European Radiology

, Volume 15, Issue 9, pp 1906–1914 | Cite as

In vitro characterization of atherosclerotic carotid plaque with multidetector computed tomography and histopathological correlation

  • Thomas T. de Weert
  • Mohamed Ouhlous
  • Pieter E. Zondervan
  • Johanna M. Hendriks
  • Diederik W. J. Dippel
  • Marc R. H. M. van Sambeek
  • Aad van der LugtEmail author


This in vitro study evaluated the performance of 16-slice multidetector computed tomography (MDCT) in the assessment of carotid plaque components, with histology as the gold standard. Twenty-one specimens (n=21) were scanned and reconstructed after optimization of the protocol. Three corresponding MDCT images and histologic sections were selected from each specimen. The Hounsfield values (HV) of the major plaque components (calcifications, fibrous tissue and lipid) were assessed. Plaque areas (mm2) assessed with MDCT were compared with the results from histologic analysis. A value of 140 kVp and an intermediate reconstruction algorithm was the optimal protocol. In 15 out of 21 specimens it was possible to match MDCT images with histology. The HV of calcifications, fibrous tissue and lipid were 45±21, 79±20 and 960±491 HU (P<0.001), respectively. Plaque areas were compared in 27 matched levels. The calcified and lipid areas on MDCT and histology correlate well (R2=0.83 and R2=0.68, respectively). The mean difference in lipid area was 0.1 mm2 (95% CI=−2.1–2.3 mm2). This in vitro study showed that MDCT is capable of characterizing and quantifying the lipid rich portion of the atherosclerotic plaque.


Multidetector computed tomography Atherosclerosis Carotid artery Stroke 



The authors wish to thank Frits van de Meer for his valuable advice and Heleen van Beusekom for the use, and help with the histology analysis system.

Aad van der Lugt is the recipient of a fellowship from the Netherlands Organisation for Health Research and Development (NWO-KF grant nr. 907-00-122).


