Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: a prospective study with tissue validation.

摘要: Background: Identifying vulnerable coronary plaque with CT angiography is limited by overlap between attenuation of necrotic core and fibrous plaque. Using x-rays differing energies alters values these components, depending on their material composition. Objectives: We sought to determine whether dual-energy (DECT) improves component discrimination compared single-energy (SECT). Methods: Twenty patients underwent DECT virtual histology intravascular ultrasound (VH-IVUS). Attenuation changes at 100 140 kV for each were defined, using 1088 areas co-registered VH-IVUS. Hounsfield unit thresholds that best detected derived SECT (conventional values) (using indices, defined as difference in the 2 voltages/their sum). Sensitivity detect components was determined 77 segments from 7 postmortem arteries. Finally, we examined 60 plaques vivo feasibility sensitivity clinical VH-IVUS edefined core. Results: In contrast conventional SECT, mean indices tissue significantly different minimal ranges (necrotic core, 0.007 [95% CI, e0.001 0.016]; tissue, 0.028 0.016e0.050]; P < .0001). increased diagnostic accuracy arteries (sensitivity, 64%; specificity, 98%) 50%; 94%).