Lumen enhancement influences absolute noncalcific plaque density on multislice computed tomography coronary angiography: ex-vivo validation and in-vivo demonstration

Abstract

The purpose of this study was to define the in-vitro and in-vivo effects of intracoronary enhancement on the absolute density values of coronary plaques during multislice computed tomography. We studied seven ex-vivo left coronary artery specimens surrounded by olive oil and filled with isotonic saline and four solutions with decreasing dilutions of contrast material: control (isotonic saline), 1/200, 1/80, 1/50, and 1/20. The multislice computed tomography protocol was: slice/collimation 32 x 2 x 0.6 mm and rotation time 330 ms. The attenuation (Hounsfield units) value of atherosclerotic plaques was measured for each dilution in lumen, plaque (noncalcified coronary wall thickening), calcium, and surrounding oil. In-vivo assessment was performed in 12 patients (nine men; mean age 58.7 +/- 9.9 years) who underwent two subsequent multislice computed tomography scans (arterial and delayed) after intravenous administration of a single bolus of contrast material. The attenuation values of lumen and plaques during arterial and delayed computed tomography were compared. The results were compared with one-way analysis of variance and correlated with Pearson's test. Mean lumen (45 +/- 38-669 +/- 151 HU) and plaque (11 +/- 35-101 +/- 72 HU) attenuation differed significantly (P < 0.001) among the different dilutions. The attenuation of lumen and plaque of coronary plaques showed moderate correlation (r = 0.54, P < 0.001). The mean attenuation value in vivo for the arterial and delayed phase scans differed significantly (P < 0.001) for lumen (325 +/- 70 and 174 +/- 46 HU, respectively) and plaque (138 +/- 71 and 100 +/- 52 HU, respectively). Coronary plaque attenuation values are significantly modified by differences in lumen contrast densities both ex vivo and in vivo. This should be taken into account when considering the distinction between lipid and fibrous plaques.