Journal of Cardiovascular Computed Tomography
Volume 2, Issue 4 , Pages 234-242, July 2008

Potential of dual-energy computed tomography to characterize atherosclerotic plaque: ex vivo assessment of human coronary arteries in comparison to histology

  • Mitya Barreto, MS

      Affiliations

    • Imaging Institute, Cardiovascular Imaging Lab, Cleveland Clinic, Desk Hb6, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    • Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA
    • Lerner Research Institute, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
    • ,
  • Paul Schoenhagen, MD

      Affiliations

    • Imaging Institute, Cardiovascular Imaging Lab, Cleveland Clinic, Desk Hb6, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    • Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA
    • Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
    • ,
  • Anuja Nair, PhD

      Affiliations

    • Lerner Research Institute, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
    • Volcano Corporation, Cleveland, OH, USA
    • ,
  • Stacy Amatangelo, BS

      Affiliations

    • Volcano Corporation, Cleveland, OH, USA
    • ,
  • Margherita Milite, PhD

      Affiliations

    • Siemens Medical Solutions, Erlangen, Germany
    • ,
  • Nancy A. Obuchowski, PhD

      Affiliations

    • Imaging Institute, Cardiovascular Imaging Lab, Cleveland Clinic, Desk Hb6, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    • Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
    • ,
  • Michael L. Lieber, MS

      Affiliations

    • Imaging Institute, Cardiovascular Imaging Lab, Cleveland Clinic, Desk Hb6, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    • Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
    • ,
  • Sandra S. Halliburton, PhD

      Affiliations

    • Imaging Institute, Cardiovascular Imaging Lab, Cleveland Clinic, Desk Hb6, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    • Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA
    • Lerner Research Institute, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
    • Corresponding Author InformationCorresponding author.

Received 27 March 2008; accepted 24 May 2008. published online 03 June 2008.

Background

Noninvasive characterization of coronary atherosclerotic plaque is limited with current computed tomography (CT) techniques. Dual-energy CT (DECT) has the potential to provide additional attenuation data for better differentiation of plaque components.

Objective

We attempted to characterize coronary atherosclerotic plaque with DECT.

Methods

Seven human coronary arteries acquired at autopsy were scanned consecutively at 80 and 140 kVp with CT. Vessels were perfused with saline, and data were acquired before and after contrast agent injection. Lesions were identified, and attenuation measurements were made from CT image quadrants. CT quadrants were classified as densely calcified, fibrocalcific, fibrous, lipid-rich, or normal vessel wall, corresponding to matched histology images. Attenuation values at each peak tube voltage were compared within plaque types for both noncontrast and contrast scans. Further, dual-energy index (DEI) values computed from attenuation were analyzed for classification of plaque.

Results

In 14 lesions, a total of 56 quadrants were identified. Histology results classified 8 (14%) as densely calcified, 8 (14%) as fibrocalcific, 9 (16%) as fibrous, 5 (9%) as lipid-rich, and 25 (45%) as normal vessel wall. Calcified lesions attenuated significantly more at 80 kVp in both contrast and noncontrast scans, whereas fibrous plaque attenuated more at 80 kVp only for contrast-enhanced scans. No differences were found for lipid-rich plaques. Using DEI values, only densely calcified plaques could be distinguished from other plaque types except fibrocalcific plaques in contrast images.

Conclusions

Only densely calcified and fibrocalcific plaques showed a true change in attenuation at 80 versus 140 kVp. Therefore, calcified plaques could be distinguished from noncalcified plaques with DECT, but further classification of plaque types was not possible.

Keywords: Atherosclerosis, Computed tomography, Coronary disease, Diagnosis, Imaging

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 Conflict of interest: Margherita Milite is an employee of Siemens Medical Solutions. Sandra S. Halliburton receives research funding from Siemens Medical Solutions.

PII: S1934-5925(08)00318-3

doi:10.1016/j.jcct.2008.05.146

Journal of Cardiovascular Computed Tomography
Volume 2, Issue 4 , Pages 234-242, July 2008

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