Advertisement

How reliable are 40 MHz IVUS and 64-slice MDCT in characterizing coronary plaque composition? An ex vivo study with histopathological comparison

  • Romain Chopard
  • Loic Boussel
  • Pascal Motreff
  • Gilles Rioufol
  • Alain Tabib
  • Philippe Douek
  • David Meyronet
  • Didier Revel
  • Gérard FinetEmail author
Original Paper

Abstract

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

Keywords

Atherosclerosis Intravascular ultrasound Multidetector computed tomography 

Notes

Conflict of interest statement

No conflict of interest exists regarding this manuscript.

References

  1. 1.
    Libby P (2001) Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 104:365–372PubMedGoogle Scholar
  2. 2.
    Virmani R, Kolodgie FD, Burke AP et al (2000) Lessons from sudden cardiac death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275PubMedGoogle Scholar
  3. 3.
    Glaglov S, Weisenberg E, Zarins C et al (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Eng J Med. 316:1371–1375Google Scholar
  4. 4.
    Mintz GS, Nissen SE, Anderson WD et al (2001) American college of cardiology clinical expert consensus on standards for acquisition, measurements and reporting of intravascular studies. A report of the American College of Cardiology task force on clinical expert consensus document. JACC 37–5:1478–1492Google Scholar
  5. 5.
    Se Nissen, Gurley CL, Grnies CL et al (1991) Intravascular assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 84:1087–1099Google Scholar
  6. 6.
    Di Mario C, Te SH, Madretsma S et al (1992) Detection and characterization of vascular lesions by intravascular ultrasound: an in vitro study correlated with histology. J Am Soc Echocardiogr 5:135–146PubMedGoogle Scholar
  7. 7.
    Rasheed Q, Nair R, Sheehan H et al (1994) Correlation of intracoronary ultrasound plaque characteristics in atherosclerotic coronary artery disease patients with clinical variables. Am J Cardiol 73:753–758CrossRefPubMedGoogle Scholar
  8. 8.
    Palmer ND, Northridge D, Lessels A et al (1999) In vitro analysis of coronary atheromatous lesions by intravascular ultrasound. Eur Heart J 20:1701–1706CrossRefPubMedGoogle Scholar
  9. 9.
    Ropers D, Baum U, Pohle K et al (2003) Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation. 107:664–666CrossRefPubMedGoogle Scholar
  10. 10.
    Burgstahler C, Reimann A, Beck T et al (2007) Influence of a lipid-lowering therapy on calcified and noncalcified coronary plaques monitored by multislice detector computed tomography: results of the New Age II Pilot Study. Invest Radiol 42:196–203CrossRefPubMedGoogle Scholar
  11. 11.
    Leber AW, Knez A, Becker A et al (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 43:1241–1247CrossRefPubMedGoogle Scholar
  12. 12.
    Molewsky F, Ropers D, Pohle K et al (2004) Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice computed tomography versus intravascular ultrasound. Am J Cardiol 94:1294–1297CrossRefGoogle Scholar
  13. 13.
    Achenbach S, Ropers D, Hoffmann U et al (2004) Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol 43:842–847CrossRefPubMedGoogle Scholar
  14. 14.
    Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154CrossRefPubMedGoogle Scholar
  15. 15.
    Carrascosa PM, Capunay CM, Garcia-Merletti P et al (2006) Characterization of coronary atherosclerotic plaque by multidetector computed tomography. Am J Cardiol 97:598–602CrossRefPubMedGoogle Scholar
  16. 16.
    Pohle K, Achenbach S, MacNeil B et al (2006) Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. Atherosclerosis. 190(1):174–180CrossRefPubMedGoogle Scholar
  17. 17.
    Iriart X, Brunot S, Coste P et al (2007) Early characterization of atherosclerotic coronary plaques with multidetector computed tomography in patients with acute coronary syndrome: A comparative study with intravascular ultrasound. Eur Radiol 17(10):2581–2588CrossRefPubMedGoogle Scholar
  18. 18.
    Becker CR, Nikolaou K, Muders M et al (2003) Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT. Eur Radiol 13:2094–2098CrossRefPubMedGoogle Scholar
