Journal of Cardiovascular Computed Tomography
Volume 3 , Pages S91-S98 , November 2009

Methods of plaque quantification and characterization by cardiac computed tomography

  • Pal Maurovich-Horvat, MD

      Affiliations

    • Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA
    • Semmelweis University, Heart Center, Budapest, Hungary
    • Corresponding Author InformationCorresponding author.
    • ,
  • Maros Ferencik, MD, PhD

      Affiliations

    • Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA
    • Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
    • ,
  • Fabian Bamberg, MD, MPH

      Affiliations

    • Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA
    • ,
  • Udo Hoffmann, MD, MPH

      Affiliations

    • Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA

Received 8 July 2009 ,Accepted 23 October 2009.

References 

  1. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21–e181
  2. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657–671
  3. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47(8 Suppl):C13–C18
  4. Narula J, Garg P, Achenbach S, Motoyama S, Virmani R, Strauss HW. Arithmetic of vulnerable plaques for noninvasive imaging. Nat Clin Pract Cardiovasc Med. 2008;5(Suppl 2):S2–S10
  5. Schaar JA, Mastik F, Regar E, den Uil CA, Gijsen FJ, Wentzel JJ, et al. Current diagnostic modalities for vulnerable plaque detection. Curr Pharm Des. 2007;13:995–1001
  6. Fayad ZA, Fuster V, Nikolaou K, Becker C. Computed tomography and magnetic resonance imaging for noninvasive coronary angiography and plaque imaging: current and potential future concepts. Circulation. 2002;106:2026–2034
  7. Sanz J, Fayad ZA. Imaging of atherosclerotic cardiovascular disease. Nature. 2008;451:953–957
  8. Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2001;37:1478–1492
  9. Nissen SE, Yock P. Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation. 2001;103:604–616
  10. Potkin BN, Bartorelli AL, Gessert JM, Neville RF, Almagor Y, Roberts WC, et al. Coronary artery imaging with intravascular high-frequency ultrasound. Circulation. 1990;81:1575–1585
  11. Nishimura RA, Edwards WD, Warnes CA, Reeder GS, Holmes DR, Tajik AJ, et al. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol. 1990;16:145–154
  12. Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA. 2006;295:1556–1565
  13. Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogel RA, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA. 2004;291:1071–1080
  14. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495–1504
  15. Brown BG, Zhao XQ. Is intravascular ultrasound the gold standard surrogate for clinically relevant atherosclerosis progression?. J Am Coll Cardiol. 2007;49:933–938
  16. Poon M. Technology insight: Cardiac CT angiography. Nat Clin Pract Cardiovasc Med. 2006;3:265–275
  17. Roberts WT, Bax JJ, Davies LC. Cardiac CT and CT coronary angiography: technology and application. Heart. 2008;94:781–792
  18. De Feyter PJ, Meijboom WB, Weustink A, Van Mieghem C, Mollet NR, Vourvouri E, et al. Spiral multislice computed tomography coronary angiography: a current status report. Clin Cardiol. 2007;30:437–442
  19. Schoepf UJ, Zwerner PL, Savino G, Herzog C, Kerl JM, Costello P. Coronary CT angiography. Radiology. 2007;244:48–63
  20. Achenbach S, Moselewski F, Ropers D, Ferencik M, Hoffmann U, MacNeill B, 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. Circulation. 2004;109:14–17
  21. Nieman K, Oudkerk M, Rensing BJ, van Ooijen P, Munne A, van Geuns RJ, et al. Coronary angiography with multi-slice computed tomography. Lancet. 2001;357:599–603
  22. Achenbach S, Marwan M, Schepis T, Pflederer T, Bruder H, Allmendinger T, et al. High-pitch spiral acquisition: a new scan mode for coronary CT angiography. J Cardiovasc Comput Tomogr. 2009;3:117–121
  23. Cordeiro MA, Lima JA. Atherosclerotic plaque characterization by multidetector row computed tomography angiography. J Am Coll Cardiol. 2006;47(8 Suppl):C40–C47
