Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death. (August 2018)

• Record Type: Journal Article
• Authors: Han, Donghee; Torii, Sho; Yahagi, Kazuyuki; Lin, Fay Y.; Lee, Ji Hyun; Rizvi, Asim; Gransar, Heidi; Park, Mahn-Won; Roudsari, Hadi Mirhedayati; Stuijfzand, Wijnand J.; Baskaran, Lohendran; ó Hartaigh, Bríain; Park, Hyung-bok; Lee, Sang-eun; Ali, Zabiullah; Kutys, Robert; Chang, Hyuk-Jae; Earls, James P.; Fowler, David; Virmani, Renu; Min, James K.
• Is Part Of: Atherosclerosis. Volume 275(2018)
• Page Start: 426
• Page End: 433
• Publication Date: 2018-08
• Subjects: Atherosclerosis -- Coronary computed tomography angiography -- Histology -- Lipid rich plaque -- Necrotic core; ACS acute coronary syndrome -- VPC vulnerable plaque characteristics -- CCTA coronary computed tomography angiography -- QCT quantitative coronary atherosclerotic plaque analysis CT -- HU Hounsfield units -- LAP low-attenuation plaque -- NPV negative predictive value -- PPV positive predictive value -- IVUS intravascular ultrasound -- DECT dual energy CT; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2018.05.024
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque. Methods: 8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque (LAP) was defined as any pixel < 30, 45, 60, 75, and 90 HU cut-offs within a coronary plaque. The area of LAP was calculated in each cross-section. Results: Among 105 cross-sections, 37 (35.2%) cross-sectional histology images contained lipid rich plaque. Although the highest specificity for identifying lipid rich plaque was shown with <30 HU cut-off (88.2%), sensitivity (e.g. 55.6% for <75 HU, 16.2% for <30 HU) and negative predictive value (e.g. 75.9% for <75 HU, 65.9% for <30 HU) tended to increase with higher HU cut-offs. For quantitative measurement, <75 HU showed the highest correlation coefficient (0.292, p = 0.003) and no significant differences were observed between lipid rich plaque area and LAP area between histology and CT analysis (Histology: 0.34 ± 0.73 mm 2, QCT: 0.37 ± 0.71 mm 2, p = 0.701). Conclusions: LAP area by CCTA using a <75 HU cut-off value demonstrated high sensitivity and quantitative agreement with lipid rich plaque area by histology analysis. Highlights: Lipid rich plaques are related to future risk of acute coronary syndrome. Quantitative coronary plaque (QCT) analysis enables to quantify lipid rich plaques. 75 HU is a reliable cut-off for quantification of lipid rich plaque in QCT analysis.