Multi-detector CT Characterization of Coronary Atheromatous Plaques

Abstract

Cardiovascular diseases are the number one cause of death globally. The number of people who die from cardiovascular diseases, mainly from coronary heart disease and stroke, will increase to reach 23.3 million by 2030 from an estimated 17.3 million deaths in 2008. Cardiovascular diseases are projected to remain the single leading cause of death by 2030 globally. Acute myocardial infarction and sudden cardiac death remain the first manifestations of coronary atherosclerosis in the majority of the population (50% of men and 64% of women), which accounts for these unfavourable statistics. Most individuals do not, therefore, experience any symptoms or warning signs before the coronary event occurs. Prevention of acute coronary events seems to be the only effective strategy to reduce the burden of cardiovascular disease and improve mortality and morbidity rates. Considerable efforts are ongoing to predict where acute coronary events will happen on an individual plaque level. The identification of patients at high risk of developing acute coronary events remains a major challenge in cardiovascular imaging. MDCT is a great noninvasive option for characterization of coronary atheromatous plaque it can quantify; and, to a certain extent, characterize coronary atherosclerotic plaque. It can predict and so prevent ACS. Imaging findings associated with vulnerable plaque include spotty calcification, presence of napkin ring sign low mean Hounsfield units heterogenous attenuation soft tissue plaque composition as well as positive remodelling. All these factors had a lot of contribution in predicting plaque vulnerability thus facilitating a more rapid medical action. However, CT characterization of coronary atherosclerotic plaque remains challenging and requires optimization of image quality. Imaging barriers for correct analysis of plaque components with CT include limited contrast and spatial resolutions, motion artifacts, heterogeneous plaque composition, and a lack of standardization regarding the assessment of coronary lesions. However, it can be expected that further technical improvements regarding data acquisition and reconstruction as well as an increasing number of prognostic and outcome studies will help to establish CT as a tool for early identification of patients at increased risk for