冠状动脉周围脂肪CT值与斑块性质及所在分支的相关性研究

目的 探讨分析冠状动脉周围脂肪(PCAT)CT值与斑块性质及所在分支的相关性。方法 通过冠状动脉CTA检查,入组管腔轻-中度狭窄的患者178例(疾病组),管腔无狭窄的106例(对照组),测量疾病组中不同冠状动脉分支中、不同性质斑块与同支正常区域的PCAT的CT值,并测量所有病例的心外膜脂肪(EAT)及左胸壁皮下脂肪CT值。结果 疾病组较对照组平均年龄大,平均心率快,高血压的发生率高,EAT及左胸壁皮下脂肪CT值较高(P<0.05)。对比各性质斑块、各冠状动脉分支斑块与同支正常区域PCAT的CT值,发现部分钙化、非钙化斑块PCAT的CT值对比正常差异有统计学意义(P<0.05)。右冠状动脉(RCA)斑块、左主干-左前降支(LM-LAD)斑块PCAT的CT值对比正常差异有统计学意义(P<0.05)。分析斑块性质及冠状动脉分支部位对斑块PCAT的CT值的影响,发现钙化斑块PCAT的CT值较部分钙化及非钙化斑块PCAT的CT值低,且差异有统计学意义(P<0.05),而冠状动脉分支部位对斑块PCAT的CT值无明显影响(F=0.603,P=0.548)。结论 PCAT、EA...     

基于CCTA的冠状动脉周围脂肪组织影像组学特征预测急性冠状动脉综合征

目的 评估基于冠状动脉CT血管成像（CCTA）的冠状动脉周围脂肪组织（PCAT）影像组学特征对疑似冠心病病人2年内发生急性冠状动脉综合征（ACS）的预测能力。方法 回顾性收集接受CCTA检查的疑似冠心病病人,将CCTA检查后2年内发生ACS的病人作为ACS组（81例）,2年内未发生ACS的疑似冠心病病人作为对照组（81例）。ACS组年龄44~85岁,平均（64.01±10.09）岁,男57例;对照组年龄39~89岁,平均（62.91±10.11）岁,男56例。将2组病人随机以 3∶1 的比例分为训练集（ACS组60例,对照组60例）和验证集（ACS组21例,对照组21例）。筛选基于CCTA的PCAT影像组学特征,采用多因素Logistic回归分析构建PCAT影像组学评分模型,并基于PCAT影像组学特征中的CT密度值建立PCAT密度模型。采用DeLong检验比较不同数据集中2个模型的诊断效能差异。采用受试者操作特征（ROC）曲线、校准曲线及决策曲线比较2种模型的预测效能。结果 训练集和验证集中,ACS组和对照组病人的临床资料间差异均无统计学意义（均P>0.05）。从基于CCTA影像所示的冠状动脉斑块周围PCAT共提取107个影像组学特征,最终筛选出21个最优影像组学特征,包括形态学特征5个、直方图特征1个、纹理特征15个,采用Logistic回归分析构建PCAT影像组学评分模型。基于提取的PCAT组学特征中平均 CT密度值构建PCAT密度模型。2种模型预测2年内发生ACS事件的诊断效能分析显示,PCAT 影像组学评分模型在训练集及验证集中的曲线下面积（AUC）（AUC=0.841,0.839） 均高于PCAT 密度的AUC（AUC=0.603,0.588）。训练集中,PCAT影像组学评分的诊断效能优于PCAT密度模型（P<0.05）,并在验证集中得到验证（P<0.05）。PCAT影像组学评分对发生ACS事件的预测结果与实际结果一致性高于PCAT密度。PCAT影像组学评分的临床应用价值显著优于PCAT 密度。结论 基于CCTA 的PCAT影像组学特征可为ACS事件的发生提供更多的预测信息。PCAT 影像组学评分对2年内发生ACS事件的预测能力显著优于PCAT 密度。     

