Detecting unstable plaques in humans using cardiac CT: Can it guide treatments?

Abstract

Advances in imaging technology have driven the rapid expansion in the use of CT in the assessment of coronary atherosclerotic plaque. Based on a rapidly growing evidence base, current guidelines recommend coronary CT angiography as the first‐line diagnostic test for patients presenting with stable chest pain. There is a growing need to refine current methods for diagnosis and risk stratification to improve the individualisation of preventative therapies. Imaging assessments of high‐risk plaque with CT can be used to differentiate stable from unstable patterns of coronary atherosclerosis and potentially to improve patient risk stratification. This review will focus on coronary imaging with CT with a specific focus on the detection of coronary atherosclerosis, high‐risk plaque features, and the implications for patient management.

Non-Invasive Modalities in the Assessment of Vulnerable Coronary Atherosclerotic Plaques

“…Interestingly, plaques characterized as TCFAs in IVUS were usually of mixed morphology in MSCT [ 40 ]. Similar results have been reported previously, with the presence of high-risk features (positive remodeling, spotty calcification, non-calcified plaques) being associated with ACS compared to stable CAD [ 41 ]. Small spotty plaque calcifications identified through coronary CT angiography (CCTA) were also correlated to the percentage of necrotic core and the prevalence of TCFA as assessed with IVUS [ 42 ].…”

“…Certain identifiable patterns are indicative of a vulnerable plaque phenotype, namely ( a ) low plaque attenuation, ( b ) spotty calcification, and ( c ) the napkin ring sign. Reproduced with permission from Marwa Daghem et al [ 41 ], British Journal of Pharmacology; published by John Wiley & Sons Ltd., 2021, used under Creative Commons CC BY 4.0 license. HU: Hounsfield units.…”

From the vulnerable plaque to the vulnerable patient: Current concepts in atherosclerosis

“…These articles were commissioned leading on from a British CT is an X-ray-based technique for fine detail discrimination of tissue morphology. Daghem and Newby (Daghem & Newby, 2019) review the importance of CT in cardiology. The detection of calcification and its use in quantifying plaque burden has been a major breakthrough achieved with non-invasive imaging.…”

“…Originally defined by histology, defining vulnerable plaques in at-risk (vulnerable) patients is now possible using a raft of imaging techniques including PET, CT, MRI and intravascular ultra- CT is an X-ray-based technique for fine detail discrimination of tissue morphology. Daghem and Newby (Daghem & Newby, 2021) review the importance of CT in cardiology. The detection of calcification and its use in quantifying plaque burden has been a major breakthrough achieved with non-invasive imaging.…”

“…Now multiple modalities are available in the research setting and increasingly in routine clinical practice. Two complementary reviews from Sriranjan et al (Sriranjan et al, 2021) and Daghem and Newby (Daghem & Newby, 2021) review the use PET and CT in assessing vulnerable patients and defining vulnerable plaques.…”