title: Multislice computed tomographic coronary angiography for quantitative assessment of culprit lesions in acute coronary syndromes.
abstract: BACKGROUND
  We studied the characteristics of low-density plaque (LDP) burden in patients with acute coronary syndrome (ACS), using 64-slice computed tomography (CT) assessment. Though several CT plaque features such as positive remodelling, adjacent spotty calcification or the presence of LDP have been demonstrated to be associated with unstable plaques, it is still unknown whether their severity and extent present any differences between different types of ACS.
  
  
  METHODS
  In 45 subjects with ACS (22 unstable angina and 23 non-ST-elevation myocardial infarction [NSTEMI]), 118 coronary plaques were evaluated using a CT multislice 64 assessment including the burden with atheroma having a CT density below 30, 60, or 100 Hounsfield units (HU), remodelling index and spotty calcification.
  
  
  RESULTS
  Culprit lesions tend to be larger in volume (111.11 mm(3) vs 62.25 mm(3); P < 0.0001), have a higher remodelling index (1.27 vs 1.01; P < 0.0001), and present a significantly larger LDP with a density < 30 HU (23.3 mm(3) vs 7.6 mm(3); P < 0.0001) or < 60 HU (33.4 mm(3) vs 16.9 mm(3); P < 0.0001) than nonculprit lesions. The presence of a plaque more than 20 mm(3) in volume with a CT density < 30 HU (P = 0.0009) and the presence of all 3 markers of plaque vulnerability (LDP, spotty calcifications or positive remodelling) (P = 0.01) significantly correlated with the presence of an NSTEMI.
  
  
  CONCLUSIONS
  Culprit lesions demonstrated larger plaque volumes, a higher burden with low-density cores, and more intense remodelling than nonculprit lesions, whereas culprit lesions associated with NSTEMI showed a higher burden with lower density cores than those associated with unstable angina.
authors: University of Medicine and Pharmacy of Targu-Mures, Targu Mures, Romania.
authors: Theodora
authors: T
authors: Benedek
authors: Mariann
authors: M
authors: Gyöngyösi
authors: Imre
authors: I
authors: Benedek
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D000465:Algorithms; D000789:Angina, Unstable / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index