title: CTA for screening of complicated atherosclerotic carotid plaque--American Heart Association type VI lesions as defined by MRI.
abstract: OBJECTIVE
  High-resolution carotid MR imaging can accurately identify complicated American Heart Association lesion type VI plaques, which are characterized by thrombus, hemorrhage, or a ruptured fibrous cap. The purpose of this study is to evaluate whether CTA can be used as screening tool to predict the presence or absence of American Heart Association lesion type VI plaques as defined by high-resolution MR imaging.
  
  
  METHODS
  Fifty-one patients with suspected ischemic stroke or TIA with carotid CTA and carotid MR imaging performed within 14 days of the event/admission from April 2008 to December 2010 were reviewed. Vessels with stents or occlusion were excluded (n = 2). Each carotid artery was assigned an American Heart Association lesion type classification by MR imaging. The maximum wall thickness, maximum soft plaque component thickness, maximum calcified component thickness, and its attenuation (if the soft plaque component thickness was >2 mm) were obtained from the CTA.
  
  
  RESULTS
  The maximum soft plaque component thickness proved the best discriminating factor to predict a complicated plaque by MR imaging, with a receiver operating characteristic area under the curve of 0.89. The optimal sensitivity and specificity for detection of complicated plaque by MR imaging was achieved with a soft plaque component thickness threshold of 4.4 mm (sensitivity, 0.65; specificity, 0.94; positive predictive value, 0.75; and negative predictive value, 0.9). No complicated plaque had a soft tissue plaque thickness <2.2 mm (negative predictive value, 1) and no simple (noncomplicated) plaque had a thickness >5.6 mm (positive predictive value, 1).
  
  
  CONCLUSIONS
  Maximum soft plaque component thickness as measured by carotid CTA is a reliable indicator of a complicated plaque, with a threshold of 2.2 mm representing little to no probability of a complicated American Heart Association lesion type VI plaque.
authors.affiliation: Department of Radiology, University of Texas Medical Branch, Galveston, Texas.
authors.forename: M
authors.initials: M
authors.lastname: Trelles
authors.forename: K M
authors.initials: KM
authors.lastname: Eberhardt
authors.forename: M
authors.initials: M
authors.lastname: Buchholz
authors.forename: A
authors.initials: A
authors.lastname: Schindler
authors.forename: A
authors.initials: A
authors.lastname: Bayer-Karpinska
authors.forename: M
authors.initials: M
authors.lastname: Dichgans
authors.forename: M F
authors.initials: MF
authors.lastname: Reiser
authors.forename: K
authors.initials: K
authors.lastname: Nikolaou
authors.forename: T
authors.initials: T
authors.lastname: Saam
mesh_terms: D000368:Aged; D000465:Algorithms; D000792:Angiography / Q000379:methods*; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity