Non-calcified coronary atherosclerotic plaque visualization on CT: effects of contrast-enhancement and lipid-content fractions

Computed tomography (CT) may characterize lipid-rich and presumably rupture-prone non-calcified coronary atherosclerotic plaque based on its Hounsfield-Unit (HU), but still inconclusively. This study aimed to evaluate factors influencing the HU-value of non-calcified plaque using software simulation. Several realistic virtual plaqueburdened coronary phantoms were constructed at 5 μm resolution. CT scanning was simulated with settings resembling a 64-row multi-detector CT (64-MDCT) and reconstructed at 64-MDCT (0.4 mm) and MicroCT (48 μm) resolutions. Influences of lumen contrast-enhancement, stenosis-grades, and plaque compositions on plaque visualization were analyzed. Lumen contrast-enhancement and mean plaque HU-value were positively correlated (R² > 0.92), with approximately the same slopes for all plaque compositions. Percentage lipid-content and mean plaque HU-value were negatively correlated (R² > 0.98). Stenosis-grade and noise had minimal influence on the correlations. Influence of lumen contrast-enhancement on plaque HU-value was following a specific exponentially declining pattern (y = Ae^?λx + c) from the lumen border until 2-pixel radius. Outside 2-pixel radius, plaque HU-values deviated maximally 5 HU from non-contrast-enhanced reference. Thus, to avoid lumen contrast-enhancement influence, plaques should be measured outside 2-pixel radius from the lumen border. Based on the patterns found, a lumen influence correction algorithm may be developed. HU-based plaque percentage lipid-content determination might serve as an alternative plaque characterization method. However, its applicability is still hindered by many inherent limitations.