Feasibility of Noninvasive Assessment of Thin-Cap Fibroatheroma by Multidetector Computed Tomography

J Am Coll Cardiol Img. 2009; 2(12):1412-1419

Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, Tanimoto T, Takemoto K, Takarada S, Kubo T, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T

OBJECTIVES: The purpose of this study was to investigate whether multidetector computed tomography (MDCT) can noninvasively help assess thin-cap fibroatheroma (TCFA). Plaque rupture and thrombus formation play key roles in the onset of acute coronary syndrome. TCFA is recognized as a precursor lesion for plaque rupture, and MDCT angiography can potentially help identify plaques prone to rupture.

METHODS: We enrolled 105 patients with coronary artery disease (acute coronary syndromes, n = 31; stable angina pectoris, n = 74). Culprit lesions were assessed by both MDCT and optical coherence tomography (OCT). Patients were divided into a TCFA and a non-TCFA group according to OCT findings; clinical and MDCT observations were compared for 2 groups.

RESULTS: There were no differences in patients’ characteristics between the 2 groups. OCT revealed 25 TCFAs at the culprit site in 105 patients. Acute coronary syndrome was more frequent in the TCFA group than in the non-TCFA group (52% vs. 23%, p = 0.01). High-sensitive C-reactive protein was higher in the TCFA group (0.32 ± 0.32 mg/dl vs. 0.17 ± 0.16 mg/dl, p < 0.001). Positive remodeling identified by MDCT was observed more frequently in the TCFA group than in the non-TCFA group (76% vs. 31%, p < 0.001). Computed tomography attenuation value of the culprit plaque in the TCFA group was lower than that in the non-TCFA group (35.1 ± 32.3 HU vs. 62.0 ± 33.6 HU, p < 0.001). The frequency of ring-like enhancement in the TCFA group was higher than in the non-TCFA group (44% vs. 4%, p < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of ring-like enhancement for detecting TCFA are 44%, 96%, 79%, and 85%, respectively. By stepwise regression, the ring-like enhancement, high-sensitive C-reactive protein, and diagnosis of acute events were associated with the presence of TCFA at the culprit site.

CONCLUSIONS: MDCT can identify differences in plaque morphologies between TCFA and non-TCFA. From our results, MDCT may provide for the noninvasive assessment of vulnerable plaque.

PMID:

3 Responses

  1. Ronen Rubinshtein, MD  on December 15th, 2009

    Important work describing the feasibility of MDCT to diagnose TCFA while using OCT as reference method.

  2. Paul Schoenhagen, MD  on December 15th, 2009

    A related manuscript is:
    Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome.
    Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, Naruse H, Ishii J, Hishida H, Wong ND, Virmani R, Kondo T, Ozaki Y, Narula J.
    J Am Coll Cardiol. 2009 Jun 30;54(1):49-57.
    PMID: 19555840

  3. Jacobo Kirsch, MD  on December 26th, 2009

    More data for the “vulnerable plaque” school of thought! When Motoyama et al. published their paper earlier this year, there was some question as to whether the plaque described was truly the culprit lesion. In this paper, the authors do try to define the culprit lesion initially by using a combination of ECG findings, LV wall motion abnormalities in echo, and/or scintigraphic correlation to the stenotic lesion on conventional angiography.

    As in Motoyama’s paper; positive remodeling was associated with TCFA.

    You can see TPM.com’s post and comments on Motoyama’s paper here.


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