  24. Moselewski F, Ropers D, Pohle K, Hoffmann U, Ferencik M, Chan RC, et al. Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice multidetector computed tomography versus intravascular ultrasound. Am J Cardiol. 2004;94:1294–1297
  25. Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43:842–847
  26. Virmani R, Burke AP, Kolodgie FD, Farb A. Vulnerable plaque: the pathology of unstable coronary lesions. J Interv Cardiol. 2002;15:439–446
  27. Leber AW, Knez A, Becker A, Becker C, von Ziegler F, Nikolaou K, et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol. 2004;43:1241–1247
  28. Caussin C, Ohanessian A, Ghostine S, Jacq L, Lancelin B, Dambrin G, et al. Characterization of vulnerable nonstenotic plaque with 16-slice computed tomography compared with intravascular ultrasound. Am J Cardiol. 2004;94:99–104
  29. Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K, et al. Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol. 2006;47:672–677
  30. Sun J, Zhang Z, Lu B, Yu W, Yang Y, Zhou Y, et al. Identification and quantification of coronary atherosclerotic plaques: a comparison of 64-MDCT and intravascular ultrasound. AJR Am J Roentgenol. 2008;190:748–754
  31. Petranovic M, Soni A, Bezzera H, Loureiro R, Sarwar A, Raffel C, et al. Assessment of nonstenotic coronary lesions by 64-slice multidetector computed tomography in comparison to intravascular ultrasound: evaluation of nonculprit coronary lesions. J Cardiovasc Comput Tomogr. 2009;3:24–31
  32. Hur J, Kim YJ, Lee HJ, Nam JE, Choe KO, Seo JS, et al. Quantification and characterization of obstructive coronary plaques using 64-slice computed tomography: a comparison with intravascular ultrasound. J Comput Assist Tomogr. 2009;33:186–192
  33. Sarwar A, Rieber J, Mooyaart EA, Seneviratne SK, Houser SL, Bamberg F, et al. Calcified plaque: measurement of area at thin-section flat-panel CT and 64-section multidetector CT and comparison with histopathologic findings. Radiology. 2008;249:301–306
  34. Hoffmann U, Kwait DC, Handwerker J, Chan R, Lamuraglia G, Brady TJ. Vascular calcification in ex vivo carotid specimens: precision and accuracy of measurements with multi-detector row CT. Radiology. 2003;229:375–381
  35. Schroeder S, Kopp AF, Ohnesorge B, Flohr T, Baumbach A, Kuettner A, et al. Accuracy and reliability of quantitative measurements in coronary arteries by multi-slice computed tomography: experimental and initial clinical results. Clin Radiol. 2001;56:466–474
  36. Brodoefel H, Burgstahler C, Sabir A, Yam CS, Khosa F, Claussen CD, et al. Coronary plaque quantification by voxel analysis: dual-source MDCT angiography versus intravascular sonography. AJR Am J Roentgenol. 2009;192:W84–W89
  37. Blackmon KN, Streck J, Thilo C, Bastarrika G, Costello P. Joseph Schoepf U: Reproducibility of automated noncalcified coronary artery plaque burden assessment at coronary CT angiography. J Thorac Imaging. 2009;24:96–102
  38. Hoffmann U, Bamberg F, Chae CU, Nichols JH, Rogers IS, Seneviratne SK, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009;53:1642–1650
  39. Butler J, Mooyaart EA, Dannemann N, Bamberg F, Shapiro MD, Ferencik M, et al. Relation of the metabolic syndrome to quantity of coronary atherosclerotic plaque. Am J Cardiol. 2008;101:1127–1130
  40. Hoffmann U, Nagurney JT, Moselewski F, Pena A, Ferencik M, Chae CU, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation. 2006;114:2251–2260
  41. Ferencik M, Nieman K, Achenbach S. Noncalcified and calcified coronary plaque detection by contrast-enhanced multi-detector computed tomography: a study of interobserver agreement. J Am Coll Cardiol. 2006;47:207–209
  42. Lehman SJ, Schlett CL, Bamberg F, Lee H, Donnelly P, Shturman L, Kriegel MF, Brady TJ, Hoffmann U: Assessment of coronary plaque progression in coronary CT angiography using a Semi-Quantitative Score. JACC Cardiovasc Imaging. In press.
