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 VirmaniJames K. Min

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Abstract

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 mm 2 , QCT: 0.37 ± 0.71 mm 2 , 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.

Original languageEnglish
Pages (from-to)426-433
Number of pages8
JournalAtherosclerosis
Volume275
DOIs
Publication statusPublished - 2018 Aug

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Sudden Cardiac Death
Histology
Lipids
Computed Tomography Angiography
Sudden Death

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Han, Donghee ; Torii, Sho ; Yahagi, Kazuyuki ; Lin, Fay Y. ; Lee, Ji Hyun ; Rizvi, Asim ; Gransar, Heidi ; Park, Mahn Won ; Roudsari, Hadi Mirhedayati ; Stuijfzand, Wijnand J. ; Baskaran, Lohendran ; ó Hartaigh, Bríain ; Park, Hyung bok ; Lee, Sang eun ; Ali, Zabiullah ; Kutys, Robert ; Chang, Hyuk Jae ; Earls, James P. ; Fowler, David ; Virmani, Renu ; Min, James K. / Quantitative measurement of lipid rich plaque by coronary computed tomography angiography : A correlation of histology in sudden cardiac death. In: Atherosclerosis. 2018 ; Vol. 275. pp. 426-433.
@article{0f917d89ae1844488bf1bf4d479dc710,
title = "Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death",
abstract = "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 mm 2 , QCT: 0.37 ± 0.71 mm 2 , 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.",
author = "Donghee Han and Sho Torii and Kazuyuki Yahagi and Lin, {Fay Y.} and Lee, {Ji Hyun} and Asim Rizvi and Heidi Gransar and Park, {Mahn Won} and Roudsari, {Hadi Mirhedayati} and Stuijfzand, {Wijnand J.} and Lohendran Baskaran and {{\'o} Hartaigh}, Br{\'i}ain and Park, {Hyung bok} and Lee, {Sang eun} and Zabiullah Ali and Robert Kutys and Chang, {Hyuk Jae} and Earls, {James P.} and David Fowler and Renu Virmani and Min, {James K.}",
year = "2018",
month = "8",
doi = "10.1016/j.atherosclerosis.2018.05.024",
language = "English",
volume = "275",
pages = "426--433",
journal = "Atherosclerosis",
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Han, D, Torii, S, Yahagi, K, Lin, FY, Lee, JH, Rizvi, A, Gransar, H, Park, MW, Roudsari, HM, Stuijfzand, WJ, Baskaran, L, ó Hartaigh, B, Park, HB, Lee, SE, Ali, Z, Kutys, R, Chang, HJ, Earls, JP, Fowler, D, Virmani, R & Min, JK 2018, 'Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death', Atherosclerosis, vol. 275, pp. 426-433. https://doi.org/10.1016/j.atherosclerosis.2018.05.024

Quantitative measurement of lipid rich plaque by coronary computed tomography angiography : A correlation of histology in sudden cardiac death. / Han, Donghee; Torii, Sho; Yahagi, Kazuyuki; Lin, Fay Y.; Lee, Ji Hyun; Rizvi, Asim; Gransar, Heidi; Park, Mahn Won; Roudsari, Hadi Mirhedayati; Stuijfzand, Wijnand J.; Baskaran, Lohendran; ó Hartaigh, Bríain; Park, Hyung bok; Lee, Sang eun; Ali, Zabiullah; Kutys, Robert; Chang, Hyuk Jae; Earls, James P.; Fowler, David; Virmani, Renu; Min, James K.

In: Atherosclerosis, Vol. 275, 08.2018, p. 426-433.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quantitative measurement of lipid rich plaque by coronary computed tomography angiography

T2 - A correlation of histology in sudden cardiac death

AU - Han, Donghee

AU - Torii, Sho

AU - Yahagi, Kazuyuki

AU - Lin, Fay Y.

AU - Lee, Ji Hyun

AU - Rizvi, Asim

AU - Gransar, Heidi

AU - Park, Mahn Won

AU - Roudsari, Hadi Mirhedayati

AU - Stuijfzand, Wijnand J.

AU - Baskaran, Lohendran

AU - ó Hartaigh, Bríain

AU - Park, Hyung bok

AU - Lee, Sang eun

AU - Ali, Zabiullah

AU - Kutys, Robert

AU - Chang, Hyuk Jae

AU - Earls, James P.

AU - Fowler, David

AU - Virmani, Renu

AU - Min, James K.

PY - 2018/8

Y1 - 2018/8

N2 - 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 mm 2 , QCT: 0.37 ± 0.71 mm 2 , 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.

AB - 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 mm 2 , QCT: 0.37 ± 0.71 mm 2 , 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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U2 - 10.1016/j.atherosclerosis.2018.05.024

DO - 10.1016/j.atherosclerosis.2018.05.024

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JO - Atherosclerosis

JF - Atherosclerosis

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