Abstract
A Hindmarsh‐Rose model perceptibility phantom containing inserts with various in vitro atherosclerotic plaque compositions was constructed and imaged on a clinical 64 slice multidetector (MDCT) system using 80 and 120 kVp settings and two other cone‐beam (CBCT) systems at 80 kVp. Perceptibility of the simulated lipid‐fibrotic plaque solutions in the images was evaluated by six observers. The effective doses of the protocols employed were estimated using phantom CTDI‐vol measurements placed at identical settings. The CBCT system allowed reduction in effective dose in comparison with the conventional MDCT system for imaging of the carotid plaque phantoms without degrading image quality. The CBCT dose was less than MDCT, with a mean dose of 1.14±0.01 mSv and 1.11±0.02 mSv for MDCT using two measuring techniques vs. 0.35±0.01 mSv for CBCT. The image quality analysis showed no significant differences in the contrast‐detail (C‐D) curves of the best performing CBCT vs. clinical MDCT (p>0.05) using a Mann‐Whitney U test. Results indicate that low‐tube‐potential CBCT may produce comparable C‐D resolution for phantom‐based representations of soft plaque types with respect to MDCT systems. This study suggests that the utility of low kVp CT techniques for evaluating carotid vulnerable atherosclerotic plaque merits further study.PACS numbers: 87.53.Bn, 87.57.N‐, 87.57.Q‐, 87.57.cj
Highlights
IntroductionThe current clinical diagnostic methods for detecting vulnerable atherosclerotic plaque are largely based on stenosis angiography and intravascular ultrasound (IVUS).(1,2) These approaches have limitations, and neither has the ability to differentiate soft plaque (fibrotic vs. fatty plaque), which are rupture-prone and known to induce plaque instability
The current clinical diagnostic methods for detecting vulnerable atherosclerotic plaque are largely based on stenosis angiography and intravascular ultrasound (IVUS).(1,2) These approaches have limitations, and neither has the ability to differentiate soft plaque, which are rupture-prone and known to induce plaque instability
One set of images obtained using each imaging modality for the set of phantoms are presented in Fig. 5 showing axial views of a lipid-fibrotic plaque mixture using a Philips MDCT system at both 80 kVp, 120 kVp, and CBCT images from Morita and Planmeca at 80 kVp
Summary
The current clinical diagnostic methods for detecting vulnerable atherosclerotic plaque are largely based on stenosis angiography and intravascular ultrasound (IVUS).(1,2) These approaches have limitations, and neither has the ability to differentiate soft plaque (fibrotic vs. fatty plaque), which are rupture-prone and known to induce plaque instability. Most plaque imaging studies are either in vivo, animal, or endarterectomy ex vivo These approaches all have limitations in their abilities to fully characterize vulnerable plaque including long scan times, high radiation dose loads (which eliminate longitudinal studies), and animal plaque deviation. A Hindmarsh-Rose model-based lesion composition phantom may be used to test the contrast relationships between fatty, fibrotic, and calcified components of vulnerable plaque, and compare the results between two competing modalities. One curve can be produced from each technique (different imaging systems, or same system under different operating conditions), and compared to another.[6]
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