Masahiro Higashi1,2, Naoaki Yamada2, Satoshi Imakita3, Chikao Yutani4,5, Hatsue Ishibashi-Ueda6, Koji Iihara7, Hiroaki Naito8. 1. Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan. 2. Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. 3. Hi-Medic Clinic, Osaka, Japan. 4. Department of Pathology, Amagasaki Central Hospital, Amagasaki, Japan. 5. Department of Pathology, Cardiovascular Center Osaka Gyoumeikan Hospital, Osaka, Japan. 6. Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan. 7. Department of Neurosurgery, Graduate School of Medical Science Kyushu University, Fukuoka, Japan. 8. Department of Radiology, Nippon Life Hospital, Osaka, Japan.
Abstract
OBJECTIVE: Pathologic features of atherosclerotic plaques on CT are not established. We compared CT values among pathologically confirmed plaque constituents and evaluated their ability to distinguish plaque constituents. METHODS: 50 histopathological images of carotid endarterectomy samples from 10 males and 2 females (age 54-74 years, average 65.9 years) were examined. We compared pre-operative CT [pre-contrast (CT-P), early post-contrast phase (CT-E), delayed post-contrast phase (CT-D)] of lipid-rich necrotic core (NC) and fibrous tissue (F) plaque components with pathological images. The ability of features to differentiate plaque components using several discrimination techniques were compared. RESULTS: CT values of NC and F were 36 ± 13, 45 ± 11 (mean ± standard deviation, Hounsfield unit, HU), 41 ± 17, 69 ± 18, and 44 ± 16, 70 ± 13 in CT-P (p < 0.01), CT-E (p < 0.0001), and CT-D (p < 0.0001), respectively. The threshold, sensitivity, and accuracy for distinguishing NC from F were 44 HU, 74%, and 68%; 55 HU, 85%, and 85%; and 63 HU, 92%, and 84% in CTP, CT-E, and CT-D, respectively. CT-P had lower accuracy than CT-E and CT-D (both p < 0.05), but CT-E and CT-D were similar. CT-E and CT-D yielded 90 and 91% sensitivity and accuracy, respectively in linear discrimination analysis. CONCLUSION: In both pre- and post-contrast CT, CT values were lower in NC than F. Although values overlapped, using two-phase post-contrast CTs improved discrimination ability. ADVANCES IN KNOWLEDGE: Our findings may help to establish computer-aided diagnosis of vulnerable atherosclerotic plaques in future.
OBJECTIVE: Pathologic features of atherosclerotic plaques on CT are not established. We compared CT values among pathologically confirmed plaque constituents and evaluated their ability to distinguish plaque constituents. METHODS: 50 histopathological images of carotid endarterectomy samples from 10 males and 2 females (age 54-74 years, average 65.9 years) were examined. We compared pre-operative CT [pre-contrast (CT-P), early post-contrast phase (CT-E), delayed post-contrast phase (CT-D)] of lipid-rich necrotic core (NC) and fibrous tissue (F) plaque components with pathological images. The ability of features to differentiate plaque components using several discrimination techniques were compared. RESULTS: CT values of NC and F were 36 ± 13, 45 ± 11 (mean ± standard deviation, Hounsfield unit, HU), 41 ± 17, 69 ± 18, and 44 ± 16, 70 ± 13 in CT-P (p < 0.01), CT-E (p < 0.0001), and CT-D (p < 0.0001), respectively. The threshold, sensitivity, and accuracy for distinguishing NC from F were 44 HU, 74%, and 68%; 55 HU, 85%, and 85%; and 63 HU, 92%, and 84% in CTP, CT-E, and CT-D, respectively. CT-P had lower accuracy than CT-E and CT-D (both p < 0.05), but CT-E and CT-D were similar. CT-E and CT-D yielded 90 and 91% sensitivity and accuracy, respectively in linear discrimination analysis. CONCLUSION: In both pre- and post-contrast CT, CT values were lower in NC than F. Although values overlapped, using two-phase post-contrast CTs improved discrimination ability. ADVANCES IN KNOWLEDGE: Our findings may help to establish computer-aided diagnosis of vulnerable atherosclerotic plaques in future.
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