Donghee Han1, Sho Torii2, Kazuyuki Yahagi2, Fay Y Lin3, Ji Hyun Lee1, Asim Rizvi3, Heidi Gransar4, Mahn-Won Park3, Hadi Mirhedayati Roudsari3, Wijnand J Stuijfzand3, Lohendran Baskaran3, Bríain Ó Hartaigh3, Hyung-Bok Park5, Sang-Eun Lee5, Zabiullah Ali6, Robert Kutys2, Hyuk-Jae Chang5, James P Earls7, David Fowler6, Renu Virmani2, James K Min8. 1. Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA; Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. CVPath Institute, Inc., Gaithersburg, MD, USA. 3. Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA. 4. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA. 5. Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 6. Office of the Chief Medical Examiner, Baltimore, MD, USA. 7. Fairfax Radiological Consultants, 5553 Rockpoint Dr, Clifton, VA, USA. 8. Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu.
Abstract
BACKGROUND AND AIMS: Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque. METHODS: 8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque (LAP) was defined as any pixel < 30, 45, 60, 75, and 90 HU cut-offs within a coronary plaque. The area of LAP was calculated in each cross-section. RESULTS: Among 105 cross-sections, 37 (35.2%) cross-sectional histology images contained lipid rich plaque. Although the highest specificity for identifying lipid rich plaque was shown with <30 HU cut-off (88.2%), sensitivity (e.g. 55.6% for <75 HU, 16.2% for <30 HU) and negative predictive value (e.g. 75.9% for <75 HU, 65.9% for <30 HU) tended to increase with higher HU cut-offs. For quantitative measurement, <75 HU showed the highest correlation coefficient (0.292, p = 0.003) and no significant differences were observed between lipid rich plaque area and LAP area between histology and CT analysis (Histology: 0.34 ± 0.73 mm2, QCT: 0.37 ± 0.71 mm2, p = 0.701). CONCLUSIONS: LAP area by CCTA using a <75 HU cut-off value demonstrated high sensitivity and quantitative agreement with lipid rich plaque area by histology analysis. Published by Elsevier B.V.
BACKGROUND AND AIMS: Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque. METHODS: 8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque (LAP) was defined as any pixel < 30, 45, 60, 75, and 90 HU cut-offs within a coronary plaque. The area of LAP was calculated in each cross-section. RESULTS: Among 105 cross-sections, 37 (35.2%) cross-sectional histology images contained lipid rich plaque. Although the highest specificity for identifying lipid rich plaque was shown with <30 HU cut-off (88.2%), sensitivity (e.g. 55.6% for <75 HU, 16.2% for <30 HU) and negative predictive value (e.g. 75.9% for <75 HU, 65.9% for <30 HU) tended to increase with higher HU cut-offs. For quantitative measurement, <75 HU showed the highest correlation coefficient (0.292, p = 0.003) and no significant differences were observed between lipid rich plaque area and LAP area between histology and CT analysis (Histology: 0.34 ± 0.73 mm2, QCT: 0.37 ± 0.71 mm2, p = 0.701). CONCLUSIONS: LAP area by CCTA using a <75 HU cut-off value demonstrated high sensitivity and quantitative agreement with lipid rich plaque area by histology analysis. Published by Elsevier B.V.
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