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J Am Coll Cardiol, 2001; 37:1430-1435
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography1

Stephen Schroeder, MD*, Andreas F. Kopp, MD{dagger}, Andreas Baumbach, MD||, Christoph Meisner, MA{ddagger}, Axel Kuettner, MD*, Christian Georg, MD{dagger}, Bernd Ohnesorge, PhD§, Christian Herdeg*, Claus D. Claussen, MD{dagger} and Karl R. Karsch, MD, FESC, FACC, FRCP||

* Department of Internal Medicine, Division of Cardiology, Eberhard-Karls-University Tuebingen, Forchheim, Germany
{dagger} Department of Radiology, Division of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Forchheim, Germany
{ddagger} Institute for Medical Information Processing, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
§ Siemens AG, Medical Engineering, Computed Tomography, Forchheim, Germany
|| Bristol Heart Institute, University of Bristol, Bristol, UK

Manuscript received June 21, 2000; revised manuscript received November 14, 2000, accepted December 15, 2000.

Reprint requests and correspondence: Prof. Dr. Karl R. Karsch, Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.
K.R.Karsch{at}bristol.ac.uk

OBJECTIVES

The aim of the present study was to evaluate the accuracy in determining coronary lesion configuration by multislice computed tomography (MSCT). The results were compared with the findings of intracoronary ultrasound (ICUS).

BACKGROUND

The risk of acute coronary syndromes caused by plaque disruption and thrombosis depends on plaque composition rather than stenosis severity. Thus, the reliable noninvasive assessment of plaque configuration would constitute an important step forward for risk stratification in patients with known or suspected coronary artery disease. Just recently, MSCT scanners became available for general purpose scanning. Due to improved spatial and temporal resolution, this new technology holds promise to allow for differentiation of coronary lesion configuration.

METHODS

The ICUS and MSCT scans (Somatom Volume Zoom, Siemens, Forchheim, Germany) were performed in 15 patients. Plaque composition was analyzed according to ICUS (plaque echogenity: soft, intermediate, calcified) and MSCT criteria (plaque density expressed by Hounsfield units [HU]).

RESULTS

Thirty-four plaques were analyzed. With ICUS, the plaques were classified as soft (n = 12), intermediate (n = 5) and calcified (n = 17). Using MSCT, soft plaques had a density of 14 ± 26 HU (range –42 to +47 HU), intermediate plaques of 91 ± 21 HU (61 to 112 HU) and calcified plaques of 419 ± 194 HU (126 to 736 HU). Nonparametric Kruskal-Wallis test revealed a significant difference of plaque density among the three groups (p < 0.0001).

CONCLUSIONS

Our results indicate that coronary lesion configuration might be correctly differentiated by MSCT. Since also rupture-prone soft plaques can be detected by MSCT, this noninvasive method might become an important diagnostic tool for risk stratification in the near future.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CT = computed tomography
  EBCT = electron beam computed tomography
  HU = Hounsfield unit
  ICUS = intracoronary ultrasound
  LAD = left anterior descending artery
  MRI = magnetic resonance imaging
  MSCT = multislice computed tomography
  PTCA = percutaneous transluminal coronary angioplasty
  RCA = right coronary artery




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A. W. Leber, A. Knez, A. Becker, C. Becker, F. von Ziegler, K. Nikolaou, C. Rist, M. Reiser, C. White, G. Steinbeck, et al.
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., April 7, 2004; 43(7): 1241 - 1247.
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B. Desjardins and E. A. Kazerooni
ECG-Gated Cardiac CT
Am. J. Roentgenol., April 1, 2004; 182(4): 993 - 1010.
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A. Kuettner, A. F. Kopp, S. Schroeder, T. Rieger, J. Brunn, C. Meisner, M. Heuschmid, T. Trabold, C. Burgstahler, J. Martensen, et al.
Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease
J. Am. Coll. Cardiol., March 3, 2004; 43(5): 831 - 839.
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S. Achenbach, D. Ropers, U. Hoffmann, B. MacNeill, U. Baum, K. Pohle, T. J. Brady, E. Pomerantsev, J. Ludwig, F. A. Flachskampf, et al.
assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography
J. Am. Coll. Cardiol., March 3, 2004; 43(5): 842 - 847.
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S. Achenbach, F. Moselewski, D. Ropers, M. Ferencik, U. Hoffmann, B. MacNeill, K. Pohle, U. Baum, K. Anders, I.-k. Jang, 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, January 6, 2004; 109(1): 14 - 17.
[Abstract] [Full Text] [PDF]

