Measuring noncalcified coronary atherosclerotic plaque using voxel analysis with MDCT angiography: a pilot clinical study.

OBJECTIVE The purpose of our study was to evaluate a new method using voxel analysis for quantifying noncalcified plaque in coronary arteries using MDCT angiography (MDCTA) compared with luminal stenosis by catheter coronary arteriography. MATERIALS AND METHODS Forty-one normal and eight abnormal arterial cross sections with noncalcified plaque selected from 40 patients undergoing MDCTA were analyzed for percentage of stenosis and plaque volume using a voxel analysis technique. RESULTS Using voxel analysis, the normal arterial wall thickness was determined to be 0.8 +/- 0.4 mm. Attenuation values (in Hounsfield units) for normal segments ranged between 30 and 175 H and for abnormal (plaque-containing) segments ranged from -49 to 139 H (p < 0.05). Plaque volume measurements varied from 0.90 to 156 mm(3) with good interobserver correlation (R(2) = 0.9671). Percentage of stenosis correlated with quantitative coronary arteriography measurement (R(2) = 0.55). Voxel analysis underestimated the percentage of stenosis (Pearson's correlation coefficient, 1.2; p = 0.03). CONCLUSION The study shows that the voxel analysis technique appears to be an accurate and reproducible method to measure arterial wall thickness, noncalcified plaque, and degree of arterial stenosis using density values measured in Hounsfield units. The technique may be useful on further correlative studies.

[1]  W D Wagner,et al.  A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[2]  Konstantin Nikolaou,et al.  Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. , 2006, Journal of the American College of Cardiology.

[3]  Samin K. Sharma,et al.  Noninvasive in vivo human coronary artery lumen and wall imaging using black-blood magnetic resonance imaging. , 2000, Circulation.

[4]  W. Quist,et al.  Noninvasive characterization of plaque morphology using helical computed tomography. , 1998, The Journal of cardiovascular surgery.

[5]  N. Matsumoto,et al.  Evaluation of plaque texture by means of multislice computed tomography in patients with acute coronary syndrome and stable angina. , 2004, Circulation journal : official journal of the Japanese Circulation Society.

[6]  S. Achenbach,et al.  Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice multidetector computed tomography versus intravascular ultrasound. , 2004, The American journal of cardiology.

[7]  S. Nissen,et al.  Coronary angiography and intravascular ultrasound. , 2001, The American journal of cardiology.

[8]  Stephen J. Nicholls,et al.  Application of intravascular ultrasound in anti-atherosclerotic drug development , 2006, Nature reviews. Drug discovery.

[9]  T. Paavonen,et al.  Association between myocardial infarction and the mast cells in the adventitia of the infarct-related coronary artery. , 1999, Circulation.

[10]  Maximilian Reiser,et al.  Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. , 2003, The American journal of cardiology.

[11]  G. Rubin,et al.  New method of measuring coronary diameter by electron-beam computed tomographic angiography using adjusted thresholds determined by calibration with aortic opacity. , 2004, Circulation journal : official journal of the Japanese Circulation Society.

[12]  S. Achenbach,et al.  Detection of Calcified and Noncalcified Coronary Atherosclerotic Plaque by Contrast-Enhanced, Submillimeter Multidetector Spiral Computed Tomography: A Segment-Based Comparison With Intravascular Ultrasound , 2003, Circulation.

[13]  A Zalewski,et al.  Adventitial remodeling after coronary arterial injury. , 1996, Circulation.

[14]  Konstantin Nikolaou,et al.  Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. , 2005, Journal of the American College of Cardiology.

[15]  T Sandor,et al.  Quantitative angiographic and statistical methods to assess serial changes in coronary luminal diameter and implications for atherosclerosis regression trials. , 1992, The American journal of cardiology.

[16]  Damini Dey,et al.  Automated 3-dimensional quantification of noncalcified and calcified coronary plaque from coronary CT angiography. , 2009, Journal of cardiovascular computed tomography.

[17]  Measuring noncalcified coronary atherosclerotic plaque using voxel analysis with MDCT angiography: phantom validation. , 2008, AJR. American journal of roentgenology.

[18]  W. Bautz,et al.  Detection of Coronary Artery Stenoses With Thin-Slice Multi-Detector Row Spiral Computed Tomography and Multiplanar Reconstruction , 2003, Circulation.

[19]  M. Budoff,et al.  Effects of window and threshold levels on the accuracy of three-dimensional rendering techniques in coronary artery electron-beam CT angiography. , 2001, Academic radiology.

[20]  Zahi A Fayad,et al.  Acute coronary syndromes: biology , 1999, The Lancet.

[21]  H Anno,et al.  Minimum scan speeds for suppression of motion artifacts in CT. , 1992, Radiology.

[22]  Stephen Schroeder,et al.  Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. , 2005, Journal of the American College of Cardiology.

[23]  Faisal Khosa,et al.  Coronary plaque quantification by voxel analysis: dual-source MDCT angiography versus intravascular sonography. , 2009, AJR. American journal of roentgenology.

[24]  R. Frye,et al.  A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. , 1975, Circulation.

[25]  E. Topol,et al.  Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. , 1995, Circulation.

[26]  Konstantin Nikolaou,et al.  Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT , 2003, European Radiology.

[27]  G. Rubin,et al.  Coronary artery: quantitative evaluation of normal diameter determined with electron-beam CT compared with cine coronary angiography initial experience. , 2003, Radiology.

[28]  Fausto J. Pinto,et al.  Intravascular ultrasound imaging of coronary arteries. Is three layers the norm , 1991 .

[29]  M. Bell,et al.  Outcome > or = 10 years after successful percutaneous transluminal coronary angioplasty. , 1997, American Journal of Cardiology.

[30]  Akihiro Sato,et al.  Quantitative vascular measurements in arterial occlusive disease. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[31]  C. J. Ritchie,et al.  Evaluation of electron beam CT coronary angiography in healthy subjects. , 1997, AJR. American journal of roentgenology.

[32]  C Georg,et al.  Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. , 2001, Journal of the American College of Cardiology.

[33]  I. Gradus-Pizlo,et al.  Left anterior descending coronary artery wall thickness measured by high-frequency transthoracic and epicardial echocardiography includes adventitia. , 2003, The American journal of cardiology.

[34]  W Moshage,et al.  In-plane coronary arterial motion velocity: measurement with electron-beam CT. , 2000, Radiology.

[35]  Aloke V. Finn,et al.  Atherosclerotic Plaque Progression and Vulnerability to Rupture: Angiogenesis as a Source of Intraplaque Hemorrhage , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[36]  P. Kovanen,et al.  Adventitial mast cells connect with sensory nerve fibers in atherosclerotic coronary arteries. , 2000, Circulation.

[37]  Renu Virmani,et al.  Vulnerable plaque: the pathology of unstable coronary lesions. , 2002, Journal of interventional cardiology.

[38]  P. Yock,et al.  Intravascular ultrasound: novel pathophysiological insights and current clinical applications. , 2001, Circulation.

[39]  Konstantin Nikolaou,et al.  Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. , 2004, Journal of the American College of Cardiology.

[40]  Gorka Bastarrika,et al.  Reproducibility of Automated Noncalcified Coronary Artery Plaque Burden Assessment at Coronary CT Angiography , 2009, Journal of thoracic imaging.