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    J Korean Soc Radiol. 2011 Apr;64(4):309-315. Korean.
    Published online Apr 30, 2011.
    https://doi.org/10.3348/jksr.2011.64.4.309
    Copyright © 2011 The Korean Society of Radiology
    Original Article

    Analysis of Complex Coronary Plaque in Multidetector Computed Tomography: Comparison with Conventional Coronary Angiography

    Dong Hun Kim, M.D.,1 Duk-Won Bang, M.D.,2 Eun Ha Suk, M.D.,3 and Yoon Haeng Cho, M.D.4
      • 1Department of Radiology, Soonchunhyang University Hospital Bucheon, Korea.
      • 2Department of Internal Medicine, Soonchunhyang University Hospital, Korea.
      • 3Department of Anesthesiology and Pain Medicine, Asan Medical Center, Korea.
      • 4Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Korea.
    • Address reprint requests to: Dong Hun Kim, M.D., Ph.D., Department of Radiology, Soonchunhang University Bucheon Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon, Gyeonggi-do 420-853, Korea. Tel. 82-32-621-5851, Fax. 82-32-621-5874, Email: dhk0827@schmc.ac.kr
    Received June 03, 2010; Accepted March 06, 2011.

    Abstract

    Purpose

    To delineate complex plaque morphology in patients with stable angina using coronary computed tomographic angiography (CTA).

    Materials and Methods

    36 patients with complex plaques proven by conventional coronary angiography (CAG), who had taken CTA for evaluation of typical angina, were enrolled in this study. Intravascular ultrasonography (IVUS) was performed in 14 patients (16 lesions). We compared CTA with CAG for plaque features and analyzed vascular cutoff, intraluminal filling defect in a patent vessel, irregularity of plaque, and ulceration. Also, the density of plaque was evaluated on CTA.

    Results

    CAG and CTA showed complex morphology in 44 cases (100%) and 34 cases, (77%), respectively, with features including abrupt vessel cutoff (27 vs. 16%, κ= 0.57), intraluminal filling defect (32 vs. 30%, κ= 0.77), irregularity (75 vs. 52%, κ= 0.52), and ulceration (16 vs. 11%, κ= 0.60). CTA indicated that the complex lesions were hypodense (mean = 66 ± 21 Houndsfield Units).

    Conclusion

    CTA is a very accurate and useful non-invasive imaging modality for evaluating complex plaque in patients with typical angina.

    Keywords
    Tomography, X-Ray Computed; Angiography; Coronary Vessels

    Figures

    Fig. 1
    A 71-year-old man with chest pain. Invasive coronary angiography (A) shows LCX plaque characterized by bulky, lucent lesion with occlusion of distal LCX (arrows). CTA image (B) reveals similar morphology characterized by a bulky, hypodense plaque (arrows) with contrast filling distally in distal segment of LCX.

    Fig. 2
    A 63-year-old man with unstable ruptured RCA lesion. Invasive coronary angiography (A) documents filling defect, complex plaque severely narrowing the proximal segment of RCA (arrows). CTA image (B) shows a concordant bulky, eccentric and hypodense filling defect in proximal segment of RCA (arrow).

    Fig. 3
    A 78-year-old man with acute chest pain. Coronary angiogram (A) demonstrates severely irregular, stenotic lesion (black arrow) and occlusion (white arrow) in the proximal and middle segment of RCA, respectively. The CTA image (B) shows eccentric and hypodense plaque with irregular margin (arrow) compared to invasive coronary angiography.

    Fig. 4
    A 69-year-old man with atypical chest pain over 7 days duration. Invasive coronary angiography (A) shows hazy irregular lesion (dark arrow), with punctuate zone of ulceration (arrow) in middle segment of LAD. CTA (B) demonstrates the LAD lesion as irregular and eccentric low density plaque with intra-plaque contrast penetration indicative of ulceration (arrow).

    Tables

    Table 1
    Complex Plaque Features in CTA and CAG

    Table 2
    Predictive Accuracy of Complex Plaque Features by CTA

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    MeSH Terms
    Angina, Stable
    Angiography
    Coronary Angiography
    Coronary Vessels
    Glycosaminoglycans
    Humans
    Tomography, X-Ray Computed
    Ulcer
    Ultrasonography, Interventional
    Metrics
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