冠脉CT血管成像定量分析比较急性冠脉综合征和稳定冠脉冠心病患者中斑块狭窄的差异

【摘要】目的：探讨冠脉CT血管成像(CTA)分析急性冠脉综合征(ACS)及稳定型冠心病的斑块负荷及血管狭窄的价值。方法：选取符合要求的ACS患者及其年龄、性别均匹配的稳定型冠心病患者各40例为研究对象,分为ACS组和对照组,均行CTA检测并采用自动计算机软件包定量计算斑块及血管体积、各斑块负荷、血管狭窄及血管重建指标。结果：ACS组的非钙化斑块(NCP)负荷、总斑块负荷、狭窄程度及重建指数均明显高于对照组,差异有统计学意义(P=0.000),而各种斑块及总斑块体积、血管体积及钙化斑块(CP)负荷在两组间的差异无统计学意义(P>0.05)。NCP负荷及正性重建在ACS组中所占的比例均明显高于对照组,差异有统计学意义(P值分别为0.001,0.035,0.007),而对照组中的CP负荷则高于ACS组,差异有统计学意义（P=0.003)。结论：CTA可有效的鉴别ACS和稳定型冠心病的斑块负荷及血管狭窄等的差异,值得临床合理应用。     

冠状动脉周围脂肪组织在不同斑块类型中的差异

目的 探究不同斑块类型的冠状动脉周围脂肪组织（PCAT）的差异。资料与方法 回顾性分析2020年3月—2021年6月在兰州大学第二医院经冠状动脉CT血管造影确诊为冠心病的488例患者共279个钙化斑块，其中153个非钙化斑块，56个混合斑块。分析一般临床资料、斑块位置及PCAT定量参数如体积、脂肪衰减指数（FAI）在不同斑块类型间的差异。采用受试者工作特征曲线评估FAI对不同斑块类型的诊断效能。结果 不同斑块类型患者年龄、性别、体重指数、高危因素（吸烟、高血压、高血糖、高脂血症）及斑块位置差异无统计学意义（P均>0.05）；非钙化斑块的PCAT体积小于钙化斑块及混合斑块（H=65.649,P<0.001）；非钙化斑块及混合斑块的FAI大于钙化斑块[分别为-73.0（-80.0，-67.0）Hu、-76.5（-83.8，-70.0）Hu、-85.0（-92.0，-80.0）Hu;H=134.005,P<0.001）。使用FAI区分钙化和非钙化斑块的曲线下面积为0.821(95%CI 0.778～0.864)，使用FAI区分钙化和混合斑块的曲线下面积为0.747(95%C...     

CT 测量心外膜脂肪组织体积与冠状动脉斑块的关系

目的：CT测量心外膜脂肪组织(EAT)体积与冠状动脉粥样硬化斑块的关系。方法141例疑似冠心病患者行多层螺旋 CT 造影检查,精确测量相应 EAT 体积。(1)根据造影检查结果确定冠状动脉粥样硬化斑块的有无和类型,分别进行斑块组与非斑块组,钙化斑块组、混合斑块组、非钙化斑块组,心外膜脂肪体积的比较。(2)按照不同性别分组,比较斑块组与非斑块组 EAT体积的差异。(3)依据年龄不同分组,比较斑块组与非斑块组在不同年龄段 EAT 体积的差异。结果冠状动脉有斑块63例,其中钙化斑块15例,非钙化斑块20例,混合斑块28例;无斑块78例。斑块组 EAT 体积大于非斑块组,两者之间存在统计学差异(P <0.05)。不同性质斑块之间 EAT 体积差异无统计学意义。EAT 体积在斑块组和非斑块组均为女性高于男性,但差异无统计学意义。按年龄分组后,各年龄组内 EAT 体积均为斑块组大于非斑块组,但只有在65岁后,差别存在统计学意义。结论EAT 体积与冠状动脉粥样硬化斑块形成存在较强的相关性,在65岁后表现的更加明显。相关性不受性别影响。     

