Journal article 183 views 41 downloads
Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
,
Ike Okonji,
Suk F Cheng,
Argyrios A Giannopoulos,
Pragash Kamalathevan,
Julian Halcox ,
Manuel Rodriguez-Justo,
Toby Richards
The British Journal of Radiology, Volume: 96, Issue: 1147
Swansea University Authors:
Daniel Obaid , Julian Halcox
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© 2023 The Authors. Published by the British Institute of Radiology. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0).
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DOI (Published version): 10.1259/bjr.20220982
Abstract
Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histological...
| Published in: | The British Journal of Radiology |
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| ISSN: | 0007-1285 1748-880X |
| Published: |
Oxford University Press (OUP)
2023
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa63850 |
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| Abstract: |
Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histologically proven vulnerable plaques. Methods: Seventy patients underwent carotid CT angiography and carotid endarterectomy. A derivation cohort of 20 patients had CT images matched with histology and carotid plaque components attenuation defined. In a validation cohort of 50 patients, CT-derived plaque maps were compared in 43 symptomatic vs 40 asymptomatic carotid plaques and accuracy detecting vulnerable plaques calculated. Results: In 250 plaque areas co-registered with histology, the median attenuation (HU) of necrotic core 43(26-63), fibrous plaque 127(110-162) and calcified plaque 964 (816-1207) created significantly different ratios of plaque/contrast attenuation. CT-derived plaque maps revealed symptomatic plaques had larger necrotic core than asymptomatic (13.5%(5.9-33.3) vs 7.4%(2.3-14.3), p = 0.004) with large necrotic core predicting symptoms (area under ROC curve 0.68, p = 0.004). Twenty-four of 47 carotid plaques were histologically classified as most vulnerable (Starry-Type VI). Plaque maps revealed Type VI plaques had a greater necrotic core volume than Type IV/V plaques and a necrotic core/fibrous plaque ratio >0.5 distinguished Type VI plaques with sensitivity 75.0% (55.1-88.0) and specificity of 39.1% (22.2-59.2). Conclusions: Carotid plaque components can be differentiated by CT using a ratio of plaque/contrast attenuation. CT-derived plaque map volumes of necrotic core help distinguished the most vulnerable plaques. Advances in knowledge: CT-derived plaque maps based on plaque/contrast attenuation may provide new markers of carotid plaque vulnerability. |
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| Keywords: |
Carotid plaque, carotid CT angiography, carotid endarterectomy |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Swansea University. |
| Issue: |
1147 |