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

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

^* Department of Internal Medicine, Division of Cardiology, Eberhard-Karls-University Tuebingen, Forchheim, Germany
Department of Radiology, Division of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Forchheim, Germany
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

View larger version (40K): [in a new window]   Figure 1 Retrospectively ECG-gated four-slice spiral reconstruction using segmented reconstruction with 500-ms rotation time. Left: Single phase reconstruction with a temporal resolution of 250 ms (Trotation/2 = 250 ms). Reconstruction with M = 1 sectors is performed for heart rates 65 beats/min. Right: Bi-phase reconstruction with a temporal resolution of up to 125 ms (Trotation/4 = 125 ms) using image data obtained within two consecutive RR intervals. Reconstruction with M = 2 sectors is performed for heart rates >65 beats/min. Recon: Image reconstruction at a defined time point within the RR interval. In our series: relative retrospective gating with 38% to 50% referred to the RR interval (in early diastole) for image reconstruction of the right coronary artery, and approximately 50% RR (in mid diastole) for reconstruction of the left coronary artery. z-position: patient position.

View larger version (114K): [in a new window]   Figure 2 Soft plaque as assessed by MSCT and ICUS. Left: MSCT image, axial slice. Right: ICUS image, longitudinal slice. Plaque marked by an arrow. Ao = aorta; ICUS = intracoronary ultrasound; LAD = left anterior descending artery; MSCT = multislice computed tomography; PT = pulmonary trunk.

View larger version (118K): [in a new window]   Figure 3 Intermediate plaque as assessed by MSCT and ICUS. Left: MSCT image, axial slice. Right: ICUS image, sagittal slice. Plaque marked by an arrow. Ao = aorta; ICUS = intracoronary ultrasound; LAD = left anterior descending artery; MSCT = multislice computed tomography; PT = pulmonary trunk.

View larger version (118K): [in a new window]   Figure 4 Calcified plaque as assessed by MSCT and ICUS. Left: MSCT image, axial slice. Right: ICUS image, sagittal slice. Plaque marked by an arrow. Ao = aorta; ICUS = intracoronary ultrasound; LAD = left anterior descending artery; MSCT = multislice computed tomography; PT = pulmonary trunk.

View larger version (12K): [in a new window]   Figure 5 Comparison of plaque configuration (ICUS) and plaque density (MSCT). Box-and-whiskers plot showing range and quartiles. The box extends from the 25th percentile to the 75th percentile, with a line at the median (the 50th percentile). The whiskers extend above and below the box to show the highest and lowest values. HU = Hounsfield unit; ICUS = intracoronary ultrasound; MSCT = multislice computed tomography.