Current Cardiovascular Imaging Reports

, Volume 3, Issue 6, pp 366–371

Coronary Artery CT Angiography for Plaque Imaging



Cardiac CT is becoming a mainstream and integral part of many cardiology practices based on a vast base of literature supporting and validating its clinical utility. As the technology continues to advance, coronary imaging has improved in stride. In the next several years, cardiac CT may become the “gatekeeper” of cardiac testing, surpassing the more common and widespread nuclear testing as the initial strategy in evaluating ischemia. Unfortunately, in spite of an arsenal of tests available to detect clinically significant stable coronary artery disease, many people continue to suffer acute myocardial infarction and other acute coronary syndromes, leading to significant morbidity and mortality due to unstable coronary artery disease. These unstable, “vulnerable” plaques continue to plague cardiologists across the globe. The ability to identify vulnerable plaque is a step in the right direction toward therapy. It is in this particular arena that advancements in cardiac CT technology may bear the most fruit. A growing body of evidence supporting the utility of cardiac CT in plaque imaging has emerged and has demonstrated that potentially unstable coronary artery disease is able to be identified accurately and noninvasively.


Intravascular ultrasound (IVUS) Virtual histology intravascular ultrasound (VH-IVUS) Multidetector row computed tomography angiography (MDCTA) Thin-capped fibroatheroma (TCFA) 


