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Titel:

Association of Tube Voltage With Plaque Composition on Coronary CT Angiography: Results From PARADIGM Registry.

Dokumenttyp:
Article; Journal Article; Research Support, Non-U.S. Gov't
Autor(en):
Takagi, Hidenobu; Leipsic, Jonathon A; Indraratna, Praveen; Gulsin, Gaurav; Khasanova, Elina; Tzimas, Georgios; Lin, Fay Y; Shaw, Leslee J; Lee, Sang-Eun; Andreini, Daniele; Al-Mallah, Mouaz H; Budoff, Matthew J; Cademartiri, Filippo; Chinnaiyan, Kavitha; Choi, Jung Hyun; Conte, Edoardo; Marques, Hugo; de Araújo Gonçalves, Pedro; Gottlieb, Ilan; Hadamitzky, Martin; Maffei, Erica; Pontone, Gianluca; Shin, Sanghoon; Kim, Yong-Jin; Lee, Byoung Kwon; Chun, Eun Ju; Sung, Ji Min; Virmani, Renu; Samady...     »
Abstract:
OBJECTIVES: This study sought to investigate the impact of low tube voltage scanning heterogeneity of coronary luminal attenuation on plaque quantification and characterization with coronary computed tomography angiography (CCTA). BACKGROUND: The impact of low tube voltage and coronary luminal attenuation on quantitative coronary plaque remains uncertain. METHODS: A total of 1,236 consecutive patients (age: 60 ± 9 years; 41% female) who underwent serial CCTA at an interval of ≥2 years were included from an international registry. Patients with prior revascularization or nonanalyzable coronary CTAs were excluded. Total coronary plaque volume was assessed and subclassified based on specific Hounsfield unit (HU) threshold: necrotic core, fibrofatty plaque, and fibrous plaque and dense calcium. Luminal attenuation was measured in the aorta. RESULTS: With increasing luminal HU (<350, 350-500, and >500 HU), percent calcified plaque was increased (16%, 27%, and 40% in the median; P < 0.001), and fibrofatty plaque (26%, 13%, and 4%; P < 0.001) and necrotic core (1.6%, 0.3%, and 0.0%; P < 0.001) were decreased. Higher tube voltage scanning (80, 100, and 120 kV) resulted in decreasing luminal attenuation (689 ± 135, 497 ± 89, and 391 ± 73 HU; P < 0.001) and calcified plaque volume (59%, 34%, and 23%; P < 0.001) and increased fibrofatty plaque (3%, 9%, and 18%; P < 0.001) and necrotic core (0.2%, 0.1%, and 0.6%; P < 0.001). Mediation analysis showed that the impact of 100 kV on plaque composition, compared with 120 kV, was primarily caused by an indirect effect through blood pool attenuation. Tube voltage scanning of 80 kV maintained a direct effect on fibrofatty plaque and necrotic core in addition to an indirect effect through the luminal attenuation. CONCLUSIONS: Low tube voltage usage affected plaque morphology, mainly through an increase in luminal HU with a resultant increase in calcified plaque and a reduction in fibrofatty and necrotic core. These findings should be considered as CCTA-based plaque measures are being used to guide medical management and, in particular, when being used as a measure of treatment response. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).
Zeitschriftentitel:
JACC Cardiovasc Imaging
Jahr:
2021
Band / Volume:
14
Heft / Issue:
12
Seitenangaben Beitrag:
2429-2440
Volltext / DOI:
doi:10.1016/j.jcmg.2021.07.011
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/34419398
Print-ISSN:
1936-878X
TUM Einrichtung:
Institut für Radiologie und Nuklearmedizin
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