Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes

Sadako Motoyama, Takeshi Kondo, Masayoshi Sarai, Atsushi Sugiura, Hiroto Harigaya, Takahisa Sato, Kaori Inoue, Masanori Okumura, Junichi Ishii, Hirofumi Anno, Renu Virmani, Yukio Ozaki, Hitoshi Hishida, Jagat Narula

Research output: Contribution to journalArticle

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Abstract

Objectives: To evaluate the feasibility of noninvasive assessment of the characteristics of disrupted atherosclerotic plaques, the authors interrogated the culprit lesions in acute coronary syndromes (ACS) by multislice computed tomography (CT). Background: Disrupted atherosclerotic plaques responsible for ACS histopathologically demonstrate large lipid cores and positive vascular remodeling. It is expected that plaques vulnerable to rupture should bear similar imaging signatures by CT. Methods: Either 0.5-mm × 16-slice or 64-slice CT was performed in 38 patients with ACS and compared with 33 patients with stable angina pectoris (SAP) before percutaneous coronary intervention. The coronary plaques in ACS and SAP were evaluated for the CT plaque characteristics, including vessel remodeling, consistency of noncalcified plaque (NCP <30 HU or 30 HU <NCP <150 HU), and spotty or large calcification. Results: In the CT profile of culprit ACS and SAP lesions, the frequency of 30 HU <NCP <150 HU (100% vs. 100%, p = NS) was not different, and large calcification (22% vs. 55%, p = 0.004) was significantly more frequent in the stable lesions. Positive remodeling (87% vs. 12%, p < 0.0001), NCP <30 HU (79% vs. 9%, p < 0.0001), and spotty calcification (63% vs. 21%, p = 0.0005) were significantly more frequent in the ACS lesions. Presence of all 3 (i.e., positive remodeling, NCP <30 HU, and spotty calcification) showed a high positive predictive value, and absence of all 3 showed a high negative predictive value for the culprit plaques associated with ACS. Conclusions: The CT characteristics of plaques associated with ACS include positive vascular remodeling, low plaque density, and spotty calcification. It is logical to presume that plaques vulnerable to rupture harbor similar characteristics.

Original languageEnglish
Pages (from-to)319-326
Number of pages8
JournalJournal of the American College of Cardiology
Volume50
Issue number4
DOIs
Publication statusPublished - 24-07-2007

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Acute Coronary Syndrome
Tomography
Stable Angina
Atherosclerotic Plaques
Rupture
Multidetector Computed Tomography
Percutaneous Coronary Intervention
Lipids

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Motoyama, Sadako ; Kondo, Takeshi ; Sarai, Masayoshi ; Sugiura, Atsushi ; Harigaya, Hiroto ; Sato, Takahisa ; Inoue, Kaori ; Okumura, Masanori ; Ishii, Junichi ; Anno, Hirofumi ; Virmani, Renu ; Ozaki, Yukio ; Hishida, Hitoshi ; Narula, Jagat. / Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes. In: Journal of the American College of Cardiology. 2007 ; Vol. 50, No. 4. pp. 319-326.
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title = "Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes",
abstract = "Objectives: To evaluate the feasibility of noninvasive assessment of the characteristics of disrupted atherosclerotic plaques, the authors interrogated the culprit lesions in acute coronary syndromes (ACS) by multislice computed tomography (CT). Background: Disrupted atherosclerotic plaques responsible for ACS histopathologically demonstrate large lipid cores and positive vascular remodeling. It is expected that plaques vulnerable to rupture should bear similar imaging signatures by CT. Methods: Either 0.5-mm × 16-slice or 64-slice CT was performed in 38 patients with ACS and compared with 33 patients with stable angina pectoris (SAP) before percutaneous coronary intervention. The coronary plaques in ACS and SAP were evaluated for the CT plaque characteristics, including vessel remodeling, consistency of noncalcified plaque (NCP <30 HU or 30 HU <NCP <150 HU), and spotty or large calcification. Results: In the CT profile of culprit ACS and SAP lesions, the frequency of 30 HU <NCP <150 HU (100{\%} vs. 100{\%}, p = NS) was not different, and large calcification (22{\%} vs. 55{\%}, p = 0.004) was significantly more frequent in the stable lesions. Positive remodeling (87{\%} vs. 12{\%}, p < 0.0001), NCP <30 HU (79{\%} vs. 9{\%}, p < 0.0001), and spotty calcification (63{\%} vs. 21{\%}, p = 0.0005) were significantly more frequent in the ACS lesions. Presence of all 3 (i.e., positive remodeling, NCP <30 HU, and spotty calcification) showed a high positive predictive value, and absence of all 3 showed a high negative predictive value for the culprit plaques associated with ACS. Conclusions: The CT characteristics of plaques associated with ACS include positive vascular remodeling, low plaque density, and spotty calcification. It is logical to presume that plaques vulnerable to rupture harbor similar characteristics.",
author = "Sadako Motoyama and Takeshi Kondo and Masayoshi Sarai and Atsushi Sugiura and Hiroto Harigaya and Takahisa Sato and Kaori Inoue and Masanori Okumura and Junichi Ishii and Hirofumi Anno and Renu Virmani and Yukio Ozaki and Hitoshi Hishida and Jagat Narula",
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Motoyama, S, Kondo, T, Sarai, M, Sugiura, A, Harigaya, H, Sato, T, Inoue, K, Okumura, M, Ishii, J, Anno, H, Virmani, R, Ozaki, Y, Hishida, H & Narula, J 2007, 'Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes', Journal of the American College of Cardiology, vol. 50, no. 4, pp. 319-326. https://doi.org/10.1016/j.jacc.2007.03.044

Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes. / Motoyama, Sadako; Kondo, Takeshi; Sarai, Masayoshi; Sugiura, Atsushi; Harigaya, Hiroto; Sato, Takahisa; Inoue, Kaori; Okumura, Masanori; Ishii, Junichi; Anno, Hirofumi; Virmani, Renu; Ozaki, Yukio; Hishida, Hitoshi; Narula, Jagat.

In: Journal of the American College of Cardiology, Vol. 50, No. 4, 24.07.2007, p. 319-326.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes

AU - Motoyama, Sadako

AU - Kondo, Takeshi

AU - Sarai, Masayoshi

AU - Sugiura, Atsushi

AU - Harigaya, Hiroto

AU - Sato, Takahisa

AU - Inoue, Kaori

AU - Okumura, Masanori

AU - Ishii, Junichi

AU - Anno, Hirofumi

AU - Virmani, Renu

AU - Ozaki, Yukio

AU - Hishida, Hitoshi

AU - Narula, Jagat

PY - 2007/7/24

Y1 - 2007/7/24

N2 - Objectives: To evaluate the feasibility of noninvasive assessment of the characteristics of disrupted atherosclerotic plaques, the authors interrogated the culprit lesions in acute coronary syndromes (ACS) by multislice computed tomography (CT). Background: Disrupted atherosclerotic plaques responsible for ACS histopathologically demonstrate large lipid cores and positive vascular remodeling. It is expected that plaques vulnerable to rupture should bear similar imaging signatures by CT. Methods: Either 0.5-mm × 16-slice or 64-slice CT was performed in 38 patients with ACS and compared with 33 patients with stable angina pectoris (SAP) before percutaneous coronary intervention. The coronary plaques in ACS and SAP were evaluated for the CT plaque characteristics, including vessel remodeling, consistency of noncalcified plaque (NCP <30 HU or 30 HU <NCP <150 HU), and spotty or large calcification. Results: In the CT profile of culprit ACS and SAP lesions, the frequency of 30 HU <NCP <150 HU (100% vs. 100%, p = NS) was not different, and large calcification (22% vs. 55%, p = 0.004) was significantly more frequent in the stable lesions. Positive remodeling (87% vs. 12%, p < 0.0001), NCP <30 HU (79% vs. 9%, p < 0.0001), and spotty calcification (63% vs. 21%, p = 0.0005) were significantly more frequent in the ACS lesions. Presence of all 3 (i.e., positive remodeling, NCP <30 HU, and spotty calcification) showed a high positive predictive value, and absence of all 3 showed a high negative predictive value for the culprit plaques associated with ACS. Conclusions: The CT characteristics of plaques associated with ACS include positive vascular remodeling, low plaque density, and spotty calcification. It is logical to presume that plaques vulnerable to rupture harbor similar characteristics.

AB - Objectives: To evaluate the feasibility of noninvasive assessment of the characteristics of disrupted atherosclerotic plaques, the authors interrogated the culprit lesions in acute coronary syndromes (ACS) by multislice computed tomography (CT). Background: Disrupted atherosclerotic plaques responsible for ACS histopathologically demonstrate large lipid cores and positive vascular remodeling. It is expected that plaques vulnerable to rupture should bear similar imaging signatures by CT. Methods: Either 0.5-mm × 16-slice or 64-slice CT was performed in 38 patients with ACS and compared with 33 patients with stable angina pectoris (SAP) before percutaneous coronary intervention. The coronary plaques in ACS and SAP were evaluated for the CT plaque characteristics, including vessel remodeling, consistency of noncalcified plaque (NCP <30 HU or 30 HU <NCP <150 HU), and spotty or large calcification. Results: In the CT profile of culprit ACS and SAP lesions, the frequency of 30 HU <NCP <150 HU (100% vs. 100%, p = NS) was not different, and large calcification (22% vs. 55%, p = 0.004) was significantly more frequent in the stable lesions. Positive remodeling (87% vs. 12%, p < 0.0001), NCP <30 HU (79% vs. 9%, p < 0.0001), and spotty calcification (63% vs. 21%, p = 0.0005) were significantly more frequent in the ACS lesions. Presence of all 3 (i.e., positive remodeling, NCP <30 HU, and spotty calcification) showed a high positive predictive value, and absence of all 3 showed a high negative predictive value for the culprit plaques associated with ACS. Conclusions: The CT characteristics of plaques associated with ACS include positive vascular remodeling, low plaque density, and spotty calcification. It is logical to presume that plaques vulnerable to rupture harbor similar characteristics.

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JF - Journal of the American College of Cardiology

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