Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations

Objective: To evaluate the diagnostic accuracy of 16 slice computed tomography (CT) in determining plaque morphology and composition in an experimental setting. The results were compared with histopathological analysis as the reference standard. Methods: Nine human popliteal arteries derived from amputations because of atherosclerotic disease were investigated with multislice spiral CT (MSCT). Atherosclerotic lesions were morphologically classified (completely or partially occlusive, concentric, eccentric), and tissue densities were determined within these plaques. In addition, vessel dimensions were quantitatively measured. Results: The results were compared with histological analysis. The concordance index κ for morphological classification was 0.88. Plaque density (n  =  51 lesions) was significantly different (p < 0.0001) between lipid rich, fibrotic, and calcified lesions (Stary stage III: n  =  2, 58 (8) Hounsfield units (HU); Stary V: n  =  11, 50 (21) HU; Stary VI: n  =  14, 96 (42) HU; Stary VII: n  =  6, 858 (263) HU; Stary VIII: n  =  18, 126 (99) HU). The concordance index κ for the classification of plaques based on density was 0.51. Vessel dimensions had a good correlation (r  =  0.98). Conclusions: 16 slice CT was found to be a reliable non-invasive imaging technique for assessing atherosclerotic plaque morphology and composition. Although calcified lesions can be differentiated from non-calcified lesions, the diagnostic accuracy in further subclassifying non-calcified plaques as lipid rich and fibrotic is low, even under experimental conditions.

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