Papers with particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Epstein SE, Quyymi AA, Bonow RO: Sudden cardiac death without warning. Possible mechanisms and implications for screening asymptomatic populations. N Engl J Med 1989, 321:320–324.CrossRefPubMedGoogle Scholar
  2. 2.
    Morbidity and Mortality 2009 Chart Book on Cardiovascular, Lung, and Blood Diseases. National Institutes of Health/National Heart, Lung, and Blood Institute; 2009.Google Scholar
  3. 3.
    Ambrose JA, Tannenbaum MA, Alexopoulos D, et al.: Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol 1988, 12:56–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Glagov S, Weisenberg E, Zarins CK, et al.: Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987, 316:1371–1375.CrossRefPubMedGoogle Scholar
  5. 5.
    Libby P: The interface of atherosclerosis and thrombosis: basic mechanisms. Vasc Med 1998, 3:225–229.CrossRefPubMedGoogle Scholar
  6. 6.
    Falk E, Shah PK, Fuster V: Coronary plaque disruption. Circulation 1995, 92:657–671.PubMedGoogle Scholar
  7. 7.
    Virmani R, Kolodgie FD, Burke AP, et al.: Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000, 20:1262–1275.PubMedGoogle Scholar
  8. 8.
    Dalager-Pederson S, Ravn HB, Falk E: Atherosclerosis and acute coronary events. Am J Cardiol 1998, 82:37T–40T.CrossRefGoogle Scholar
  9. 9.
    Athanasiadis A, Haase KK, Wullen B, et al.: Lesion morphology assessed by pre-interventional intravascular ultrasound does not predict the incidence of severe coronary artery dissections. Eur Heart J 1998, 19:870–878.CrossRefPubMedGoogle Scholar
  10. 10.
    • Budoff MJ, Shaw LJ, Liu ST, et al.: Long-term prognosis associated with coronary calcification: Observations from a registry of 25,253 patients. J Am Coll Cardiol 2007, 49:1860–1870. This is an important demonstration of outcomes data and CAC scores.CrossRefPubMedGoogle Scholar
  11. 11.
    Akram K, O’Donnell RE, King S, et al.: Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. Atherosclerosis 2009, 203:533–537.CrossRefPubMedGoogle Scholar
  12. 12.
    Mowatt G, Cook JA, Hillis GS, et al.: 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis. Heart 2008, 94:1386–1393.CrossRefPubMedGoogle Scholar
  13. 13.
    • Miller JM, Rochitte CE, Dewey M, et al.: Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008, 359:2324–2336. This is an important multicenter study reflecting the accuracy of coronary MDCTA compared to invasive angiography in a real-world population.CrossRefPubMedGoogle Scholar
  14. 14.
    • Nair A, Kuban BD, Tuzcu EM, et al.: Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002, 106:2200–2206. This is a good overview of plaque characteristics for noninvasive cardiologists.CrossRefPubMedGoogle Scholar
  15. 15.
    Gotsman MS, Mosseri M, Rozenman Y, et al.: Atherosclerosis studies by intravascular ultrasound. Adv Exp Med Biol 1997, 430:197–212.PubMedGoogle Scholar
  16. 16.
    Moore MP, Spencer T, Salter DM, et al.: Characterization of coronary atherosclerotic morphology by spectral analysis of radiofrequency signal: in vitro intravascular ultrasound study with histological and radiological validation. Heart 1998, 79:459–467.PubMedGoogle Scholar
  17. 17.
    Nasu K, Tsuchikane E, Katoh O, et al.: Accuracy of in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology. J Am Coll Cardiol 2006, 47:2405–2412.CrossRefPubMedGoogle Scholar
  18. 18.
    Leber AW, Knez A, von Ziegler F, et al.: 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 2005, 46:154.CrossRefGoogle Scholar
  19. 19.
    Achenbach S, Moselewski F, Ropers D, 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.CrossRefPubMedGoogle Scholar
  20. 20.
    Shroeder S, Kopp AF, Baumbach A, et al.: Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol 2001, 37:1430–1435.CrossRefGoogle Scholar
  21. 21.
    Bamberg F, Dannemann N, Shapiro MD, et al.: Association between cardiovascular risk profiles and the presence and extent of different types of coronary atherosclerotic plaque as detected by multidetector computed tomography. Arterioscler Thromb Vasc Biol 2008, 28:568–574.CrossRefPubMedGoogle Scholar
  22. 22.
    Mollet NR, Cademartiri F, Nieman K, et al.: Noninvasive assessment of coronary plaque burden using multislice computed tomography. Am J Cardiol 2005, 95:1165–1169.CrossRefPubMedGoogle Scholar
  23. 23.
    •• Pundziute G, Schuijf JD, Jukema JW, et al.: Head-to head comparison of coronary plaque evaluation between multislice computed tomography and intravascular ultrasound radiofrequency data analysis. J Am Coll Cardiol Intv 2008, 1:176–182. This article details important comparison data between VH-IVUS and MDCTA.Google Scholar
  24. 24.
    Pundziute G, Schuijf JD, Jukema JW, et al.: Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis. Eur Heart J 2008, 29:2373–2381.CrossRefPubMedGoogle Scholar
  25. 25.
    Pundziute G, Schuijf JD, Jukema JW, et al.: Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease. J Am Coll Cardiol 2007, 49:62–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Kolodgie FD, Virmani R, Burke AP, et al.: Pathologic assessment of the vulnerable human coronary plaque. Heart 2004, 90:1385–1391.CrossRefPubMedGoogle Scholar
  27. 27.
    Rodriguez-Granillo GA, Garcia-Garcia HM, McFadden EP, et al.: In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis. J Am Coll Cardiol 2005, 46:2038–2042.CrossRefPubMedGoogle Scholar
  28. 28.
    Motoyama S, Kondo T, Sarai M, et al.: Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007, 50:319–326.CrossRefPubMedGoogle Scholar
  29. 29.
    •• Kitagawa T, Yamamoto H, Horiguchi J, et al.: Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. J Am Coll Cardiol Img 2009, 2:153–160. This is a very good study looking at characteristics of vulnerable plaque that are associated with ACS.Google Scholar
  30. 30.
    Kawasaki T, Koga S, Koga N, et al.: Characterization of hyperintense plaque with noncontrast T1-weighted cardiac magnetic resonance coronary plaque imaging. J Am Coll Cardiol Img 2009, 2:720–728.Google Scholar
  31. 31.
    Stone GW: Providing Regional Observations to Study Predictors of Events in the Coronary Tree Clinical Trial. Presented at Late-Breaking Trials. Transcatheter Therapeutics. San Francisco, CA; September 24, 2009.Google Scholar
  32. 32.
    Schmid M, Achenbach S, Ropers D, et al.: Assessment of changes in non-calcified atherosclerotic plaque volume in the left main and left anterior descending arteries over time by 64-slice computed tomography. Am J Cardiol 2008, 101:579–584.CrossRefPubMedGoogle Scholar
  33. 33.
    Voros S, Joshi PH, Vazquez G, et al.: Cardiovascular computed tomographic assessment of the effect of combination lipoprotein therapy on coronary arterial plaque: Rationale and design of the AFRICA (Atorvastatin plus Fenofibric acid in the Reduction of Intermediate Coronary Atherosclerosis) study. J Cardiovasc Comput Tomogr 2010, 4:164–172.CrossRefPubMedGoogle Scholar
  34. 34.
    Voros S: What are the potential advantages and disadvantages of volumetric CT scanning? J Cardiovasc Comput Tomogr 2009, 3:67–70.CrossRefPubMedGoogle Scholar
  35. 35.
    Knollman F, Ducke F, Krist L, et al.: Quantification of atherosclerotic coronary plaque components by submillimeter computed tomography. Int J Cardiovasc Imaging 2008, 24:301–310.CrossRefGoogle Scholar
  36. 36.
    Leber AW, Knez A, von Ziegler F, et al.: 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 2005, 46:147–154.CrossRefPubMedGoogle Scholar
  37. 37.
    Leber AW, Becker A, Knez A, 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.CrossRefPubMedGoogle Scholar
  38. 38.
    Voros S: Can computed tomography angiography of the coronary arteries characterize atherosclerotic plaque composition? Is the CAT (scan) out of the bag? J Am Coll Cardiol Intv 2008, 1:183–185.Google Scholar
  39. 39.
    Voros S, et al.: Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in lesions with non-obstructive fractional flow reserve: results from the ATLANTA I study. JACC Cardiovasc Interv 2010, In revision.Google Scholar
  40. 40.
    • Achenbach S, Boehmer K, Pflederer T, et al.: Influence of slice thickness and reconstruction kernel on the computed tomographic attenuation of coronary atherosclerotic plaque. J Cardiovasc Comput Tomogr 2010, 4:110–115. This is a nice demonstration of some of the technical aspects and difficulties with coronary plaque imaging.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Peripheral Interventions and Advanced Cardiac ImagingINTEGRIS Baptist Medical CenterOklahoma CityUSA

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