引起冠状动脉功能学缺血性的斑块特征分析

目的 以有创分数血流储备(FFR)为标准,鉴别引起冠状动脉功能性缺血斑块的影像学特征,进一步提高冠状动脉CT血管造影(CCTA)的诊断效能。方法 回顾性纳入2012年9月至2020年1月在本院30天内接受CCTA、有创性冠状动脉造影(ICA)以及导丝FFR检查患者,在CCTA上记录血管狭窄度以及斑块参数,包括非钙化斑块、病变长度、钙化的形态、正性重构、“餐巾环征”、狭窄程度。FFR<0.80的病变被认为功能性缺血性病变。将单因素逻辑回归中有统计学意义的斑块参数纳入多因素模型,受试者工作特征曲线(ROC)分析模型的曲线下面积(AUC),并与单独血管狭窄率模型比较。结果 共纳入173例患者[男112例(61.73±8.34岁]的204枚斑块。将3个单因素有意义的参数(即“餐巾环征”、正性重构、点状钙化)与血管狭窄率共同建立的模型,AUC达到0.837,显著高于单独以血管狭窄率建立的模型(AUC为0.679,P<0.001)。结论 研究表明部分高危斑块特征与血管狭窄率组合建模后对于预测有血流动力学意义的狭窄有着更高的准确率。     

HIV感染患者冠状动脉斑块特征定量参数、高危斑块形态特征与CT-FFR的相关性研究

目的 基于冠状动脉CT血管造影(CCTA)研究人类免疫缺陷病毒感染[HIV(+)]患者中冠状动脉斑块特征参数及高危斑块形态学特征与血流储备分数(FFR)测量值之间的相关性。方法 回顾性分析行CCTA检查的121例HIV(+)共167支血管的临床及影像资料。所有患者均接受CCTA检查。测量计算冠状动脉血管基于CCTA的无创性血流储备分数(CT-FFR)值,将CT-FFR≤0.80定义为冠状动脉缺血性改变,并依据CT-FFR值将其分为CT-FFR>0.80组(n=103)和CT-FFR≤0.80组(n=64)。使用半自动软件测量其斑块特征参数：斑块总体积、脂质斑块体积、钙化斑块体积、纤维斑块体积、非钙化斑块体积、最小管腔面积、斑块长度、狭窄程度、重塑指数及偏心指数;分析高危斑块形态学特征：低衰减斑块、正性重构、点状钙斑、“餐巾环征”。分析比较两组间冠状动脉斑块特征参数及高危斑块形态特征的差异,采用单因素及多因素Logistic回归分析CT-FFR≤0.80的相关危险因素。结果 与CT-FFR>0.80组相比,CT-FFR≤0.80组中斑块长度更长[13.2 mm(8.5 mm,...     

基于CT影像组学在冠状动脉周围脂肪中的研究

【摘要】冠状动脉周围脂肪组织（PCAT）是一种独特的,具有高度多样化的分泌组织,与相邻血管壁双向作用,在血管炎症时通过改变其表型促进动脉粥样硬化的发生。传统的心脏CT血管造影(CCTA)通过PCAT衰减变化来检测斑块周围炎症变化,而机器学习和影像组学特征的提取有利于对PCAT生物学变化进行识别,对患者风险分层、针对性的预防策略以及疾病管理具有重要的临床意义。本文就PCAT在心血管疾病中的生物学作用、影像学评估方法以及影像组学在PCAT应用中的研究现状作一综述。     

冠状动脉CT血管成像在急性冠状动脉综合征中的应用进展

对于疑诊急性冠状动脉综合征(ACS)患者, 当肌钙蛋白和/或心电图不能明确诊断且患者有中低度可能为冠心病时, 欧洲指南推荐(Ⅰ类)用冠状动脉CT血管成像(CCTA)来排除ACS。CCTA除了可以显示病变的狭窄、位置等解剖信息, 还可定量分析斑块信息和冠状动脉周围脂肪密度, 提供血流储备分数等功能学信息, 在ACS中的应用日趋广泛。本文综述CCTA在优化可疑ACS的诊疗路径、诊断ACS、预测ACS患者预后的研究进展, 并展望未来冠状动脉CT血管成像在ACS中应用的科研方向。     

