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Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation

BACKGROUND: Identifying vulnerable coronary plaque with coronary CT angiography is limited by overlap between attenuation of necrotic core and fibrous plaque. Using x-rays with differing energies alters attenuation values of these components, depending on their material composition. OBJECTIVES: We s...

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Autores principales: Obaid, Daniel R., Calvert, Patrick A., Gopalan, Deepa, Parker, Richard A., West, Nick E.J., Goddard, Martin, Rudd, James H.F., Bennett, Martin R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070076/
https://www.ncbi.nlm.nih.gov/pubmed/24939072
http://dx.doi.org/10.1016/j.jcct.2014.04.007
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author Obaid, Daniel R.
Calvert, Patrick A.
Gopalan, Deepa
Parker, Richard A.
West, Nick E.J.
Goddard, Martin
Rudd, James H.F.
Bennett, Martin R.
author_facet Obaid, Daniel R.
Calvert, Patrick A.
Gopalan, Deepa
Parker, Richard A.
West, Nick E.J.
Goddard, Martin
Rudd, James H.F.
Bennett, Martin R.
author_sort Obaid, Daniel R.
collection PubMed
description BACKGROUND: Identifying vulnerable coronary plaque with coronary CT angiography is limited by overlap between attenuation of necrotic core and fibrous plaque. Using x-rays with differing energies alters attenuation values of these components, depending on their material composition. OBJECTIVES: We sought to determine whether dual-energy CT (DECT) improves plaque component discrimination compared with single-energy CT (SECT). METHODS: Twenty patients underwent DECT and virtual histology intravascular ultrasound (VH-IVUS). Attenuation changes at 100 and 140 kV for each plaque component were defined, using 1088 plaque areas co-registered with VH-IVUS. Hounsfield unit thresholds that best detected necrotic core were derived for SECT (conventional attenuation values) and for DECT (using dual-energy indices, defined as difference in Hounsfield unit values at the 2 voltages/their sum). Sensitivity of SECT and DECT to detect plaque components was determined in 77 segments from 7 postmortem coronary arteries. Finally, we examined 60 plaques in vivo to determine feasibility and sensitivity of clinical DECT to detect VH-IVUS–defined necrotic core. RESULTS: In contrast to conventional SECT, mean dual-energy indices of necrotic core and fibrous tissue were significantly different with minimal overlap of ranges (necrotic core, 0.007 [95% CI, –0.001 to 0.016]; fibrous tissue, 0.028 [95% CI, 0.016–0.050]; P < .0001). DECT increased diagnostic accuracy to detect necrotic core in postmortem arteries (sensitivity, 64%; specificity, 98%) compared with SECT (sensitivity, 50%; specificity, 94%). DECT sensitivity to detect necrotic core was lower when analyzed in vivo, although still better than SECT (45% vs 39%). CONCLUSIONS: DECT improves the differentiation of necrotic core and fibrous plaque in ex vivo postmortem arteries. However, much of this improvement is lost when translated to in vivo imaging because of a reduction in image quality.
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spelling pubmed-40700762014-06-26 Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation Obaid, Daniel R. Calvert, Patrick A. Gopalan, Deepa Parker, Richard A. West, Nick E.J. Goddard, Martin Rudd, James H.F. Bennett, Martin R. J Cardiovasc Comput Tomogr Original Research Article BACKGROUND: Identifying vulnerable coronary plaque with coronary CT angiography is limited by overlap between attenuation of necrotic core and fibrous plaque. Using x-rays with differing energies alters attenuation values of these components, depending on their material composition. OBJECTIVES: We sought to determine whether dual-energy CT (DECT) improves plaque component discrimination compared with single-energy CT (SECT). METHODS: Twenty patients underwent DECT and virtual histology intravascular ultrasound (VH-IVUS). Attenuation changes at 100 and 140 kV for each plaque component were defined, using 1088 plaque areas co-registered with VH-IVUS. Hounsfield unit thresholds that best detected necrotic core were derived for SECT (conventional attenuation values) and for DECT (using dual-energy indices, defined as difference in Hounsfield unit values at the 2 voltages/their sum). Sensitivity of SECT and DECT to detect plaque components was determined in 77 segments from 7 postmortem coronary arteries. Finally, we examined 60 plaques in vivo to determine feasibility and sensitivity of clinical DECT to detect VH-IVUS–defined necrotic core. RESULTS: In contrast to conventional SECT, mean dual-energy indices of necrotic core and fibrous tissue were significantly different with minimal overlap of ranges (necrotic core, 0.007 [95% CI, –0.001 to 0.016]; fibrous tissue, 0.028 [95% CI, 0.016–0.050]; P < .0001). DECT increased diagnostic accuracy to detect necrotic core in postmortem arteries (sensitivity, 64%; specificity, 98%) compared with SECT (sensitivity, 50%; specificity, 94%). DECT sensitivity to detect necrotic core was lower when analyzed in vivo, although still better than SECT (45% vs 39%). CONCLUSIONS: DECT improves the differentiation of necrotic core and fibrous plaque in ex vivo postmortem arteries. However, much of this improvement is lost when translated to in vivo imaging because of a reduction in image quality. Elsevier 2014-05 /pmc/articles/PMC4070076/ /pubmed/24939072 http://dx.doi.org/10.1016/j.jcct.2014.04.007 Text en © 2014 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.
spellingShingle Original Research Article
Obaid, Daniel R.
Calvert, Patrick A.
Gopalan, Deepa
Parker, Richard A.
West, Nick E.J.
Goddard, Martin
Rudd, James H.F.
Bennett, Martin R.
Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation
title Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation
title_full Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation
title_fullStr Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation
title_full_unstemmed Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation
title_short Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation
title_sort dual-energy computed tomography imaging to determine atherosclerotic plaque composition: a prospective study with tissue validation
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070076/
https://www.ncbi.nlm.nih.gov/pubmed/24939072
http://dx.doi.org/10.1016/j.jcct.2014.04.007
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