  43. Kopp AF, Schroeder S, Baumbach A, Kuettner A, Georg C, Ohnesorge B, et al. Non-invasive characterisation of coronary lesion morphology and composition by multislice CT: first results in comparison with intracoronary ultrasound. Eur Radiol. 2001;11:1607–1611
  44. Schroeder S, Kopp AF, Baumbach A, Meisner C, Kuettner A, Georg C, et al. Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol. 2001;37:1430–1435
  45. Schroeder S, Kuettner A, Leitritz M, Janzen J, Kopp AF, Herdeg C, et al. Reliability of differentiating human coronary plaque morphology using contrast-enhanced multislice spiral computed tomography: a comparison with histology. J Comput Assist Tomogr. 2004;28:449–454
  46. Nikolaou K, Becker CR, Muders M, Babaryka G, Scheidler J, Flohr T, et al. Multidetector-row computed tomography and magnetic resonance imaging of atherosclerotic lesions in human ex vivo coronary arteries. Atherosclerosis. 2004;174:243–2
  47. Becker CR, Nikolaou K, Muders M, Babaryka G, Crispin A, Schoepf UJ, et al. Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT. Eur Radiol. 2003;13:2094–2098
  48. Viles-Gonzalez JF, Poon M, Sanz J, Rius T, Nikolaou K, Fayad ZA, et al. In vivo 16-slice, multidetector-row computed tomography for the assessment of experimental atherosclerosis: comparison with magnetic resonance imaging and histopathology. Circulation. 2004;110:1467–1472
  49. Pohle K, Achenbach S, Macneill B, Ropers D, Ferencik M, Moselewski F, et al. Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. Atherosclerosis. 2007;190:174–180
  50. Ferencik M, Chan RC, Achenbach S, Lisauskas JB, Houser SL, Hoffmann U, et al. Arterial wall imaging: evaluation with 16-section multidetector CT in blood vessel phantoms and ex vivo coronary arteries. Radiology. 2006;240:708–716
  51. Cademartiri F, Mollet NR, Runza G, Bruining N, Hamers R, Somers P, et al. Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observations in an ex vivo model of coronary computed tomography angiography. Eur Radiol. 2005;15:1426–1431
  52. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319–326
  53. Kitagawa T, Yamamoto H, Ohhashi N, Okimoto T, Horiguchi J, Hirai N, et al. Comprehensive evaluation of noncalcified coronary plaque characteristics detected using 64-slice computed tomography in patients with proven or suspected coronary artery disease. Am Heart J. 2007;154:1191–1198
  54. Schmid M, Pflederer T, Jang IK, Ropers D, Sei K, Daniel WG, et al. Relationship between degree of remodeling and CT attenuation of plaque in coronary atherosclerotic lesions: an in-vivo analysis by multi-detector computed tomography. Atherosclerosis. 2008;197:457–4
  55. Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, et al. Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol. 2006;47:1655–1662
  56. Schoenhagen P, Ziada KM, Vince DG, Nissen SE, Tuzcu EM. Arterial remodeling and coronary artery disease: the concept of “dilated” versus “obstructive” coronary atherosclerosis. J Am Coll Cardiol. 2001;38:297–306
  57. Barreto M, Schoenhagen P, Nair A, Amatangelo S, Milite M, Obuchowski NA, et al. Potential of dual-energy computed tomography to characterize atherosclerotic plaque: ex vivo assessment of human coronary arteries in comparison to histology. J Cardiovasc Comput Tomogr. 2008;2:234–242
  58. Boll DT, Hoffmann MH, Huber N, Bossert AS, Aschoff AJ, Fleiter TR. Spectral coronary multidetector computed tomography angiography: dual benefit by facilitating plaque characterization and enhancing lumen depiction. J Comput Assist Tomogr. 2006;30:804–811
  59. Hyafil F, Cornily JC, Feig JE, Gordon R, Vucic E, Amirbekian V, et al. Noninvasive detection of macrophages using a nanoparticulate contrast agent for computed tomography. Nat Med. 2007;13:636–641

 Conflict of interest: The authors report no conflicts of interest.

PII: S1934-5925(09)00518-8

doi: 10.1016/j.jcct.2009.10.012

Journal of Cardiovascular Computed Tomography
Volume 3 , Pages S91-S98 , November 2009

Article Tools

* Image Usage & Resolution