  1. 1.
    Golledge J, Greenhalgh RM, Davies AH (2000) The symptomatic carotid plaque. Stroke 31:774–781Google Scholar
  2. 2.
    Koelemay MJ, Nederkoorn PJ, Reitsma JB, Majoie CB (2004) Systematic review of computed tomographic angiography for assessment of carotid artery disease. Stroke 35:2306–2312Google Scholar
  3. 3.
    Heinz ER, Pizer SM, Fuchs H, Fram EK, Burger P, Drayer BP, Osborne DR (1984) Examination of the extracranial carotid bifurcation by thin-section dynamic ct: direct visualization of intimal atheroma in man (part 1). Am J Neuroradiol 5:355–359Google Scholar
  4. 4.
    Estes JM, Quist WC, Lo Gerfo FW, Costello P (1998) Noninvasive characterization of plaque morphology using helical computed tomography. J Cardiovasc Surg (Torino) 39:527–534Google Scholar
  5. 5.
    Oliver TB, Lammie GA, Wright AR, Wardlaw J, Patel SG, Peek R, Ruckley CV, Collie DA (1999) Atherosclerotic plaque at the carotid bifurcation: ct angiographic appearance with histopathologic correlation. Am J Neuroradiol 20:897–901PubMedGoogle Scholar
  6. 6.
    Walker LJ, Ismail A, McMeekin W, Lambert D, Mendelow AD, Birchall D (2002) Computed tomography angiography for the evaluation of carotid atherosclerotic plaque: correlation with histopathology of endarterectomy specimens. Stroke 33:977–981CrossRefPubMedGoogle Scholar
  7. 7.
    Schroeder S, Flohr T, Kopp AF, Meisner C, Kuettner A, Herdeg C, Baumbach A, Ohnesorge B (2001) Accuracy of density measurements within plaques located in artificial coronary arteries by X-ray multislice ct: results of a phantom study. J Comput Assist Tomogr 25:900–906Google Scholar
  8. 8.
    Nikolaou K, Becker CR, Muders M, Babaryka G, Scheidler J, Flohr T, Loehrs U, Reiser MF, Fayad ZA (2004) Multidetector-row computed tomography and magnetic resonance imaging of atherosclerotic lesions in human ex vivo coronary arteries. Atherosclerosis 174:243–252Google Scholar
  9. 9.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedGoogle Scholar
  10. 10.
    Becker CR, Nikolaou K, Muders M, Babaryka G, Crispin A, Schoepf UJ, Loehrs U, Reiser MF (2003) Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row ct. Eur Radiol 13:2094–2098CrossRefGoogle Scholar
  11. 11.
    Leber AW, Knez A, Becker A, Becker C, von Ziegler F, Nikolaou K, Rist C, Reiser M, White C, Steinbeck G, Boekstegers P (2004) 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 43:1241–1247Google Scholar
  12. 12.
    Kopp AF, Schroeder S, Baumbach A, Kuettner A, Georg C, Ohnesorge B, Heuschmid M, Kuzo R, Claussen CD (2001) Non-invasive characterisation of coronary lesion morphology and composition by multislice ct: first results in comparison with intracoronary ultrasound. Eur Radiol 11:1607–1611CrossRefPubMedGoogle Scholar
  13. 13.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedGoogle Scholar
  14. 14.
    Davies MJ, Woolf N, Rowles P, Richardson PD (1994) Lipid and cellular constituents of unstable human aortic plaques. Basic Res Cardiol 89(Suppl 1):33–39Google Scholar
  15. 15.
    Montauban van Swijndregt AD, Elbers HR, Moll FL, de Letter J, Ackerstaff RG (1998) Ultrasonographic characterization of carotid plaques. Ultrasound Med Biol 24:489–493Google Scholar
  16. 16.
    Liapis CD, Kakisis JD, Kostakis AG (2001) Carotid stenosis: factors affecting symptomatology. Stroke 32:2782–2786PubMedGoogle Scholar
  17. 17.
    Zhao XQ, Yuan C, Hatsukami TS, Frechette EH, Kang XJ, Maravilla KR, Brown BG (2001) Effects of prolonged intensive lipid-lowering therapy on the characteristics of carotid atherosclerotic plaques in vivo by mri: a case-control study. Arterioscler Thromb Vasc Biol 21:1623–1629Google Scholar
  18. 18.
    Dobrin PB (1996) Effect of histologic preparation on the cross-sectional area of arterial rings. J Surg Res 61:413–415Google Scholar
  19. 19.
    Zhang Z, Berg MH, Ikonen AE, Vanninen RL, Manninen HI (2004) Carotid artery stenosis: reproducibility of automated 3d ct angiography analysis method. Eur Radiol 14:665–672CrossRefPubMedGoogle Scholar
  20. 20.
    Ulzheimer S, Kalender WA (2003) Assessment of calcium scoring performance in cardiac computed tomography. Eur Radiol 13:484–497PubMedGoogle Scholar
  21. 21.
    Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228:826–833PubMedGoogle Scholar
  22. 22.
    Raggi P, Cooil B, Callister TQ (2001) Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J 141:375–382Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Thomas T. de Weert
    • 1
  • Mohamed Ouhlous
    • 1
  • Pieter E. Zondervan
    • 2
  • Johanna M. Hendriks
    • 3
  • Diederik W. J. Dippel
    • 4
  • Marc R. H. M. van Sambeek
    • 3
  • Aad van der Lugt
    • 1
    Email author
  1. 1.Department of RadiologyErasmus MCRotterdamThe Netherlands
  2. 2.Department of PathologyErasmus MCRotterdamThe Netherlands
  3. 3.Department of Vascular SurgeryErasmus MCRotterdamThe Netherlands
  4. 4.Department of NeurologyErasmus MCRotterdamThe Netherlands

Personalised recommendations