Eun Ju Chun1, Jin Hee Han2, Seung Min Yoo3, Hwa Yeon Lee4, In Sup Song5, Charles S White6. 1. Department of Radiology, Seoul National University Bundang Hospital, South Korea. 2. Department of Radiology, CHA University Bundang Medical Center, Bundang, South Korea. 3. Department of Radiology, CHA University Bundang Medical Center, Bundang, South Korea. Electronic address: smyoo@cha.ac.kr. 4. Smile Radiologic Clinic, Seoul, South Korea. 5. Department of Radiology, Chun Ju Jesus Hospital, South Korea. 6. Department of Radiology, University of Maryland, Baltimore, MD, USA.
Abstract
BACKGROUND: The CT finding of "vulnerable plaque" is widely regarded as similar to that of a culprit lesion in an acute coronary syndrome (ACS). However, this hypothesis may not be accurate, since "vulnerable plaques" may substantially change their morphology when they rupture to cause an ACS. METHODS: We retrospectively evaluated coronary CT angiography data sets of 25 patients with ACS who had vulnerable (n = 10) or culprit plaques (n = 15). We analyzed CT features including positive remodeling (PR), low attenuation plaque (LAP), the napkin ring sign (NRS), degree of stenosis (normal, <50%, 50-99%, 100%), and myocardial hypoperfusion in the left ventricle. RESULTS: There was no difference in the prevalence of PR, NRS, or LAP between vulnerable and culprit plaques. In contrast, a majority (80%, 8/10) of vulnerable plaques were associated with <50% luminal stenosis while total occlusion was identified in 47% (7/15) of culprit plaques (p = .037). In all patients with occlusion, myocardial hypoperfusion was demonstrated in the corresponding arterial territory on CT. CONCLUSION: CT features of vulnerable and culprit plaques differ in cases with thrombotic occlusion reflecting dynamic plaque changes related to the episode of ACS.
BACKGROUND: The CT finding of "vulnerable plaque" is widely regarded as similar to that of a culprit lesion in an acute coronary syndrome (ACS). However, this hypothesis may not be accurate, since "vulnerable plaques" may substantially change their morphology when they rupture to cause an ACS. METHODS: We retrospectively evaluated coronary CT angiography data sets of 25 patients with ACS who had vulnerable (n = 10) or culprit plaques (n = 15). We analyzed CT features including positive remodeling (PR), low attenuation plaque (LAP), the napkin ring sign (NRS), degree of stenosis (normal, <50%, 50-99%, 100%), and myocardial hypoperfusion in the left ventricle. RESULTS: There was no difference in the prevalence of PR, NRS, or LAP between vulnerable and culprit plaques. In contrast, a majority (80%, 8/10) of vulnerable plaques were associated with <50% luminal stenosis while total occlusion was identified in 47% (7/15) of culprit plaques (p = .037). In all patients with occlusion, myocardial hypoperfusion was demonstrated in the corresponding arterial territory on CT. CONCLUSION: CT features of vulnerable and culprit plaques differ in cases with thrombotic occlusion reflecting dynamic plaque changes related to the episode of ACS.
Authors: Andrew Lin; Márton Kolossváry; Sebastien Cadet; Priscilla McElhinney; Markus Goeller; Donghee Han; Jeremy Yuvaraj; Nitesh Nerlekar; Piotr J Slomka; Mohamed Marwan; Stephen J Nicholls; Stephan Achenbach; Pál Maurovich-Horvat; Dennis T L Wong; Damini Dey Journal: JACC Cardiovasc Imaging Date: 2022-01-12