High-resolution CT imaging of carotid artery atherosclerotic plaques

Max Wintermark, Sumayya Jawadi, J. H. Rapp, T. Tihan, E. Tong, D. V. Glidden, S. Abedin, S. Schaeffer, G. Acevedo-Bolton, B. Boudignon, B. Orwoll, X. Pan, D. Saloner

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of "vulnerable plaque." The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard. MATERIALS AND METHODS: Eight patients with transient ischemic attacks who underwent carotid CTA and "en bloc" endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist's reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques. RESULTS: There was a 72.6% agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; P = .001) and large hemorrhages (κ = 0.712; P = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness (R 2 = 0.77; P < .001). CONCLUSION: The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination.

Original languageEnglish (US)
Pages (from-to)875-882
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume29
Issue number5
DOIs
StatePublished - May 1 2008
Externally publishedYes

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Carotid Stenosis
Atherosclerotic Plaques
Endarterectomy
Reading
Hemorrhage
Lipids
Carotid Artery Diseases
Computed Tomography Angiography
Transient Ischemic Attack
Connective Tissue
Stroke
Prospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Wintermark, M., Jawadi, S., Rapp, J. H., Tihan, T., Tong, E., Glidden, D. V., ... Saloner, D. (2008). High-resolution CT imaging of carotid artery atherosclerotic plaques. American Journal of Neuroradiology, 29(5), 875-882. https://doi.org/10.3174/ajnr.A0950

High-resolution CT imaging of carotid artery atherosclerotic plaques. / Wintermark, Max; Jawadi, Sumayya; Rapp, J. H.; Tihan, T.; Tong, E.; Glidden, D. V.; Abedin, S.; Schaeffer, S.; Acevedo-Bolton, G.; Boudignon, B.; Orwoll, B.; Pan, X.; Saloner, D.

In: American Journal of Neuroradiology, Vol. 29, No. 5, 01.05.2008, p. 875-882.

Research output: Contribution to journalArticle

Wintermark, M, Jawadi, S, Rapp, JH, Tihan, T, Tong, E, Glidden, DV, Abedin, S, Schaeffer, S, Acevedo-Bolton, G, Boudignon, B, Orwoll, B, Pan, X & Saloner, D 2008, 'High-resolution CT imaging of carotid artery atherosclerotic plaques', American Journal of Neuroradiology, vol. 29, no. 5, pp. 875-882. https://doi.org/10.3174/ajnr.A0950
Wintermark, Max ; Jawadi, Sumayya ; Rapp, J. H. ; Tihan, T. ; Tong, E. ; Glidden, D. V. ; Abedin, S. ; Schaeffer, S. ; Acevedo-Bolton, G. ; Boudignon, B. ; Orwoll, B. ; Pan, X. ; Saloner, D. / High-resolution CT imaging of carotid artery atherosclerotic plaques. In: American Journal of Neuroradiology. 2008 ; Vol. 29, No. 5. pp. 875-882.
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abstract = "BACKGROUND AND PURPOSE: Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of {"}vulnerable plaque.{"} The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard. MATERIALS AND METHODS: Eight patients with transient ischemic attacks who underwent carotid CTA and {"}en bloc{"} endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist's reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques. RESULTS: There was a 72.6{\%} agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; P = .001) and large hemorrhages (κ = 0.712; P = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness (R 2 = 0.77; P < .001). CONCLUSION: The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination.",
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AU - Wintermark, Max

AU - Jawadi, Sumayya

AU - Rapp, J. H.

AU - Tihan, T.

AU - Tong, E.

AU - Glidden, D. V.

AU - Abedin, S.

AU - Schaeffer, S.

AU - Acevedo-Bolton, G.

AU - Boudignon, B.

AU - Orwoll, B.

AU - Pan, X.

AU - Saloner, D.

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N2 - BACKGROUND AND PURPOSE: Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of "vulnerable plaque." The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard. MATERIALS AND METHODS: Eight patients with transient ischemic attacks who underwent carotid CTA and "en bloc" endarterectomy were enrolled in a prospective study. An ex vivo micro-CT study of each endarterectomy specimen was obtained, followed by histologic examination. A systematic comparison of CTA images with histologic sections and micro-CT images was performed to determine the CT attenuation associated with each component of the atherosclerotic plaques. A computer algorithm was subsequently developed that automatically identifies the components of the carotid atherosclerotic plaques, based on the density of each pixel. A neuroradiologist's reading of this computer analysis was compared with the interpretation of the histologic slides by a pathologist with respect to the types and characteristics of the carotid plaques. RESULTS: There was a 72.6% agreement between CTA and histologic examination in carotid plaque characterization. CTA showed perfect concordance for calcifications. A significant overlap between densities associated with lipid-rich necrotic core, connective tissue, and hemorrhage limited the reliability of individual pixel readings to identify these components. However, CTA showed good correlation with histologic examination for large lipid cores (κ = 0.796; P = .001) and large hemorrhages (κ = 0.712; P = .102). CTA performed well in detecting ulcerations (κ = 0.855) and in measuring the fibrous cap thickness (R 2 = 0.77; P < .001). CONCLUSION: The composition of carotid atherosclerotic plaques determined by CTA reflects plaque composition defined by histologic examination.

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