冠状动脉CTA多参数AI特征对急性冠脉综合征的诊断价值

目的:基于冠状动脉CTA(CCTA)探讨通过人工智能技术获取罪犯斑块多参数特征对急性冠脉综合征(ACS)的诊断价值。方法:本研究共纳入65名ACS患者,根据侵入性冠脉造影(ICA)结果将斑块分为罪犯斑块组(n=65)和非罪犯斑块组(n=67),利用CCTA对冠脉血管进行分析,通过人工智能软件获得冠脉周围脂肪衰减指数(FAI)、基于CCTA血流储备分数(FFRct)及斑块定量参数,比较罪犯斑块与非罪犯斑块的差异性及罪犯斑块的影响因素。同时根据罪犯斑块组中的FFRct值进行分组,分为FFRct>0.8组(n=28),FFRct≤0.8组(n=37),比较其FFRct与斑块定量参数的相关性。结果:罪犯斑块与非罪犯斑块在FAI、FFRct、最狭窄处管腔面积(MLA)、重构指数(RI)及钙化斑块负荷存在差异性(P均<0.05)。FAI、FFRct、RI、MLA是罪犯斑块的主要影响因素(P值分别为0.002、0.002、0.004、0.025),FAI、FFRct、MLA、RI及4个指标联合诊断模型诊断罪犯斑块的ROC曲线显示,联合诊断模型的曲线下面积最大(AUC=0.792),提示其...     

The effect of patient and imaging characteristics on coronary CT angiography assessed pericoronary adipose tissue attenuation and gradient

BackgroundCoronary CT angiography (CCTA) pericoronary adipose tissue (PCAT) markers are promising indicators of inflammation.ObjectiveTo determine the effect of patient and imaging parameters on the associations between non-calcified plaque (NCP) and PCAT attenuation and gradient.MethodsThis was a single-center, retrospective analysis of consecutive patients with stable chest pain who underwent CCTA and had zero calcium scores. CCTA images were evaluated for the presence of NCP, obstructive stenosis, segment stenosis and involvement score (SSS, SIS), and high-risk plaque (HRP). PCAT markers were assessed using semi-automated software. Uni- and multivariable regression models correcting for patient and imaging characteristics between plaque and PCAT markers were evaluated.ResultsOverall, 1652 patients had zero calcium score (mean age: 51 years ?± ?11 [SD], 871 women); PCAT attenuation values ranged between ?123 HU and ?51 HU, and 649 patients had plaque. In univariable analysis, the presence of NCP, SSS, SIS, and HRP were associated with PCAT attenuation (2, 1, 1, 6 HU; respectively; p ?< ?.001 all); while obstructive stenosis was not (1 HU, p ?= ?.58). In multivariable analysis, none of the plaque markers were associated with PCAT attenuation (0 HU p ?= ?.93, 0 HU p ?= ?.39, 1 HU p ?= ?.18, 2 HU p ?= ?.10, 1 HU p ?= ?.71, respectively), while patient and imaging characteristics showed significant associations, such as: male sex (1 HU, p ?= ?.003), heart rate [1/min] (?0.2 HU, p ?< ?.001), 120 ?kVp (8 HU, p ?< ?.001) and pixel spacing [mm³] (32 HU, p ?< ?.001). Similar results were observed for PCAT gradient.ConclusionPCAT markers were significantly associated with NCP, however the associations did not persist following correction for patient and imaging characteristics.     

