliated to Shandong First Medical University, Jinan, China.
Canon Medical System (China), Beijing, China.
Quant Imaging Med Surg. 2025 Jul 1;15(7):6287-6300. doi: 10.21037/qims-2024-2989. Epub 2025 Jun 30.
Carotid computed tomography angiography (CTA) has limited diagnostic value in evaluating the vulnerability of soft plaques. This study compared conventional CTA and black-blood computed tomography (BBCT) in terms of image quality and the ability to diagnose carotid soft plaques.
Patients who underwent carotid CTA and magnetic resonance (MR) vessel wall examination were included in this prospective study. The image quality of plaques was evaluated through objective evaluation [CT values, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) based on CTA and BBCT] and subjective evaluation. Plaque burden was assessed with the normalized wall index (NWI) in CTA, BBCT, and MR images, as was the remodeling index (RI). The number of soft plaques in CTA, BBCT, and MR images was recorded. The sensitivity, specificity, and accuracy of an NWI higher than 0.56 and an RI higher than 1.0 from CTA and BBCT images in assessing the vulnerability of soft plaques were calculated with MR vessel wall images as a reference standard.
A total of 37 patients comprising 53 soft plaques (25 males and 12 females) were analyzed. The average CT values, SNR, and CNR of soft plaques in BBCT were significantly higher compared to those in CTA (BBCT: 65.38±21.34, 16.31±7.69, 6.47±4.97; CTA: 45.58±14.09, 7.16±3.15, 4.45±2.83; all P values <0.05). The image noise in BBCT was significantly lower than that in CTA (BBCT: 10.73±3.75; CTA: 15.52±6.59; P<0.05), while the subjective image score of BBCT (3.04±0.51) was significantly higher than that of CTA (2.32±0.61) (P<0.001). The sensitivity and specificity of an NWI higher than 0.56 with BBCT were 0.98 and 0.86, respectively, which were superior to those with CTA at 0.83 and 0.57, respectively. Meanwhile, the sensitivity and specificity of an RI higher than 1.0 with BBCT were 0.86 and 0.95, respectively, which were superior to those with CTA at 0.71 and 0.85, respectively. The sensitivity and specificity of BBCT in diagnosing vulnerable plaques were 0.90 and 0.93, respectively, while those of CTA were 0.62 and 0.79, respectively. The area under the receiver operating characteristic curve of BBCT for diagnosing vulnerable plaques was 0.91 (95% CI: 0.803-0.973) while that for CTA was 0.70 (95% CI: 0.559-0.819; P<0.001).
Compared to conventional CTA, BBCT provides improved image quality and diagnostic performance in assessing carotid soft plaques.
颈动脉计算机断层血管造影（CTA）在评估软斑块易损性方面的诊断价值有限。本研究比较了传统CTA和黑血计算机断层扫描（BBCT）在图像质量和诊断颈动脉软斑块能力方面的差异。
本前瞻性研究纳入了接受颈动脉CTA和磁共振（MR）血管壁检查的患者。通过客观评估[基于CTA和BBCT的CT值、图像噪声、信噪比（SNR）和对比噪声比（CNR）]和主观评估来评价斑块的图像质量。在CTA、BBCT和MR图像中用标准化管壁指数（NWI）评估斑块负荷，还用重塑指数（RI）进行评估。记录CTA、BBCT和MR图像中软斑块的数量。以MR血管壁图像作为参考标准，计算CTA和BBCT图像中NWI高于0.56且RI高于1.0在评估软斑块易损性方面的敏感性、特异性和准确性。
共分析了37例患者，包括53个软斑块（男性25例，女性12例）。与CTA相比，BBCT中软斑块的平均CT值、SNR和CNR显著更高（BBCT：65.38±21.34，16.31±7.69，6.47±4.97；CTA：45.58±14.09，7.16±3.15，4.45±⒉83；所有P值<0.05）。BBCT中的图像噪声显著低于CTA（BBCT：10.73±3.75；CTA：15.52±6.59；P<0.05），而BBCT的主观图像评分（3.04±0.51）显著高于CTA（2.32±0.61）（P<0.001）。BBCT中NWI高于0.56的敏感性和特异性分别为0.98和0.86，分别优于CTA的0.83和0.57。同时，BBCT中RI高于1.0的敏感性和特异性分别为0.86和0.95，分别优于CTA的0.71和0.85。BBCT诊断易损斑块的敏感性和特异性分别为0.90和0.93，而CTA的敏感性和特异性分别为0.62和0.79。BBCT诊断易损斑块的受试者操作特征曲线下面积为0.91（95%CI：0.803 - 0.973），而CTA的为0.70（95%CI：0.559 - 0.819；P<0.001）。
与传统CTA相比，BBCT在评估颈动脉软斑块方面提供了更好的图像质量和诊断性能。
