收稿日期: 2014-08-09
网络出版日期: 2015-07-24
Ex vivo evaluation of dual-source CT detecting and characterizing the coronary atherosclerotic plaques
Received date: 2014-08-09
Online published: 2015-07-24
目的 双源CT增强扫描检测和定性冠状动脉粥样硬化斑块的评价。 方法 使用双源CT对冠状动脉进行0.6 mm层厚横断面增强扫描，根据CT值将斑块分为钙化、非钙化和混合斑块。病理分型作为对比标准。 结果 病理切片发现75个斑块,63个斑块被双源CT检测, 双源CT对检测所有斑块的敏感性为84%(63/75),对检测I~III型的敏感性为0%,对检测IV型、Va型、Vb型和Vc型的敏感性分别为77.8%、80%、97.9% 和85.7%。 钙化斑块、混合斑块和非钙化斑块的平均CT值 (分别是：416.5±94.4 HU、142.8±48.6 HU和46.3±34.2 HU；P<0.05) 有明显差异。以脂质为主的斑块（IV型和Va型）和以纤维为主的斑块( Vc型)的平均CT值(分别是：30.4±24.4 HU和73.3±23.3 HU；P<0.05)有显著差异。 结论 双源CT增强扫描能够检测不同类型的冠状动脉粥样硬化斑块，斑块的平均CT值能够代表斑块的主要成分，且与病理分型有很好的一致性。
关键词： 双源CT; 冠状动脉粥样硬化斑块; 病理组织学
刘云霏 , 马延贺 , 王长月 . 双源CT检测和定性冠状动脉粥样硬化斑块的评价[J]. 中国临床解剖学杂志, 2015 , 33(3) : 269 -272 . DOI: 10.13418/j.issn.1001-165x.2015.03.008
Objective To evaluate the ability of dual-source CT contrast enhancement scanning detecting and characterizing the coronary atherosclerotic plaques. Methods Coronary arteries were scanned by contrasted-enhanced DSCT with an axial slice thickness of 0.6 mm. According to the CT attenuation values, plaques were classified as calcified, mixed and non-calcified. Histopathologic classification was considered the standard of reference. Results Histopathology detected 75 plaques, among which 63 plaques were found at DSCT. The sensitivity of DSCT for detecting all plaques was 84%(63/75), for detecting I-III type plaques was 0%, for detecting IV type、Va type、Vb type and Vc type plaques were 77.8% 、80% 、97.9% and 85.7%, respectively. The mean CT attenuation values of calcified、mixed and non-calcified (416.5±94.4 HU, 142.8±48.6 HU, 46.3±34.2 HU, respectively; p<0.05) were significantly different. There was significant difference between the mean attenuation values of predominantly lipid-rich and fiber-rich plaques (30.4±24.4 HU and 73.3±23.3 HU, respectively; P<0.01). Conclusion Dual-source CT contrast enhancement scanning can detect different types of coronary atherosclerotic plaques. The plaque mean CT attenuation values can represent predominant plaque component which were correlated well with histopathologic classification.
[1] Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee[R].Circulation, 2014,129(3):e28-e292.
[2] Kolodgie FD, Virmani R, Burke AP, et al. Pathologic assessment of the vulnerable human coronary plaque[J].Heart, 2004, 90(12):1385-1391.
[3] Libby P, Theroux P. Pathophysiology of coronary artery disease[J].Circulation, 2005, 111(25):3481-3488.
[4] Davies MJ. The pathophysiology of acute coronary syndromes[J]. Heart, 2000, 83(3):361-366.
[5] Ehara S, Kobayashi Y, Yoshiyama M, et al. Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction an intravascular ultrasound study[J] . Circulation, 2004,110(22):3424-3429.
[6] Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes[J]. J Am Coll Cardiol, 2007,50(4):319–26.
[7] Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease: report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association[J]. Circulation,1975, 51 (4 Suppl):5-40.
[8] Leschka S, Seitun S, Dettmer M, et al. Ex vivo evaluation of coronary atherosclerotic plaques: characterization with dual-source CT in comparison with histopathology[J]. J Cardiovasc Comput Tomogr, 2010, 4 (5):301-308.
[9] Achenbach S, Moselewski F, Ropers D, et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound[J].Circulation, 2004, 109(1):14-17.
[10] Stary HC, Chandler AB, Dinsmore RE, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committe on Vascular Lesions of the Council on Atherosclerosis, American Heart Association[J].Circulation, 1995, 92(5):1355–1374.
[11]Becker CR, Nikolaou K, Muders M, et al. Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT[J]. Eur Radiol 2003, 13(9):2094-2098.
[12]Soeda T, Uemura S, Morikawa Y, et al. Diagnostic accuracy of dual-source computed tomography in the characterization of coronary atherosclerotic plaques: Comparison with intravascular optical coherence tomography[J]. Int J Cardiol, 2011,148(3):313-318.
[13]肖喜刚,谢德轩,申宝忠,等.多层螺旋CT对冠状动脉粥样硬化斑块性质的诊断价值[J].中华医学杂志, 2007, 87(46):3247-3250.
[14]Yeboah J, McClelland RL, Polonsky TS, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals[J]. JAMA, 2012, 308(8):788-795.
[15]Motoyama S, Kondo T, Anno H, et al. Atherosclerotic plaque characterization by 0.5-mm-slice multislice computed tomographic imaging comparison with intravascular ultrasound[J].Circ J, 2007,71(3):363- 366.
[16] 毛定飚,朱毅,陆孝禹,等.冠状动脉粥样斑块的多层螺旋CT与病理的对照研究[J].放射学实践, 2005, 20(3):202-204.
[17] Henzler T, Porubsky S, Kayed H, et al. Attenuation-based characterization of coronary atherosclerotic plaque: comparison of dual source and dual energy CT with single-source CT and histopathology[J].Eur J Radiol,2011, 80(1):54–59.
[18] 吴文辉,吕滨,蒋世良,等.多层螺旋CT对冠状动脉粥样硬化斑块的显示结果及与超声结果的对比[J].中华放射学杂志,2007,41(10):1027-1031.
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