Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography.
OBJECTIVE
The purpose of this study was to investigate whether multidetector computed tomography (MDCT) can noninvasively help assess thin-cap fibroatheroma (TCFA).


BACKGROUND
Plaque rupture and thrombus formation play key roles in the onset of acute coronary syndrome. TCFA is recognized as a precursor lesion for plaque rupture, and MDCT angiography can potentially help identify plaques prone to rupture.


METHODS
We enrolled 105 patients with coronary artery disease (acute coronary syndromes, n = 31; stable angina pectoris, n = 74). Culprit lesions were assessed by both MDCT and optical coherence tomography (OCT). Patients were divided into a TCFA and a non-TCFA group according to OCT findings; clinical and MDCT observations were compared for 2 groups.


RESULTS
There were no differences in patients' characteristics between the 2 groups. OCT revealed 25 TCFAs at the culprit site in 105 patients. Acute coronary syndrome was more frequent in the TCFA group than in the non-TCFA group (52% vs. 23%, p = 0.01). High-sensitive C-reactive protein was higher in the TCFA group (0.32 +/- 0.32 mg/dl vs. 0.17 +/- 0.16 mg/dl, p < 0.001). Positive remodeling identified by MDCT was observed more frequently in the TCFA group than in the non-TCFA group (76% vs. 31%, p < 0.001). Computed tomography attenuation value of the culprit plaque in the TCFA group was lower than that in the non-TCFA group (35.1 +/- 32.3 HU vs. 62.0 +/- 33.6 HU, p < 0.001). The frequency of ring-like enhancement in the TCFA group was higher than in the non-TCFA group (44% vs. 4%, p < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of ring-like enhancement for detecting TCFA are 44%, 96%, 79%, and 85%, respectively. By stepwise regression, the ring-like enhancement, high-sensitive C-reactive protein, and diagnosis of acute events were associated with the presence of TCFA at the culprit site.


CONCLUSIONS
MDCT can identify differences in plaque morphologies between TCFA and non-TCFA. From our results, MDCT may provide for the noninvasive assessment of vulnerable plaque.
Kashiwagi
Manabu
M
Tanaka
Atsushi
A
Kitabata
Hironori
H
Tsujioka
Hiroto
H
Kataiwa
Hideaki
H
Komukai
Kenichi
K
Tanimoto
Takashi
T
Takemoto
Kazushi
K
Takarada
Shigeho
S
Kubo
Takashi
T
Hirata
Kumiko
K
Nakamura
Nobuo
N
Mizukoshi
Masato
M
Imanishi
Toshio
T
Akasaka
Takashi
T
D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012421:Rupture; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D002097:C-Reactive Protein