Diagnostic Accuracy of 320-Row Computed Tomography for Characterizing Coronary Atherosclerotic Plaques: Comparison with Intravascular Optical Coherence Tomography

This study sought to determine the diagnostic accuracy of 320-row computed tomography (320CT) for characterizing coronary atherosclerotic plaques in comparison with optical coherence tomography (OCT).From 32 patients, 42 coronary segments were evaluated and co-registered by both 320CT and OCT. 320CT vulnerable plaque characteristics included low attenuation plaque (LAP) (30HU), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcification (SC). The presence of macrophage, neovascularization and cholesterol crystals was also determined by OCT.Minimal lumen area was 2.78 ± 1.23 mm by OCT and 3.29 ± 1.49 mm by 320CT (p 0.001). Noncalcified plaques were classified accordingly by both methods in 88.2% of the cases (p = 0.005). There was no association between any 320CT plaque type and OCT fibroatheroma (p = 0.62). The combination of 2 or more of the 320CT vulnerable plaque characteristics was associated with the presence of macrophage (74.2 vs. 25.8%; p = 0.034) and cholesterol crystals (85.7 vs. 14.3%; p = 0.04), but not with neovascularization (p = 0.65). The presence of all four characteristics demonstrated an accuracy of 75.1% for detecting OCT fibroatheroma.320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all four 320CT vulnerable plaque characteristics provided the highest accuracy for detecting fibroatheromas.320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all 320CT vulnerable plaque characteristics (low attenuation plaque (30HU), napkin-ring sign, positive remodeling and spotty calcification) provided the highest accuracy for detecting fibroatheromas compared to optical coherence tomography.