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DOI:10.2214/AJR.05.2070
AJR 2006; 187:W241
© American Roentgen Ray Society

Regression of Coronary Atherosclerotic Plaque as Shown by CT Arteriography

Kevin M. Johnson, David A. Dowe, Tara M. Catanzano and James A. Brink

Yale University School of Medicine New Haven, CT 06510
Atlantic Medical Imaging Galloway, NJ 08205
Yale University School of Medicine New Haven, CT 06510

Atherosclerosis is not a static process. A slow build up of plaque over time is the usual course, but instances of regression have also been seen [1]. These are of great interest because they may hold clues to controlling or even reversing the disease. Although plaque in the carotids, aorta, and peripheral arteries can be imaged noninvasively by several techniques, the coronary arteries have been more difficult because of their motion. Noninvasive imaging of coronary artery plaque has until recently been restricted to calcified areas. Advances in CT arteriography now enable imaging of noncalcified plaque as well [2].

A 53-year-old asymptomatic man presented with a family history of coronary atherosclerosis. His was on atorvastatin therapy, 10 mg daily, and his total serum cholesterol was 190 mg/dL. He was not hypertensive, diabetic, or a smoker. Because of his desire to better characterize his risk, he requested coronary arteriography using CT.

Imaging was performed on a 16-MDCT scanner (LightSpeed 16, GE Healthcare). Curved reformatted images of the coronary arteries were made on a GE Healthcare Advantage Workstation with dedicated software. Views of the plaque were matched for position and orientation and traced by hand (ImageJ, National Institutes of Health).

The patient's first CT scan showed plaque in the left anterior descending coronary artery 13.5 mm in length; the greatest longitudinal area was 20 mm2 and the transverse area was 5 mm2 (Fig. 9). Part of the central area had attenuation matching the enhanced arterial lumen (220 H) and represented either volume averaging with calcium or possibly an ulceration. Another part had calcium attenuation (403 H). The shoulders on either side of this had attenuation values between 80 H and 100 H.


Figure 1
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  		Fig. 9 —Thin-section maximum-intensity-projection images of left main and anterior descending coronary arteries from three noninvasive CT arteriograms show regression of plaque over 26 months during atorvastatin therapy. Images show one perspective; data sets are 3D. Observations were confirmed in multiple planes. ao = aorta and lm = left main, lcx = circumflex, sp1 = first septal perforator, d1 = first diagonal, d2 = second diagonal coronary arteries.

 
The patient increased his atorvastatin to 40 mg daily. After 14 months of clinical followup, he requested a repeat scan, which showed that the plaque size had decreased to 13 mm in length with longitudinal area of 13.5 mm2 and transverse area of 4.5 mm2 (Fig. 9). The central area now had a larger area of calcium attenuation (413 H). At 26 months, the patient developed new atypical chest discomfort and was scanned a third time. The plaque center appeared more densely calcified (606 H) than before, and the plaque size had further decreased to 13 mm in length, longitudinal area, 11 mm2; and transverse area, 5.5 mm2 (Fig. 9).

CT coronary arteriography can, in some cases, show the evolution of atherosclerotic plaque over time [3]. CT may become a useful research tool to study the natural history of plaque, the relationship between plaque burden and risk factors, and the effects of pharmacologic intervention on plaque size and composition [4]. A robust automated or semiautomated segmentation algorithm will be needed to measure plaque volumes quickly and accurately if CT is to be used to stratify risk and to follow therapy. Reproducibility of the measurements will be especially important.


References
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 References
 

  1. Jensen LO, Thayssen P, Pedersen KE, et al. Regression of coronary atherosclerosis by simvastatin: a serial intravascular ultrasound study. Circulation 2004;110 : 265-270[Abstract/Free Full Text]
  2. Achenbach S, Moselewski F, Ropers D, et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation2004; 109:14 -17[Abstract/Free Full Text]
  3. Sato Y, Inoue F, Yoshimura A, et al. Regression of an atherosclerotic coronary artery plaque demonstrated by multislice spiral computed tomography in a patient with stable angina pectoris. Heart Vessels 2003; 18:224 -226[CrossRef][Medline]
  4. Taylor A, Shaw LJ, Fayad Z, et al. Tracking atherosclerosis regression: a clinical tool in preventive cardiology. Atherosclerosis 2005;180 : 1-10[CrossRef][Medline]

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