J Korean Soc Radiol.  2011 Apr;64(4):309-315. 10.3348/jksr.2011.64.4.309.

Analysis of Complex Coronary Plaque in Multidetector Computed Tomography: Comparison with Conventional Coronary Angiography

• Kim DH
• Bang DW
• Suk EH
• Cho YH

• KMID: 1443532
• DOI: http://doi.org/10.3348/jksr.2011.64.4.309

Abstract

PURPOSE
To delineate complex plaque morphology in patients with stable angina using coronary computed tomographic angiography (CTA).
MATERIALS AND METHODS
36 patients with complex plaques proven by conventional coronary angiography (CAG), who had taken CTA for evaluation of typical angina, were enrolled in this study. Intravascular ultrasonography (IVUS) was performed in 14 patients (16 lesions). We compared CTA with CAG for plaque features and analyzed vascular cutoff, intraluminal filling defect in a patent vessel, irregularity of plaque, and ulceration. Also, the density of plaque was evaluated on CTA.
RESULTS
CAG and CTA showed complex morphology in 44 cases (100%) and 34 cases, (77%), respectively, with features including abrupt vessel cutoff (27 vs. 16%, kappa= 0.57), intraluminal filling defect (32 vs. 30%, kappa= 0.77), irregularity (75 vs. 52%, kappa= 0.52), and ulceration (16 vs. 11%, kappa= 0.60). CTA indicated that the complex lesions were hypodense (mean = 66 +/- 21 Houndsfield Units).
CONCLUSION
CTA is a very accurate and useful non-invasive imaging modality for evaluating complex plaque in patients with typical angina.

MeSH Terms

Angina, Stable
Angiography
Coronary Angiography
Coronary Vessels
Glycosaminoglycans
Humans
Tomography, X-Ray Computed
Ulcer
Ultrasonography, Interventional
Glycosaminoglycans

Figure

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  Fig. 1 A 71-year-old man with chest pain. Invasive coronary angiography (A) shows LCX plaque characterized by bulky, lucent lesion with occlusion of distal LCX (arrows). CTA image (B) reveals similar morphology characterized by a bulky, hypodense plaque (arrows) with contrast filling distally in distal segment of LCX.

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  Fig. 2 A 63-year-old man with unstable ruptured RCA lesion. Invasive coronary angiography (A) documents filling defect, complex plaque severely narrowing the proximal segment of RCA (arrows). CTA image (B) shows a concordant bulky, eccentric and hypodense filling defect in proximal segment of RCA (arrow).

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  Fig. 3 A 78-year-old man with acute chest pain. Coronary angiogram (A) demonstrates severely irregular, stenotic lesion (black arrow) and occlusion (white arrow) in the proximal and middle segment of RCA, respectively. The CTA image (B) shows eccentric and hypodense plaque with irregular margin (arrow) compared to invasive coronary angiography.

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  Fig. 4 A 69-year-old man with atypical chest pain over 7 days duration. Invasive coronary angiography (A) shows hazy irregular lesion (dark arrow), with punctuate zone of ulceration (arrow) in middle segment of LAD. CTA (B) demonstrates the LAD lesion as irregular and eccentric low density plaque with intra-plaque contrast penetration indicative of ulceration (arrow).

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