title: Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound.
abstract: OBJECTIVE
  We evaluated the accuracy of contrast-enhanced multidetector spiral computed tomography (MDCT) for the noninvasive detection and classification of coronary plaques and compared it with intracoronary ultrasound (ICUS).
  
  
  BACKGROUND
  Noninvasive determination of plaque composition and plaque burden may be important to improve risk stratification and to monitor progression of coronary atherosclerosis.
  
  
  METHODS
  We included 46 consecutive patients with a distinctive risk profile, who were investigated by ICUS (Goldvision, 20 MHz, Jomed Inc., Rancho Cordova, California). Due to the inability to slow the heart rate below 65 beats/min (n = 7) and due to renal insufficiency (n = 2), nine of 46 consecutive patients could not be studied by MDCT (Sensation 16, Siemens, Forchheim, Germany).
  
  
  RESULTS
  In the remaining 37 patients, 68 vessels were investigated by ICUS, and 58 of these vessels were visualized by MDCT with image quality sufficient for analysis. In these vessels that were divided in 3-mm sections, MDCT correctly classified 62 of 80 (78%) sections containing hypoechoic plaque areas, 87 of 112 (78%) sections containing hyperechoic plaque areas, and 150 of 158 (95%) sections containing calcified plaque tissue. In 484 of 525 (92%) sections, atherosclerotic lesions were correctly excluded. The MDCT-derived density measurements within coronary lesions revealed significantly different values for hypoechoic (49 HU [Hounsfield Units] +/- 22), hyperechoic (91 HU +/- 22), and calcified plaques (391 HU +/- 156, p < 0.02).
  
  
  CONCLUSIONS
  This study demonstrates that, in the case of diagnostic image quality, contrast-enhanced MDCT permits an accurate identification of coronary plaques and that computed tomography density values measured within plaques reflect echogenity and plaque composition.
authors.affiliation: Department of Cardiology, University of Munich, Munich, Germany. aleber@helios.med.uni-muenchen.de
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Carsten
authors.initials: C
authors.lastname: Rist
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Carl
authors.initials: C
authors.lastname: White
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
mesh_terms: D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media