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Identification and Quantification of Coronary Atherosclerotic Plaques: A Comparison of 64-MDCT and Intravascular Ultrasound

Junyan Sun1, Zhaoqi Zhang1, Biao Lu1, Wei Yu1, Ya Yang2, Yujie Zhou3, Yanhui Wang1 and Zhanming Fan1

1 Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, An Ding Men Wai An Zhen Li, Chao Yang District, 100029, Beijing, China.
2 Department of Ultrasound, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
3 Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.


Figure 1
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  		Fig. 1 —Box plot of CT density values for soft, fibrous, fibrous-soft, and calcified plaques. Differences of mean CT density values between calcified and remaining three categories of plaques were significant (p = 0.000, 0.000, and 0.000, respectively; p < 0.017). Difference between fibrous and fibrous-soft was significant (p = 0.004 [by statistical software], p < 0.017 [by Kruskal-Wallis test]). Differences between soft and fibrous, and between soft and fibrous-soft, were not significant (p = 0.030 and 0.317, respectively), with p > 0.017 (corrected value of Kruskal-Wallis test).

 

Figure 2
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  		Fig. 2A —48-year-old man with coronary artery disease. Invasive angiogram shows stenosis (arrow) of left main artery (LMA) and indicates noncalcified lesion.

 

Figure 3
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  		Fig. 2B —48-year-old man with coronary artery disease. Curved multiplanar reconstructed image of 64-MDCT shows noncalcified plaque (arrow) in LMA. Red line created by software indicates length and each 10-mm segment of LMA. LV = left ventricle.

 

Figure 4
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  		Fig. 2C —48-year-old man with coronary artery disease. Another curved multiplanar reconstructed CT image of LMA shows same noncalcified plaque (arrow) and quantitative results of plaque measured by software. LV = left ventricle.

 

Figure 5
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  		Fig. 2D —48-year-old man with coronary artery disease. Cross section obtained by intravascular ultrasound (IVUS) indicates fibrous area (hyperechoic, thick arrow) and lipid-rich area (hypoechoic, thin arrow). External elastic membrane area is 28.9 mm2 and luminal area is 5.9 mm2.

 

Figure 6
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  		Fig. 2E —48-year-old man with coronary artery disease. Cross-sectional view of noncalcified plaque obtained by 64-MDCT shows eccentric noncalcified plaque (straight arrow). Area of higher contrast enhancement is vessel lumen (curved arrow).

 

Figure 7
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  		Fig. 2F —48-year-old man with coronary artery disease. Same cross-sectional view of noncalcified plaque with color obtained by CT software. Red area indicates lipid-rich area (hypodensity, thin arrow) and blue area indicates fibrous area (hyperdensity, thick straight arrow). Green indicates contrast-enhanced vessel lumen (curved arrow). Vascular area is 30.5 mm2 and luminal area is 5.3 mm2.

 

Figure 8
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  		Fig. 3A —69-year-old man with coronary artery disease. Curved multiplanar reconstructed 64-MDCT image shows plaque containing spotty calcification (thin arrow) in left main artery (LMA) and a stent (thick arrow) in left anterior descending (LAD) coronary artery. LV = left ventricle.

 

Figure 9
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  		Fig. 3B —69-year-old man with coronary artery disease. Another curved multiplanar reconstructed 64-MDCT image shows same plaque (thin arrow) and stent (thick arrow). LAD = left anterior descending artery, LV = left ventricle.

 

Figure 10
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  		Fig. 3C —69-year-old man with coronary artery disease. Cross-sectional view of same plaque obtained by 64-MDCT shows spotty calcium with hyperdensity (straight arrow) cannot be differentiated from contrast-enhanced vessel lumen (curved arrow).

 

Figure 11
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  		Fig. 3D —69-year-old man with coronary artery disease. Same cross-sectional view of calcified plaque obtained by software with color. Red area indicates lipid-rich or lipid pool area (hypodensity, thin arrow) and blue area indicates fibrous area (hyperdensity). Yellow indicates calcification (thick straight arrow) in this plaque. Green indicates contrast-enhanced vessel lumen (curved arrow).

 

Figure 12
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  		Fig. 3E —69-year-old man with coronary artery disease. Intravascular ultrasound cross section of same plaque indicates lipid-rich or lipid pool (hyperechoic and echolucent, thin arrow) and spotty calcification (hyperechoic with shadow, thick arrow).

 

Figure 13
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  		Fig. 4A —Correlation of findings of 64-MDCT and intravascular ultrasound (IVUS). Graphs show vascular cross-sectional area (CSA) (external elastic membrane CSA) (A), luminal CSA (B), and plaque burden (C) per section determined on 64-MDCT versus IVUS. Spearman's correlation coefficients are r = 0.85, 0.82, and 0.77, respectively (p < 0.01).

 

Figure 14
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  		Fig. 4B —Correlation of findings of 64-MDCT and intravascular ultrasound (IVUS). Graphs show vascular cross-sectional area (CSA) (external elastic membrane CSA) (A), luminal CSA (B), and plaque burden (C) per section determined on 64-MDCT versus IVUS. Spearman's correlation coefficients are r = 0.85, 0.82, and 0.77, respectively (p < 0.01).

 

Figure 15
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  		Fig. 4C —Correlation of findings of 64-MDCT and intravascular ultrasound (IVUS). Graphs show vascular cross-sectional area (CSA) (external elastic membrane CSA) (A), luminal CSA (B), and plaque burden (C) per section determined on 64-MDCT versus IVUS. Spearman's correlation coefficients are r = 0.85, 0.82, and 0.77, respectively (p < 0.01).

 

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