Repeatability of quantitative pericoronary adipose tissue attenuation and coronary plaque burden from coronary CT angiography

BackgroundHigh pericoronary adipose tissue (PCAT) attenuation and non-calcified plaque burden (NCP) measured from coronary CT angiography (CTA) have been implicated in future cardiac events. We aimed to evaluate the interobserver and intraobserver repeatability of PCAT attenuation and NCP burden measurement from CTA, in a sub-study of the prospective SCOT-HEART trial.MethodsFifty consecutive CTAs from participants of the CT arm of the prospective SCOT-HEART trial were included. Two experienced observers independently measured PCAT attenuation and plaque characteristics throughout the whole coronary tree from CTA using semi-automatic quantitative software.ResultsWe analyzed proximal segments in 157 vessels. Intraobserver mean differences in PCAT attenuation and NCP plaque burden were ?0.05HU and 0.92% with limits of agreement (LOA) of ±1.54 and ± 5.97%. Intraobserver intraclass correlation coefficients (ICC) for PCAT attenuation and NCP burden were excellent (0.999 and 0.978). Interobserver mean differences in PCAT attenuation and NCP plaque burden were 0.13HU [LOA ±1.67HU] and ?0.23% (LOA ±9.61%). Interobserver ICC values for PCAT attenuation and NCP burden were excellent (0.998 and 0.944).ConclusionPCAT attenuation and NCP burden on CTA has high intraobserver and interobserver repeatability, suggesting they represent a repeatable and robust method of quantifying cardiovascular risk.     

Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease

BackgroundCoronary CTA allows characterization of non-calcified and calcified plaque and identification of high-risk plaque features.ObjectiveWe aimed to quantitatively characterize and compare coronary plaque burden from CTA in patients with a first acute coronary syndrome (ACS) and controls with stable coronary artery disease.Materials and methodsWe retrospectively analyzed consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina with a first ACS, who underwent CTA as part of their initial workup before invasive coronary angiography and age- and gender-matched controls with stable chest pain; controls also underwent CTA with subsequent invasive angiography (total n = 28). Culprit arteries were identified in ACS patients. Coronary arteries were analyzed by automated software to quantify calcified plaque (CP), noncalcified plaque (NCP), and low-density NCP (LD-NCP, attenuation <30 Hounsfield units) volumes, and corresponding burden (plaque volume × 100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum percent difference in attenuation/cross-sectional area from proximal cross-section), and plaque length.ResultsACS patients had fewer lesions (median, 1), with higher total NCP and LD-NCP burdens (NCP: 57.4% vs 41.5%; LD-NCP: 12.5% vs 8%; P ≤ .04), higher maximal stenoses (85.6% vs 53.0%; P = .003) and contrast density differences (46.1 vs 16.3%; P < .006). Per-patient CP burden was not different between ACS and controls. NCP and LD-NCP plaque burden was higher in culprit vs nonculprit arteries (NCP: 57.8% vs 9.5%; LD-NCP: 8.4% vs 0.6%; P ≤ .0003); CP was not significantly different. Culprit arteries had increased plaque lengths, remodeling indices, stenoses, and contrast density differences (46.1% vs 10.9%; P ≤ .001).ConclusionNoninvasive quantitative coronary artery analysis identified several differences for ACS, both on per-patient and per-vessel basis, including increased NCP, LD-NCP burden, and contrast density difference.     

Age related compositional plaque burden by CT in patients with future ACS

BackgroundWe examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS.MethodsA total of 234 patients with core-lab adjudicated ACS after baseline CCTA were enrolled. Atherosclerotic plaque was quantified and characterized from the main epicardial vessels and side branches on a 0.5 ?mm cross-sectional basis. Calcified plaque and non-calcified plaque were defined by above or below 350 Hounsfield units. Patients were categorized according to their age by deciles. Also, coronary artery calcium scores (CACS) were evaluated when available.ResultsPatients were on average 62.2 ?± ?11.5 years old. On the pre-ACS CCTA, patients showed diffuse, multi-site, predominantly non-obstructive atherosclerosis across all age categories, with plaque being detected in 93.5% of all ACS cases. The proportion calcified plaque from the total plaque burden increased significantly with older presentation (10% calcification in those <50 years, and 50% calcification in those >80 years old). Patients with ACS <50 years had remarkably lower atherosclerotic burden compared with older patients, but a high proportion of high risk markers such as low-attenuation plaque. CACS was >0 in 85% of the patients older than 50 years, and in 57% of patients younger than 50 years.ConclusionThe proportion of calcified plaque varied depending on patient age at the time of ACS. Only a small proportion of plaque was calcified when ACS occurred at <50 years old, while this increased gradually with older age. Purely non-calcified atherosclerotic plaque was not uncommon in patients <50 years.     