  19. 19.
    Viles-Gonzalez JF, Poon M, Sanz J et al (2004) In vivo 16-slice, multidetector-row computed tomography for the assessment of experimental atherosclerosis: comparison with magnetic resonance imaging and histopathology. Circulation. 110:1467–1472CrossRefPubMedGoogle Scholar
  20. 20.
    Nikolaou K, Becker CR, Muders M et al (2004) Multidetector-row computed tomography and magnetic resonance imaging of atherosclerotic lesions in human ex vivo coronary arteries. Atherosclerosis. 174:243–252PubMedGoogle Scholar
  21. 21.
    Schroeder S, Kuettner A, Leitritz M et al (2004) Reliability of differentiating human coronary plaque morphology using contrast-enhanced multislice spiral computed tomography: a comparison with histology. J Comput Assist Tomogr 28:449–454CrossRefPubMedGoogle Scholar
  22. 22.
    Ferencik M, Chan RC, Achenbach S et al (2006) Arterial wall imaging: evaluation with 16-section multidetector CT in blood vessel phantom and ex vivo coronary arteries. Radiology. 240:708–716CrossRefPubMedGoogle Scholar
  23. 23.
    Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160CrossRefPubMedGoogle Scholar
  24. 24.
    Prati F, Arbustini E, Labellarte A et al (2001) Correlation between high frequency intravascular ultrasound and histomorphology in human coronary arteries. Heart. 85:567–570CrossRefPubMedGoogle Scholar
  25. 25.
    Nair A, Kuban BD, Tuzcu EM et al (2002) Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation. 34:2200–2206CrossRefGoogle Scholar
  26. 26.
    Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRefGoogle Scholar
  27. 27.
    Barret JF, Keat N (2004) Artifact in CT: recognition and avoidance. RadioGraphics. 24:1262–1691CrossRefGoogle Scholar
  28. 28.
    Schroeder S, Flohr T, Kopp AF et al (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 25:900–906CrossRefPubMedGoogle Scholar
  29. 29.
    Cademartiri F, Mollet NR, Runza G et al (2005) Influence of intra coronary attenuation on coronary plaque measurements using multislice computed tomography observations in an ex vivo model of coronary computed tomography angiography. Eur Radiol 15:1426–1431CrossRefPubMedGoogle Scholar
  30. 30.
    Hyafil F, Cornily JC, Feig JE et al (2007) Non-invasive detection of macrophage using a nanoparticulate contrast agent for computed tomography. Nat Med 13:636–641CrossRefPubMedGoogle Scholar
  31. 31.
    Johnson TR, Nikolaou K, Wintersperger BJ et al (2006) Dual-source CT cardiac imaging: initial experience. Eur Radiol 16:1409–1415CrossRefPubMedGoogle Scholar
  32. 32.
    Reimann AJ, Rinck D, Birinci-Aydogan A et al (2007) Dual-source computed tomography: advances of improved temporal resolution in coronary plaque imaging. Invest Radiol 42:196–203CrossRefPubMedGoogle Scholar
  33. 33.
    Rioufol G, Elbaz M, Dubreuil O et al (2006) Adventitia measurement in coronary artery: an in vivo intravascular ultrasound study. Heart. 92:985–986CrossRefPubMedGoogle Scholar
  34. 34.
    Otsuka M, Bruining N, Van Pelt NC et al (2008) Quantification of coronary plaque by 64-slice computed tomography: a comparison with quantitative intracoronary ultrasound. Invest Radiol 43:314–321CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Romain Chopard
    • 1
  • Loic Boussel
    • 2
  • Pascal Motreff
    • 1
  • Gilles Rioufol
    • 1
  • Alain Tabib
    • 3
  • Philippe Douek
    • 2
  • David Meyronet
    • 3
  • Didier Revel
    • 2
  • Gérard Finet
    • 1
    Email author
  1. 1.Department of Interventional CardiologyCardiovascular Hospital and Claude Bernard University, INSERM Research Unit 886 and CREATIS Research Unit associated to CNRS (UMR 5515)Lyon Cedex 03France
  2. 2.Department of RadiologyCardiovascular Hospital and Claude Bernard University, INSERM Research Unit 886 and CREATIS Research Unit associated to CNRS (UMR 5515)LyonFrance
  3. 3.Department of PathologyCardiovascular Hospital and Claude Bernard University, INSERM Research Unit 886 and CREATIS Research Unit associated to CNRS (UMR 5515)LyonFrance

Personalised recommendations