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Atherosclerotic Plaque Characterization by Multidetector Row Computed Tomography Angiography

Marco A.S. Cordeiro, MD, PhD^_*,,a and João A.C. Lima, MD, MBA, FACC^_*,,a,_*

^_* Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Division of Cardiology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Cardiology, Heart Institute (InCor-DF), Zerbini Foundation, Brasilia, DF, Brazil

Manuscript received June 16, 2005; revised manuscript received September 13, 2005, accepted September 26, 2005.

^_* Reprint requests and correspondence: Dr. João A. C. Lima, 600 N. Wolfe Street, Blalock 524, The Johns Hopkins Hospital, Baltimore, Maryland 21287-0409 (Email: jlima{at}jhmi.edu).

Multidetector row computed tomography angiography (MDCTA) is seen as a potential alternative to current imaging methods for the assessment of vessel anatomy and atherosclerotic plaque composition/morphology in a great variety of arterial beds. Recent advances represented by the increase in gantry speed to <500 ms per rotation and in the number of detector rows from 4 to 64, in addition to the decrease in slice thickness to submillimetric levels, brought significant improvement in diagnostic accuracy by coronary MDCTA. In general, it has a good correlation with both intravascular ultrasound (IVUS) and histopathology for discrimination between soft, intermediate, and calcified plaques. Plaque area and volume tend to be underestimated by 12-detector row MDCTA and overestimated by 16-detector row MDCTA, but the number of patients studied so far is relatively small. However, it seems that 64-detector row MDCTA can measure plaque area and volume with greater accuracy. Plaque remodeling is overestimated in small vessels by 12-detector row MDCTA, whereas 16- and 64-detector row MDCTA show a good correlation with IVUS. Although still under development, the potential of MDCTA to characterize atherosclerotic plaque composition as well as to precisely determine plaque area, volume, and remodeling in the future is quite promising.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CAC = coronary artery calcium   CAD = coronary artery disease   CT = computed tomography   EBCTA = electron-beam computed tomography angiography   IVUS = intravascular ultrasound   MDCTA = multidetector row computed tomography angiography

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