64排螺旋CT检测冠状动脉罪犯病变积分对急性冠脉综合征的诊断价值

目的应用64排螺旋CT(64-SCT)检测冠状动脉罪犯病变指标,包括斑块类型、斑块衰减(PA)、重构指数(RI),并计算钙化积分(CS)及罪犯病变积分(CLS),探讨其对急性冠脉综合征(ACS)的诊断价值。方法 2009年1月至2010年12月对110例临床明确诊断冠心病(CAD)患者行64-SCT检查,其中ACS 43例,稳定型心绞痛(SAP)67例。测量患者冠状动脉罪犯病变指标,包括斑块类型、PA、RI,并计算CS及CLS。比较ACS和SAP两组患者上述指标的差别。结果 ACS组比SAP组拥有更多的点状钙化(92.30%比9.1%,P<0.05)、更低的PA(41.32±21.08比90.37±48.19,P<0.01)、更高的RI(1.29±0.42比0.89±0.45,P<0.01)、更低的CS(71.43±6.74比154.41±19.02,P<0.05)及更高的C15(1.15.41.12比1.06±0.63;P<0.01)。CLS>2.0可以区分ACS和SAP,其灵敏度和特异度分别为97.7%和67.3%。结论 CLS可用于区分ACS和SAP,对ACS的早期诊断具有一定价值。     

Non-invasive fractional flow reserve in vessels without severe obstructive stenosis is associated with coronary plaque burden

AimsNon-invasive fractional flow reserve derived from coronary CT angiography (FFR_CT) has been shown to be predictive of lesion-specific ischemia as assessed by invasive fractional flow reserve (FFR). However, in practice, clinicians are often faced with an abnormal distal FFR_CT in the absence of a discrete obstructive lesion. Using quantitative plaque analysis, we sought to determine the relationship between an abnormal whole vessel FFR_CT (V-FFR_CT) and quantitative measures of whole vessel atherosclerosis in coronary arteries without obstructive stenosis.MethodsFFR_CT was calculated in 155 consecutive patients undergoing coronary CTA with ≥25% but less than 70% stenosis in at least one major epicardial vessel. Semi-automated software was used to quantify plaque volumes (total plaque [TP], calcified plaque [CP], non-calcified plaque [NCP], low-density non-calcified plaque [LD-NCP]), remodeling index [RI], maximal contrast density difference [CDD] and percent diameter stenosis [%DS]. Abnormal V-FFR_CT was defined as a minimum value of ≤0.75 across the vessel (at the most distal region where FFR_CT was computed).ResultsVessels with abnormal V-FFR_CT had higher per-vessel TP (554 vs 331 mm³), CP (59 vs 25 mm³), NCP (429 vs 295 mm³), LD-NCP (65 vs 35 mm³) volume and maximum CDD (21 vs 14%) than those with normal V-FFR_CT (median, p < 0.05 for all). Using a multivariate analysis to adjust for CDD and %DS, all measures of plaque volume were predictive of abnormal V-FFR_CT (OR 2.09, 1.36, 1.95, 1.95 for TP, CP, NCP and LD-NCP volume, respectively; p < 0.05 for all).ConclusionAbnormal V-FFR_CT in vessels without obstructive stenosis is associated with multiple markers of diffuse non-obstructive atherosclerosis, independent of stenosis severity. Whole vessel FFR_CT may represent a novel measure of diffuse coronary plaque burden.     

