title: Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography.
abstract: OBJECTIVE
  Adverse plaque characteristics (APCs) by coronary computed tomography (CT) angiography (CTA) are associated with myocardial ischaemia and future acute coronary syndromes. The overall objective was to determine whether APCs on non-invasive CTA are associated with vulnerable plaque features by invasive optical coherence tomography (OCT).
  
  
  RESULTS
  Sixty-eight coronary plaques in 45 patients were evaluated by CTA and OCT. APCs by CTA were: positive remodelling (PR), remodelling index ≥1.10; low attenuation plaque (LAP), any intraplaque voxel <30 Hounsfield units; spotty calcification (SC), intraplaque calcification ≤3 mm; and 'napkin-ring' sign, low intraplaque attenuation surrounded by a higher attenuation rim. OCT evaluated plaques for thin-cap fibroatheroma (TCFA, ≤65 µm, lipid arch >90°) and macrophage infiltration. Increasing plaque vulnerability was graded by OCT as having no TCFA, TCFA without macrophage infiltration, and TCFA with macrophage infiltration. OCT lesions included those with no TCFA (n = 44), TCFA without macrophage infiltration (n = 7), and TCFA with macrophage infiltration (n = 17). Increasing plaque vulnerability grade by OCT was associated with higher diameter stenosis (43.6 vs. 40.7 vs. 57.3%, P = 0.01), and greater prevalence of PR (11 vs. 43 vs. 71%, P < 0.001), LAP (11 vs. 29 vs. 59%, P = 0.001), and SC (2 vs. 29 vs. 18%, P = 0.02), but not for napkin-ring sign (P = 0.18). In multivariable analysis, PR [odds ratio (OR) 16.9, 95% confidence interval (CI) 3.9-73.3, P < 0.001] and LAP (OR 11.2, 95% CI 2.8-44.3, P = 0.001) predicted TCFA with macrophage infiltration, whereas SC and napkin-ring sign did not.
  
  
  CONCLUSIONS
  Plaques demonstrating PR and LAP by CTA are associated with TCFA with macrophage infiltration by OCT.
authors.affiliation: Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakazato
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan hotake@med.kobe-u.ac.jp hiro_yuki15@yahoo.co.jp.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Department of Cardiology, Kobe Circulation Clinic, Kobe, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fukuya
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Departments of Medicine and Radiology, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Departments of Medicine and Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, Dalio Institute of Cardiovascular Imaging, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002114:Calcinosis / Q000175:diagnosis*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Computed tomography angiography; Optical coherence tomography; Plaque; Thin-cap fibroatheroma