Atherosclerotic plaque features relevant to rupture-risk detected by clinical photon-counting CT ex vivo: a proof-of-concept study

Springer Science and Business Media LLC - Tập 8 Số 1
Annelie Shami1, Jiangming Sun1, Chrysostomi Gialeli1, Hanna Markstad1, Andreas Edsfeldt1, Marie‐Louise Aurumskjöld2, Isabel Gonçalves3
1Department of Clinical Sciences Malmö, Lund University, Clinical Research Center, Jan Waldenströms Gata 35, CRC 91:12, 214 28, Malmö, Sweden
2Department of Clinical Sciences Malmö, Medical Radiation Physics, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
3Department of Cardiology, Malmö, Skåne University Hospital, Lund University, Lund, Sweden

Tóm tắt

Abstract Background

To identify subjects with rupture-prone atherosclerotic plaques before thrombotic events occur is an unmet clinical need. Thus, this proof-of-concept study aims to determine which rupture-prone plaque features can be detected using clinically available photon-counting computed tomography (PCCT).

 Methods

In this retrospective study, advanced atherosclerotic plaques (ex vivo, paraffin-embedded) from the Carotid Plaque Imaging Project were scanned by PCCT with reconstructed energy levels (45, 70, 120, 190 keV). Density in HU was measured in 97 regions of interest (ROIs) representing rupture-prone plaque features as demonstrated by histopathology (thrombus, lipid core, necrosis, fibrosis, intraplaque haemorrhage, calcium). The relationship between HU and energy was then assessed using a mixed-effects model for each plaque feature.

 Results

Plaques from five men (age 79 ± 8 [mean ± standard deviation]) were included in the study. Comparing differences in coefficients (b1diff) of matched ROIs on plaque images obtained by PCCT and histology confirmed that calcium was distinguishable from all other analysed features. Of greater novelty, additional rupture-prone plaque features proved discernible from each other, particularly when comparing haemorrhage with fibrous cap (p = 0.017), lipids (p = 0.003) and necrosis (p = 0.004) and thrombus compared to fibrosis (p = 0.048), fibrous cap (p = 0.028), lipids (p = 0.015) and necrosis (p = 0.017).

 Conclusions

Clinically available PCCT detects not only calcification, but also other rupture-prone features of human carotid plaques ex vivo.

 Relevance statement

Improved atherosclerotic plaque characterisation by photon-counting CT provides the ability to distinguish not only calcium, but also rupture-prone plaque features such as haemorrhage and thrombus. This may potentially improve monitoring and risk stratification of atherosclerotic patients in order to prevent strokes.

 Key points

• CT of atherosclerotic plaques mainly detects calcium.

• Many components, such as intra-plaque haemorrhage and lipids, determine increased plaque rupture risk.

• Ex vivo carotid plaque photon-counting CT distinguishes haemorrhage and thrombus.

• Improved plaque photon-counting CT evaluation may refine risk stratification accuracy to prevent strokes.

 Graphical Abstract

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Tài liệu tham khảo

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