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Noninvasive Assessment of Plaque Morphology and Composition in Culprit and Stable Lesions in Acute Coronary Syndrome and Stable Lesions in Stable Angina by Multidetector Computed Tomography

Udo Hoffmann, MD^_*,_*, Fabian Moselewski, BS^_*,, Koen Nieman, MD^_*,, Ik-Kyung Jang, MD, PhD, Maros Ferencik, MD, PhD^_*, Ayaz M. Rahman, MD^_*, Ricardo C. Cury, MD^_*, Suhny Abbara, MD^_*, Hamid Joneidi-Jafari, BS^_*, Stephan Achenbach, MD^_*,, and Thomas J. Brady, MD^_*

^_* Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Department of Internal Medicine II, University of Erlangen, Erlangen, Germany

View larger version (66K): [in a new window]   Figure 1 Stable lesion in a patient with stable angina, demonstrating hemodynamically significant proximal left circumflex (LCX) stenosis. (A) Curved thin slice (5 mm) maximum intensity projection of the long axis of the proximal LCX demonstrates significant luminal narrowing in the presence of calcified plaque (distal dashed line). (B) Proximal cross-sectional reference demonstrates a normal lumen of the LCX (area: 13 mm2). (C) Cross-section through the lesion demonstrates calcified plaque (area: 9 mm2). Small residual lumen (area: 4 mm2, degree of stenosis: 71%) and positive remodeling index (RI: 0.69). (D) Invasive selective coronary angiography demonstrates a significant stenosis of the proximal LCX (60%).

View larger version (67K): [in a new window]   Figure 2 Culprit lesion in a patient with acute coronary syndrome (ACS), demonstrating hemodynamically significant proximal right coronary artery (RCA) stenosis. (A) Curved thin slice (5 mm) maximum intensity projection of the long axis of the RCA demonstrates significant proximal luminal narrowing in the presence of non-calcified plaque (distal dashed line). (B) Proximal cross-sectional reference demonstrates a normal lumen of the RCA (area: 17 mm2). (C) Cross-section through the lesion demonstrates the non-calcified plaque (low density) (area: 27 mm2). Small residual lumen (area: 5 mm2, degree of stenosis: 71%) and positive remodeling index (RI: 1.59). (D) Invasive selective coronary angiography demonstrates a significant stenosis of the proximal RCA (73%).

View larger version (7K): [in a new window]   Figure 3 Scatterplots of (A) remodeling index and (B) plaque area (cm2) between culprit lesions in patients with acute coronary syndromes (ACS) (1), stable lesions in patients with ACS (2), and lesions in patients with stable angina (3). Square lines indicate the mean of each group. Remodeling index and plaque area were significantly different between the three groups (p = 0.04 and p = 0.02, respectively).