Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography
Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography
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DOI：
10.1016/j.atherosclerosis.2010.02.001
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发表时间：
2010-08-01
期刊：
影响因子：
5.3
通讯作者：
Achenbach, Stephan
中科院分区：
文献类型：
--
作者：
Pflederer, Tobias;Marwan, Mohamed;Achenbach, Stephan
目的：通过对比增强冠状动脉双源CT血管造影（CTA）分析急性冠状动脉综合征（ACS）冠状动脉粥样硬化斑块的典型形态学特征，并与稳定的冠状动脉病变进行比较。患者和方法：研究了55例ACS患者和55例具有相似动脉粥样硬化风险特征的稳定型心绞痛（SAP）患者。在有创置管前，使用双源CT扫描仪（旋转330 ms， 2 x 64 x 0.6 mm准直，以6 mL/s静脉注射60-80 mL造影剂）进行CT血管造影。我们分析了斑块体积（mm(3)）、平均和最小CT密度（HU）、重塑指数、斑块类型（钙化/非钙化/混合）、“点状”钙化的存在以及造影剂边缘的存在。结果：在ACS和SAP患者中，钙化和非钙化成分分别为28和10个病变，但非钙化物质比例较大，钙化物质比例较大的分别为6和23个病变，完全非钙化的分别为21和8个病变。ACS的罪魁祸首斑块和SAP的14个病变均未完全钙化。在55例ACS病例中，有11例和14例出现斑块内的“点状”钙化和被造影剂边缘包围的中心充盈缺陷，但在SAP病变中从未出现过。ACS的罪魁祸首病变和SAP患者的病变，平均斑块体积分别为192.8 +/- 114.9 mm(3)和103.8 +/- 51.8 mm(3) (p = 0.001)，平均和最小CT密度分别为85.6 +/- 45.1 HU和47.2 +/- 33.7 HU，而143.8 +/- 104.1 HU和95.9 +/- 84.0 HU (p < 0.01)，平均重塑指数分别为1.6 +/- 0.4和0.97 +/- 0.17 （p < 0.001）。结论：ACS罪犯病变斑块在无创冠状动脉CT血管造影中表现出特殊的形态特征。与稳定病变相比，ACS的罪魁祸首病变显示出更大比例的非钙化物质和“点状”钙化/造影剂边缘，斑块体积更大，CT衰减更低，重塑指数更高。2010爱思唯尔爱尔兰有限公司版权所有。
Objective: We analyzed typical morphological features of coronary atherosclerotic plaques in acute coronary syndromes (ACS) using contrast-enhanced coronary Dual-Source CT angiography (CTA) in comparison to stable coronary lesions.Patients and methods: Fifty-five patients with ACS and 55 controls with stable angina pectoris (SAP) with similar atherosclerotic risk profile were studied. CT angiography was performed using a Dual-Source CT scanner (330 ms rotation, 2 x 64 x 0.6 mm collimation, 60-80 mL contrast agent i.v. at 6 mL/s) before invasive catheterization. We analyzed plaque volume(mm(3)), mean and minimal CT density (HU), remodeling index, plaque type (calcified/non-calcified/mixed) and presence of "spotty" calcifications as well as presence of contrast rims.Results: In patients with ACS and SAP, 28 and 10 lesions showed both calcified and non-calcified components, but in a greater proportion of non-calcified material, 6 and 23 lesions showed a greater proportion of calcified material and 21 and 8 lesions were completely non-calcified, respectively. None of the culprit plaques in ACS and 14 of the lesions in SAP were completely calcified. A "spotty" pattern of calcification within the plaque and a central filling defect surrounded by a rim of contrast were present in 11 and 14 of 55 ACS cases, but never in SAP lesions. For culprit lesions in ACS and for lesions in patients with SAP, mean plaque volumes were 192.8 +/- 114.9 mm(3) and 103.8 +/- 51.8 mm(3) (p = 0.001), mean and minimal CT densities were 85.6 +/- 45.1 HU and 47.2 +/- 33.7 HU versus 143.8 +/- 104.1 HU and 95.9 +/- 84.0 HU (p < 0.01) and mean remodeling indices were 1.6 +/- 0.4 and 0.97 +/- 0.17 (p < 0.001), respectively.Conclusion: Plaques of culprit lesions in ACS show specific morphologic characteristics in non-invasive coronary CT angiography. As compared to stable lesions, culprit lesions in ACS display greater proportion of non-calcified material and presence of "spotty" calcifications/contrast rims as well as larger plaque volumes, lower CT attenuation and higher remodeling indices. (C) 2010 Elsevier Ireland Ltd. All rights reserved.