Increased coronary pericoronary adipose tissue attenuation in diabetic patients compared to non-diabetic controls: A propensity score matching analysis

BackgroundPericoronary adipose tissue (PCAT) attenuation is an indicator of active inflammation of perivascular adipose tissue, which is supposed to increase in diabetic patients. We aimed to investigate the PCAT attenuation values and high-risk plaque (HRP) features in diabetic and non-diabetic subjects with different stenotic extents.MethodsConsecutive type 2 diabetes patients and non-diabetic patients with chest pain and intermediate pre-test probability of coronary artery disease (CAD) were prospectively enrolled and underwent coronary computed tomography angiography (CCTA). At per-patient level, PCAT attenuation values of three major epicardial coronary vessels, as well as HRP features were measured. PCAT attenuation values and HRP features were compared between diabetic and non-diabetic subjects according to the presence or absence of obstructive stenosis.Results1700 patients (mean age: 65.5 ?± ?11.7, 940 males) were divided into two groups according to presence of obstructive stenosis on CCTA. Propensity score matching was performed in further analysis. RCA_PCAT was significantly higher in diabetic subjects than that in non-diabetic subjects, regardless of the presence of obstructive stenosis (?83.60 ?± ?9.51 HU vs. ?88.58 ?± ?9.37 HU, p ?< ?0.001) or absence of obstructive stenosis (?83.70 ?± ?10.32 HU vs. ?88.76 ?± ?8.28 HU, p ?< ?0.001). In contrast, HRP features were more commonly presented in diabetic patients with obstructive stenosis than in those without obstructive stenosis. According to subgroup analysis based on acquisition tube voltage, RCA_PCAT was the only parameter showing consistent difference between diabetic and non-diabetic patients.ConclusionsRCA_PCAT was significantly higher in diabetic patients than that in non-diabetic patients regardless of stenotic severity and plaque vulnerability.     

Relationship of epicardial fat volume to coronary plaque,severe coronary stenosis,and high-risk coronary plaque features assessed by coronary CT angiography

BackgroundAssociations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events.ObjectivesThis study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs).MethodsWe retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling.ResultsThere were 402 patients with a median age of 66 years (range, 23–92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm³ vs 89 ± 39 cm³), PCP (110 ± 57 cm³ vs 98 ± 45 cm³), and NCP (115 ± 44 cm³ vs EFV 100 ± 52 cm³). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3–6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9–3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1–5.1; P = 0.02) but not of positive remodeling.ConclusionsEFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.     

Interscan reproducibility of quantitative coronary plaque volume and composition from CT coronary angiography using an automated method

Objectives

Quantitative measurements of coronary plaque volume may play a role in serial studies to determine disease progression or regression. Our aim was to evaluate the interscan reproducibility of quantitative measurements of coronary plaque volumes using a standardized automated method.

Methods

Coronary dual source computed tomography angiography (CTA) was performed twice in 20 consecutive patients with known coronary artery disease within a maximum time difference of 100 days. The total plaque volume (TP), the volume of non-calcified plaque (NCP) and calcified plaque (CP) as well as the maximal remodelling index (RI) were determined using automated software.

Results

Mean TP volume was 382.3?±?236.9 mm³ for the first and 399.0?±?247.3 mm³ for the second examination (p?=?0.47). There were also no significant differences for NCP volumes, CP volumes or RI. Interscan correlation of the plaque volumes was very good (Pearson’s correlation coefficients: r?=?0.92, r?=?0.90 and r?=?0.96 for TP, NCP and CP volumes, respectively).

Conclusions

Automated software is a time-saving method that allows accurate assessment of coronary atherosclerotic plaque volumes in coronary CTA with high reproducibility. With this approach, serial studies appear to be possible.

Key Points

? Reproducibility of coronary atherosclerotic plaque volume in coronary CTA is high. ? Using automated software facilitates quantitative measurements. ? Serial studies to determine progression or regression of coronary plaque are possible.