How Reliable are 40 MHz IVUS and 64-Slice MDCT in Characterizing Coronary Plaque Composition? An Ex Vivo Study with Histopathological Comparison

International Journal of Cardiovascular Imaging . 2010; ():

Romain Chopard, Loic Boussel, Pascal Motreff, Gilles Rioufol, Alain Tabib, Philippe Douek, David Meyronet, Didier Revel, Gérard Finet

OBJECTIVES: The present study investigated whether IVUS could serve as a reliable reference in validating MDCT characterization of coronary plaque against a histological gold standard.

METHODS: Twenty-one specimens were postmortem human coronary arteries. Coronary cross-sections were imaged by 40 MHz IVUS and by 64-slice MDCT and characterized histologically as presenting calcified, fibrous or lipid-rich plaques. Plaque composition was analyzed visually and intra-plaque MDCT attenuation was measured in Hounsfield Units (HU).

RESULTS: 83 atherosclerotic plaques were identified. IVUS failed to characterize calcified plaque accurately, with a positive predictive value (ppv) of 75% versus 100% for MDCT. Lipid-rich plaque was even less accurately characterized, with ppv of 60 and 68% for IVUS and MDCT respectively. Mean MDCT attenuation was 966 ± 473 HU for calcified plaque, 83 ± 35 HU for fibrous plaque and 70.92 HU ± 41 HU for lipid-rich plaque. No significant difference in mean MDCT attenuation was found between fibrous and lipid-rich plaques (P = 0.276).

CONCLUSIONS: In vivo validation of MDCT against an IVUS reference thus appears to be an unsuitable and unreliable approach: 40 MHz IVUS suffers from acoustic ambiguities in plaque characterization, and 64-slice MDCT fails to analyze plaque morphology and components accurately.

PMID:

One Response

  1. Paul Schoenhagen, MD  on January 12th, 2010

    Based on a small number of observations, the authors discuss the strengths and limitations of validating CT coronary plaque composition against IVUS and/or histology.


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