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European Radiology
Published in: European Radiology 9/2016

01-09-2016 | Cardiac

AHA classification of coronary and carotid atherosclerotic plaques by grating-based phase-contrast computed tomography

Authors: Holger Hetterich, Nicole Webber, Marian Willner, Julia Herzen, Lorenz Birnbacher, Alexander Hipp, Mathias Marschner, Sigrid D. Auweter, Christopher Habbel, Ulrich Schüller, Fabian Bamberg, Birgit Ertl-Wagner, Franz Pfeiffer, Tobias Saam

Published in: European Radiology | Issue 9/2016

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Abstract

Objectives

To evaluate the potential of grating-based phase-contrast computed-tomography (gb-PCCT) to classify human carotid and coronary atherosclerotic plaques according to modified American Heart Association (AHA) criteria.

Methods

Experiments were carried out at a laboratory-based set-up consisting of X-ray tube (40 kVp), grating-interferometer and detector. Eighteen human carotid and coronary artery specimens were examined. Histopathology served as the standard of reference. Vessel cross-sections were classified as AHA lesion type I/II, III, IV/V, VI, VII or VIII plaques by two independent reviewers blinded to histopathology. Conservative measurements of diagnostic accuracies for the detection and differentiation of plaque types were evaluated.

Results

A total of 127 corresponding gb-PCCT/histopathology sections were analyzed. Based on histopathology, lesion type I/II was present in 12 (9.5 %), III in 18 (14.2 %), IV/V in 38 (29.9 %), VI in 16 (12.6 %), VII in 34 (26.8 %) and VIII in 9 (7.0 %) cross-sections. Sensitivity, specificity and positive and negative predictive value were ≥0.88 for most analyzed plaque types with a good level of agreement (Cohen’s kappa = 0.90). Overall, results were better in carotid (kappa = 0.97) than in coronary arteries (kappa = 0.85). Inter-observer agreement was high with kappa = 0.85, p < 0.0001.

Conclusions

These results indicate that gb-PCCT can reliably classify atherosclerotic plaques according to modified AHA criteria with excellent agreement to histopathology.

