title: Intravascular ultrasound for morphological assessment of napkin-ring sign detected on multidetector computed tomography.
abstract: BACKGROUND
  Although napkin-ring sign (NRS) plaques assessed by multidetector computed tomography (MDCT) is identified as a high-risk feature, the detailed morphological features are still unknown. The purpose of this study was to elucidate the morphological features of the MDCT-assessed NRS using intravascular ultrasound (IVUS).
  
  
  METHODS
  We evaluated 204 plaques in 193 patients with non-ST-elevation acute coronary syndrome who were diagnosed using 128-slice MDCT and were assessed using IVUS prior to coronary intervention. Morphology was compared between plaques with and without MDCT-assessed NRS. Severe IVUS-assessed attenuation was defined as an attenuation angle >180°.
  
  
  RESULTS
  NRS was detected in 49 lesions. MDCT-assessed plaque attenuation was lower (p<0.0001), and cross-sectional plaque areas at lesion sites, remodeling index, and the prevalence of positive remodeling were greater, in lesions with NRS (p<0.005, p<0.0001, and p<0.0001, respectively). Furthermore, the IVUS-assessed remodeling index and prevalence of severe attenuation and speckled echo appearance were significantly greater in lesions with NRS (p<0.01, p<0.0001, and p<0.0001, respectively). Using multivariate analysis, IVUS-assessed speckled echo appearance was identified as an independent predictor of MDCT-assessed NRS (odds ratio, 3.59; 95% confidence interval, 1.49-8.66; p<0.005).
  
  
  CONCLUSIONS
  MDCT assessment of NRS may be associated with larger heterogeneous necrotic cores and greater positive remodeling.
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan. Electronic address: ms-katou@asa-hosp.city.hiroshima.jp.
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Dote
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Miura
authors.affiliation: Department of Clinical Engineering, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyauchi
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Higashihara
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kubo
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Yamane
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kagawa
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Nagai
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.affiliation: Department of Cardiology, Hiroshima City Asa Citizens' Hospital, Hiroshima, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Acute coronary syndrome; Intravascular ultrasonography; Multidetector computed tomography; Napkin-ring sign