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Coronary plaque characterization assessed by delayed enhancement dual-layer spectral CT angiography and optical coherence tomography

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Abstract

This study aimed to prospectively evaluate delayed enhancement imaging by spectral computed tomography using soluble iodine containing contrast media to improve the in vivo characterization of coronary plaque types based on the quantification of delayed iodine enhancement. Patients with known or suspected coronary artery disease (CAD) underwent spectral coronary CT-angiography (SCCTA). Absolute delayed iodine enhancement in all visible coronary plaques was assessed. Patients with significant CAD (> 50% stenosis) further underwent invasive coronary angiography (ICA) including optical coherence tomography (OCT). We identified 50 non-calcified coronary plaques in 72 patients undergoing SCCTA. 17 patients with significant CAD underwent further ICA including OCT imaging. In those, we were able to match 35 plaques by both SCCTA and OCT. Based on OCT imaging, 22/35 matched plaques (63%) were characterized as high-risk coronary plaques (thin-cap fibroatheroma n = 2, fibroatheroma n = 20), whereas 13/35 (37%) were characterized as low-risk plaques (fibrocalcific lesion n = 3, fibrous plaques n = 9, and early-onset fibroatheroma n = 1). All plaques showed similar HU’s and could not be classified into high-risk or low-risk plaques by conventional CT measures. Minimal delayed iodine enhancement within plaques as quantified by SCCTA demonstrated significantly lower values in high-risk as compared to low-risk coronary plaques (1.0 ± 1.5 mg/ml vs. 2.2 ± 1.1 mg/ml, p = 0.021) which allowed estimation of high-risk plaques with high sensitivity and moderate specificity (77% and 56%). Measurement of delayed enhancement iodine uptake within stable coronary artery plaques using dual-layer SCCTA might contribute to a more precise estimation of plaque vulnerability surpassing conventional CT techniques.

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Funding

The authors declare that no funds, Grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Jonathan Nadjiri and Tobias Koppara have contributed equally to this work.

Authors and Affiliations

  1. Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany

    Jonathan Nadjiri

  2. Department of Internal Medicine I, Cardiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Tobias Koppara, Andre Kafka, Florian Weis, Karl-Ludwig Laugwitz & Tareq Ibrahim

  3. Department of Radiology, Kantonsspital Muensterlingen, Muensterlingen, Switzerland

    Michael Rasper

  4. Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Felix G. Gassert, Claudio E. von Schacky, Daniela Pfeiffer & Marcus R. Makowski

  5. German Center for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany

    Tobias Koppara & Karl-Ludwig Laugwitz

Authors
  1. Jonathan Nadjiri
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  2. Tobias Koppara
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  3. Andre Kafka
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  4. Florian Weis
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Contributions

All authors contributed to the study conception and design. JN and TK contributed equally to this work. Material preparation, data collection acquisition, interpretation of data and analysis were performed by JN, TK, AK, FW, MR, FGG, CES, DP, K-LL, MRM and TI. The first draft of the manuscript was written by JN and TK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript for publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jonathan Nadjiri.

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Conflict of interest

Tobias Koppara received horonaria from Abbott Medical GmbH, Germany. All other authors have nothing to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Technical University of Munich (11/2018; no: 38/18 s).

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Informed consent was obtained from all individual participants included in the study.

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Nadjiri, J., Koppara, T., Kafka, A. et al. Coronary plaque characterization assessed by delayed enhancement dual-layer spectral CT angiography and optical coherence tomography. Int J Cardiovasc Imaging 38, 2491–2500 (2022). https://doi.org/10.1007/s10554-022-02638-4

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  • DOI: https://doi.org/10.1007/s10554-022-02638-4

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