Cardiovascular Radiology
The assessment of coronary CT angiography in the diagnosis of vulnerable plaques
Xiaoxue Zhang, Yukun Pan, Ruigang Xie, Yinghui Ge
Published 2024-08-10
Cite as Chin J Radiol, 2024, 58(8): 822-828. DOI: 10.3760/cma.j.cn112149-20231113-00381
Abstract
ObjectiveTo explore the value of coronary CT angiography (CCTA) in the diagnosis of vulnerable plaques using intravascular ultrasound (IVUS) as the gold standard.
MethodsA retrospective analysis was conducted on the clinical and imaging data of coronary artery disease patients who underwent both IVUS and CCTA examinations at Fuwai Central China Cardiovascular Hospital from December 2017 to March 2022. Based on the IVUS results, the coronary plaques were divided into vulnerable and non-vulnerable plaque groups. Finally, 43 patients with a total of 88 coronary artery plaques were included, of which 26 were vulnerable plaques. Plaque analysis were performed on the CCTA images, including qualitative parameters such as low-density plaques (LAP), "napkin-ring" sign (NRS), spotty calcification (SC) and positive remodeling (PR), and the quantitative parameters such as minimum lumen area (MLA), total plaque volume (TPV), lesion length, volume and proportion of calcified plaque and fibrous plaque. The differences of CCTA parameters between the two groups were compared using t-test, chi-square test, and rank sum test. The association between CCTA parameters and the risk of vulnerable plaque was evaluated by logistic regression. Different CCTA parameters were used to establish qualitative, quantitative, and hybrid models, and the diagnostic efficacy of different models for vulnerable plaque was evaluated using the receiver operating characteristic (ROC) curve.
ResultsThere were significant differences in NRS (χ²=14.22, P<0.001), MLA (Z=3.25, P=0.001), lesion length (Z=-3.28, P=0.001), TPV (Z=-2.04, P=0.041), calcified plaque volume (Z=-2.52, P=0.012) and fibrous plaque volume (Z=-2.10, P=0.035) between vulnerable and non-vulnerable plaque groups. The logistic regression analysis showed that NRS (OR=9.66, 95%CI 2.36-39.54), MLA (OR=0.76, 95%CI 0.59-0.99) and lesion length (OR=1.03, 95%CI 1.00-1.07) were independent risk factors for vulnerable plaques. The diagnostic efficacy of the hybrid model based on CCTA parameters was superior to the qualitative model [hybrid model: area under the ROC curve (AUC)=0.82, 95%CI 0.72-0.89; qualitative model: AUC=0.68, 95%CI 0.57-0.78; Z=2.57, P=0.010].
ConclusionsCCTA parameters NRS, MLA, and lesion length are independent risk factors for coronary vulnerable plaques. The diagnostic efficacy of the hybrid model based on CCTA parameters is superior to the qualitative model for vulnerable plaques.
Key words:
Tomography, X-ray computed; Vulnerable plaque; Coronary; Intravascular ultrasound; Quantitative parameters; Qualitative parameters
Contributor Information
Xiaoxue Zhang
Intervention Center, Fuwai Central China Cardiovascular Hospital, Henan Provincial People′s Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou 450003, China
Yukun Pan
Department of Radiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People′s Hospital, Zhengzhou University People′s Hospital, Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou 450003, China
Ruigang Xie
Department of Radiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People′s Hospital, Zhengzhou University People′s Hospital, Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou 450003, China
Yinghui Ge
Department of Radiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People′s Hospital, Zhengzhou University People′s Hospital, Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou 450003, China
