Plaque Evaluation by Coronary CT Angiography

Abstract

Coronary CT angiography (CCTA) is the most promising, noninvasive tool that allows the visualization of plaque morphology. Plaque morphology characterized by positive remodeling, low attenuation plaque and napkin-ring sign in CCTA has been regarded as rupture-prone vulnerable plaques which account for about 60% of all vulnerable plaques and cause plaque rupture. Currently, importance of stenosis level and plaque volume for vulnerable plaque assessment has been recognized. CCTA is also useful from viewpoint of these evaluations. However, it is considered that evaluation by using CT number that is one of important factors of plaque evaluation is affected various factors. There remain several problems in objectivity and quantitative evaluation. Recently we developed a novel method for evaluating characteristics of plaque in more objective and quantitative way and reported the usability. Moreover, it may be possible to diagnose vulnerable plaque more correctly by comprehensive evaluation on addition to evaluation of fractional flow reserve and endothelial share stress using CCTA. In the future, it is expected construction of evidence in multi-center large-scale clinical trial and development of new evaluation method such as molecular CT imaging.