Comprehensive assessment of spotty calcifications on computed tomography angiography: Comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis

Abstract

BackgroundThe purpose of the study was to systematically compare calcification patterns in plaques on computed tomography angiography (CTA) with plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis (IVUS-VH).Methods and ResultsIn total, 108 patients underwent CTA and IVUS-VH. On CTA, calcification patterns in plaques were classified as non-calcified, spotty or dense calcifications. Plaques with spotty calcifications were differentiated into small spotty (<1 mm), intermediate spotty (1-3 mm) and large spotty calcifications (≥3 mm). Plaque characteristics deemed more high-risk on IVUS-VH were defined by % necrotic core (NC) and presence of thin cap fibroatheroma (TCFA). Overall, 300 plaques were identified both on CTA and IVUS-VH. % NC core was significantly higher in plaques with small spotty calcifications as compared to non-calcified plaques (20% vs 13%, P = .006). In addition, there was a trend for a higher % NC in plaques with small spotty calcifications than in plaques with intermediate spotty calcifications (20% vs 14%, P = .053). Plaques with small spotty calcifications had the highest % TCFA as compared to large spotty and dense calcifications (31% vs 9% and 31% vs 6%, P < .05).ConclusionPlaques with small spotty calcifications on CTA were related to plaque characteristics deemed more high-risk on IVUS-VH. Therefore, CTA may be valuable in the assessment of the vulnerable plaque.

The roles of myeloperoxidase in coronary artery disease and its potential implication in plaque rupture

“…Heavy calcification is a late manifestation of atherosclerosis and is often associated with stable rather than vulnerable plaques [5]. Importantly, coronary plaques with thin fibrous caps and larger necrotic cores, thus increasing vulnerability, have an inverse correlation with the size of spotty calcification [108] Thus, increasing coronary calcification does not necessarily indicate the presence of vulnerable inflamed plaques. Furthermore, the finding of Chen et al [107] does not exclude an association of MPO with non-calcified coronary plaques.…”

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

“…4) The morphological characteristics associated with unstable plaques are generally evaluated using three main imaging methods: Intravascular ultrasound with virtual histology (VH-IVUS), coronary computed tomography angiography (CCTA), and optical coherence tomography (OCT). 5) Intravascular ultrasound is currently the gold standard for the detection and assessment of vulnerable plaques due to its ability, when associated with virtual histology, to differentiate the soft atheroma with a lipid reach or necrotic core, which is typically associated with vulnerable plaques, from a fi brous or calcifi ed atheroma, which is generally associated with stable plaques.…”

Imaging Cardiovascular Calcification

“…An illustration of this pathophysiologic progression and current imaging techniques for vascular calcification are portrayed in Figures 1 and 2 16, 18, 19, 20, 21, 22, 23…”

“…I, Non‐contrast‐enhanced calcium scoring image demonstrating an area of calcium (white arrow) in the left anterior descending coronary artery. A and C, Reprinted from van Velzen et al18 with permission. Copyright ©2011, Wiley.…”