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Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death

 Donghee Han  ;  Sho Torii  ;  Kazuyuki Yahagi  ;  Fay Y. Lin  ;  Ji Hyun Lee  ;  Asim Rizvi  ;  Heidi Gransar  ;  Mahn-Won Park  ;  Hadi Mirhedayati Roudsari  ;  Wijnand J. Stuijfzand  ;  Lohendran Baskaran  ;  Bríain ó Hartaigh  ;  Hyung-bok Park  ;  Sang-eun Lee  ;  Zabiullah Ali  ;  Robert Kutys  ;  Hyuk-Jae Chang  ;  James P. Earls  ;  David Fowler  ;  Renu Virmani  ;  James K. Min 
 ATHEROSCLEROSIS, Vol.275 : 426-433, 2018 
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Atherosclerosis ; Coronary computed tomography angiography ; Histology ; Lipid rich plaque ; Necrotic core
BACKGROUND AND AIMS: Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque. METHODS: 8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque (LAP) was defined as any pixel < 30, 45, 60, 75, and 90 HU cut-offs within a coronary plaque. The area of LAP was calculated in each cross-section. RESULTS: Among 105 cross-sections, 37 (35.2%) cross-sectional histology images contained lipid rich plaque. Although the highest specificity for identifying lipid rich plaque was shown with <30 HU cut-off (88.2%), sensitivity (e.g. 55.6% for <75 HU, 16.2% for <30 HU) and negative predictive value (e.g. 75.9% for <75 HU, 65.9% for <30 HU) tended to increase with higher HU cut-offs. For quantitative measurement, <75 HU showed the highest correlation coefficient (0.292, p = 0.003) and no significant differences were observed between lipid rich plaque area and LAP area between histology and CT analysis (Histology: 0.34 ± 0.73 mm2, QCT: 0.37 ± 0.71 mm2, p = 0.701). CONCLUSIONS: LAP area by CCTA using a <75 HU cut-off value demonstrated high sensitivity and quantitative agreement with lipid rich plaque area by histology analysis.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hyung Bok(박형복)
Lee, Sang Eun(이상은) ORCID logo https://orcid.org/0000-0001-6645-4038
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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