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J. Gurevitch, T. Gaspar, B. Orlov, R. Amar, D. Dvir, N. Peled, and D. J. Aravot
Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography
Ann. Thorac. Surg., November 1, 2003; 76(5): 1523 - 1527.
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P. Schoenhagen, G. W. Stone, S. E. Nissen, C. L. Grines, J. Griffin, B. S. Clemson, D. G. Vince, K. Ziada, T. Crowe, C. Apperson-Hanson, et al.
Coronary Plaque Morphology and Frequency of Ulceration Distant From Culprit Lesions in Patients With Unstable and Stable Presentation
Arterioscler. Thromb. Vasc. Biol., October 1, 2003; 23(10): 1895 - 1900.
[Abstract] [Full Text] [PDF]

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H. K. Pannu, T. G. Flohr, F. M. Corl, and E. K. Fishman
Current Concepts in Multi-Detector Row CT Evaluation of the Coronary Arteries: Principles, Techniques, and Anatomy
RadioGraphics, October 1, 2003; 23(90001): S111 - 125.
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C R Peebles
Non-invasive coronary imaging: computed tomography or magnetic resonance imaging?
Heart, June 1, 2003; 89(6): 591 - 594.
[Full Text] [PDF]

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K Nieman, B J Rensing, R-J M van Geuns, J Vos, P M T Pattynama, G P Krestin, P W Serruys, and P J de Feyter
Non-invasive coronary angiography with multislice spiral computed tomography: impact of heart rate
Heart, December 1, 2002; 88(5): 470 - 474.
[Abstract] [Full Text] [PDF]

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Z. A. Fayad, V. Fuster, K. Nikolaou, and C. Becker
Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging: Current and Potential Future Concepts
Circulation, October 8, 2002; 106(15): 2026 - 2034.
[Full Text] [PDF]

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J. K. Willmann, D. Weishaupt, M. Lachat, R. Kobza, J. E. Roos, B. Seifert, T. F. Luscher, B. Marincek, and P. R. Hilfiker
Electrocardiographically Gated Multi-Detector Row CT for Assessment of Valvular Morphology and Calcification in Aortic Stenosis
Radiology, October 1, 2002; 225(1): 120 - 128.
[Abstract] [Full Text] [PDF]

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R. Erbell, T. Budde, G. Kerkhoff, S. Mohlenkamp, and A. Schmermund
Understanding the pathophysiology of the arterial wall: which method should we choose? Electron beam computed tomography
Eur. Heart J. Suppl., September 1, 2002; 4(suppl_F): F47 - F53.
[Abstract] [PDF]

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P J de Feyter and K Nieman
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Heart, March 1, 2002; 87(3): 195 - 197.
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S Schroeder, A F Kopp, B Ohnesorge, H Loke-Gie, A Kuettner, A Baumbach, C Herdeg, C D Claussen, and K R Karsch
Virtual coronary angioscopy using multislice computed tomography
Heart, March 1, 2002; 87(3): 205 - 209.
[Abstract] [Full Text] [PDF]

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T. C. Gerber, R. S. Kuzo, N. Karstaedt, G. E. Lane, R. L. Morin, P. F Sheedy II, R. E. Safford, J. L. Blackshear, and J. H. Pietan
Current Results and New Developments of Coronary Angiography With Use of Contrast-Enhanced Computed Tomography of the Heart
Mayo Clin. Proc., January 1, 2002; 77(1): 55 - 71.
[Abstract] [PDF]

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S. Achenbach and W. G. Daniel
Noninvasive Coronary Angiography -- An Acceptable Alternative?
N. Engl. J. Med., December 27, 2001; 345(26): 1909 - 1910.
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