Abstract
Cholesterol crystals (CCs) in carotid plaques might be an indicator of vulnerability, although they have not been fully investigated and non-invasive methods of assessment have not been established. This study examines the validity of assessing CCs using dual-energy computed tomography (DECT) that uses X-rays with different tube voltages for imaging, allowing material discrimination. We retrospectively evaluated patients who had undergone preoperative cervical computed tomography angiography and carotid endarterectomy between December 2019 and July 2020. We developed CC-based material decomposition images (MDIs) by scanning CCs crystallized in the laboratory using DECT. We compared the percentage of CCs in stained slides defined by cholesterol clefts with the percentage of CCs displayed by CC-based MDIs. Thirty-seven pathological sections were obtained from 12 patients. Thirty-two sections had CCs; of these, 30 had CCs on CC-based MDIs. CC-based MDIs and pathological specimens showed a strong correlation. Thus, DECT allows the evaluation of CCs in carotid artery plaques.
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Data availability
The data that support the findings of this study are not publicly available because they contain information that could compromise the privacy of research participants, but are available from the corresponding author (Takuya Saito) upon reasonable request.
Change history
18 March 2023
Missing "Graduate" in author Daisuke Ando's affiliations has been added.
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Funding
This study was supported by the Japanese Society of Cerebral Blood Flow and Metabolism as an approved study in 2021.
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Yukako Yazawa received honoraria to deliver lectures from Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Stryker, and Medtronic. Takuya Saito, Hidenori Endo, Daisuke Ando, Itsuki Miyagi, Yuichi Kawabata, Mika Watanabe, Atsushi Saito, and Miki Fujimura have reported no disclosures.
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The study protocol was reviewed and approved by the Ethics Committee of the Kohnan Hospital (approval number 2021–0113-01).
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Informed consent was waived because of the retrospective nature of the study, and the opt-out method was offered.
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Saito, T., Endo, H., Ando, D. et al. Evaluation of cholesterol crystals in carotid plaque by dual energy computed tomography. Neuroradiology 65, 979–982 (2023). https://doi.org/10.1007/s00234-023-03138-5
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DOI: https://doi.org/10.1007/s00234-023-03138-5