Key Points

• Different atherosclerotic plaque types display distinct morphological features in phase-contrast CT.
• Phase-contrast CT can detect and differentiate AHA plaque types.
• Calcifications caused streak artefacts and reduced sensitivity in type VI lesions.
• Overall agreement was higher in carotid than in coronary arteries.
Literature
1.
Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121:948–954CrossRefPubMed
2.
Stary HC (2000) Natural history and histological classification of atherosclerotic lesions: an update. Arterioscler Thromb Vasc Biol 20:1177–1178CrossRefPubMed
3.
Kolodgie FD, Gold HK, Burke AP et al (2003) Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349:2316–2325CrossRefPubMed
4.
Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275CrossRefPubMed
5.
Saam T, Hetterich H, Hoffmann V et al (2013) Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol 62:1081–1091CrossRefPubMed
6.
Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C (2002) Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 106:1368–1373CrossRefPubMed
7.
Esposito-Bauer L, Saam T, Ghodrati I et al (2013) MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 8, e67927CrossRefPubMedPubMedCentral
8.
Donath T, Pfeiffer F, Bunk O et al (2010) Toward clinical X-ray phase-contrast CT: demonstration of enhanced soft-tissue contrast in human specimen. Invest Radiol 45:445–452PubMed
9.
Pfeiffer F, Herzen J, Willner M et al (2013) Grating-based X-ray phase contrast for biomedical imaging applications. Z Med Phys 23:176–185CrossRefPubMed
10.
Momose A, Takeda K, Yoneyama A, Koyama I, Itai T (2001) Phase-contrast X-ray imaging using an x-ray interferometer for biological imaging. Anal Sci 17:i527–i530CrossRef
11.
Hetterich H, Fill S, Herzen J et al (2013) Grating-based X-ray phase-contrast tomography of atherosclerotic plaque at high photon energies. Z Med Phys 23:194–203CrossRefPubMed
12.
13.
Saam T, Herzen J, Hetterich H et al (2013) Translation of atherosclerotic plaque phase-contrast CT imaging from synchrotron radiation to a conventional lab-based X-ray source. PLoS One 8, e73513CrossRefPubMedPubMedCentral
14.
Momose A (2005) Recent advances in X-ray phase imaging. Jpn J Appl Phys 44:6355CrossRef
15.
Pfeiffer F, Weitkamp T, Bunk O, David C (2006) Phase retrieval and differential phase-contrast imaging with low-brilliance X-ray sources. Nat Phys 2:258–261CrossRef
16.
Bravin A, Coan P, Suortti P (2013) X-ray phase-contrast imaging: from pre-clinical applications towards clinics. Phys Med Biol 58:R1–R35CrossRefPubMed
17.
Willner M, Herzen J, Grandl S et al (2014) Quantitative breast tissue characterization using grating-based x-ray phase-contrast imaging. Phys Med Biol 59:1557–1571CrossRefPubMed
18.
Weitkamp T, Diaz A, David C et al (2005) X-ray phase imaging with a grating interferometer. Opt Express 13:6296–6304CrossRefPubMed
19.
20.
Willner M, Bech M, Herzen J et al (2013) Quantitative X-ray phase-contrast computed tomography at 82 keV. Opt Express 21:4155–4166CrossRefPubMed
21.
Donath T, Pfeiffer F, Bunk O et al (2009) Phase-contrast imaging and tomography at 60 keV using a conventional x-ray tube source. Rev Sci Instrum 80:053701CrossRefPubMed
22.
Gaass T, Potdevin G, Bech M et al (2013) Iterative reconstruction for few-view grating-based phase-contrast CT—an in vitro mouse model. EPL (Europhys Lett) 102:48001CrossRef
23.
Sarapata A, Willner M, Walter M et al (2015) Quantitative imaging using high-energy X-ray phase-contrast CT with a 70 kVp polychromatic X-ray spectrum. Opt Express 23:523–535CrossRefPubMed
24.
Obaid DR, Calvert PA, Gopalan D et al (2013) Atherosclerotic plaque composition and classification identified by coronary computed tomography: assessment of computed tomography-generated plaque maps compared with virtual histology intravascular ultrasound and histology. Circ Cardiovasc Imaging 6:655–664CrossRefPubMed
25.
Maurovich-Horvat P, Schlett CL, Alkadhi H et al (2012) Differentiation of early from advanced coronary atherosclerotic lesions: systematic comparison of CT, intravascular US, and optical frequency domain imaging with histopathologic examination in ex vivo human hearts. Radiology 265:393–401CrossRefPubMed
26.
Li T, Li X, Zhao X et al (2012) Classification of human coronary atherosclerotic plaques using ex vivo high-resolution multicontrast-weighted MRI compared with histopathology. AJR Am J Roentgenol 198:1069–1075CrossRefPubMed
27.
Pohle K, Achenbach S, Macneill B et al (2007) Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. Atherosclerosis 190:174–180CrossRefPubMed
28.
Pfeiffer F, Bech M, Bunk O et al (2008) Hard-X-ray dark-field imaging using a grating interferometer. Nat Mater 7:134–137CrossRefPubMed
29.
McDonald SA, Marone F, Hintermuller C et al (2009) Advanced phase-contrast imaging using a grating interferometer. J Synchrotron Radiat 16:562–572CrossRefPubMed
30.
31.
Momose A, Yashiro W, Harasse S, Kuwabara H (2011) Four-dimensional X-ray phase tomography with Talbot interferometry and white synchrotron radiation: dynamic observation of a living worm. Opt Express 19:8423–8432CrossRefPubMed
32.
Stutman D, Finkenthal M (2012) Glancing angle Talbot-Lau grating interferometers for phase contrast imaging at high x-ray energy. Appl Phys Lett 101:91108CrossRefPubMed
33.
34.
Wang Z, Huang Z, Zhang L et al (2011) Low dose reconstruction algorithm for differential phase contrast imaging. J Xray Sci Technol 19:403–415PubMed
35.
Miao H, Chen L, Bennett EE et al (2013) Motionless phase stepping in X-ray phase contrast imaging with a compact source. Proc Natl Acad Sci U S A 110:19268–19272CrossRefPubMedPubMedCentral
Metadata
Title
AHA classification of coronary and carotid atherosclerotic plaques by grating-based phase-contrast computed tomography
Authors
Holger Hetterich
Nicole Webber
Marian Willner
Julia Herzen
Lorenz Birnbacher
Alexander Hipp
Mathias Marschner
Sigrid D. Auweter
Christopher Habbel
Ulrich Schüller
Fabian Bamberg
Birgit Ertl-Wagner
Franz Pfeiffer
Tobias Saam
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4143-z

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