High-Risk Plaque Features on Coronary CT Angiography.

CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CTA) HAS BECOME AN ACCEPTED TOOL FOR THE evaluation of obstructive coronary artery disease, with high accuracy and proven prognostic implications. Although detailed information regarding plaque characteristics is available in coronary CTA datasets of sufficient quality, clinical decision making utilizing the information offered by computed tomography–based plaque analysis is not widely utilized. Nonetheless, the Society of Cardiovascular Computed Tomography Guidelines for the Interpretation and Reporting of Coronary Computed Tomographic Angiography go beyond mere stenosis measurement: “If coronary disease is present, stenosis severity, plaque morphology, and extent should be described.. Plaque type should be described as calcified, predominant calcified, noncalcified, predominant noncalcified, or partially noncalcified.. Other morphologic descriptors of a stenotic lesion, such as . apparent dissection or ulceration, and positive remodeling may also be appropriate.. Reporting of Hounsfield units in the plaque is discretional; it must be recognized that significant overlap exists between lipid and fibrous material, making interpretation of plaque HU problematic” (1). Here, we present selected images featuring high-risk plaques in coronary CTA, with accompanying clinical scenarios that indicate potential applications not currently covered by guidelines (Figures 1 to 4). A survey querying clinical decisions based on the images was e-mailed to 2,250 Society of Cardiovascular Computed Tomography members; 10% responded, and the answers are indicated in the case descriptions. It must be emphasized that considerably more data are required before formal recommendations can be made. With further research and technical developments, computed tomography–based plaque analysis may, in the future, provide noninvasive insight into the “vulnerability” of specific lesions and may possibly contribute to the prevention of acute coronary events.