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Atherosclerotic plaque features relevant to rupture-risk detected by clinical photon-counting CT ex vivo : a proof-of-concept study

Shami, Annelie LU orcid ; Sun, Jiangming LU orcid ; Gialeli, Chrysostomi LU ; Markstad, Hanna LU ; Edsfeldt, Andreas LU ; Aurumskjöld, Marie Louise LU and Gonçalves, Isabel LU orcid (2024) In European Radiology Experimental 8(1).
Abstract

Background: To identify subjects with rupture-prone atherosclerotic plaques before thrombotic events occur is an unmet clinical need. Thus, this proof-of-concept study aims to determine which rupture-prone plaque features can be detected using clinically available photon-counting computed tomography (PCCT). Methods: In this retrospective study, advanced atherosclerotic plaques (ex vivo, paraffin-embedded) from the Carotid Plaque Imaging Project were scanned by PCCT with reconstructed energy levels (45, 70, 120, 190 keV). Density in HU was measured in 97 regions of interest (ROIs) representing rupture-prone plaque features as demonstrated by histopathology (thrombus, lipid core, necrosis, fibrosis, intraplaque haemorrhage, calcium). The... (More)

Background: To identify subjects with rupture-prone atherosclerotic plaques before thrombotic events occur is an unmet clinical need. Thus, this proof-of-concept study aims to determine which rupture-prone plaque features can be detected using clinically available photon-counting computed tomography (PCCT). Methods: In this retrospective study, advanced atherosclerotic plaques (ex vivo, paraffin-embedded) from the Carotid Plaque Imaging Project were scanned by PCCT with reconstructed energy levels (45, 70, 120, 190 keV). Density in HU was measured in 97 regions of interest (ROIs) representing rupture-prone plaque features as demonstrated by histopathology (thrombus, lipid core, necrosis, fibrosis, intraplaque haemorrhage, calcium). The relationship between HU and energy was then assessed using a mixed-effects model for each plaque feature. Results: Plaques from five men (age 79 ± 8 [mean ± standard deviation]) were included in the study. Comparing differences in coefficients (b 1diff) of matched ROIs on plaque images obtained by PCCT and histology confirmed that calcium was distinguishable from all other analysed features. Of greater novelty, additional rupture-prone plaque features proved discernible from each other, particularly when comparing haemorrhage with fibrous cap (p = 0.017), lipids (p = 0.003) and necrosis (p = 0.004) and thrombus compared to fibrosis (p = 0.048), fibrous cap (p = 0.028), lipids (p = 0.015) and necrosis (p = 0.017). Conclusions: Clinically available PCCT detects not only calcification, but also other rupture-prone features of human carotid plaques ex vivo. Relevance statement: Improved atherosclerotic plaque characterisation by photon-counting CT provides the ability to distinguish not only calcium, but also rupture-prone plaque features such as haemorrhage and thrombus. This may potentially improve monitoring and risk stratification of atherosclerotic patients in order to prevent strokes. Key points: • CT of atherosclerotic plaques mainly detects calcium. • Many components, such as intra-plaque haemorrhage and lipids, determine increased plaque rupture risk. • Ex vivo carotid plaque photon-counting CT distinguishes haemorrhage and thrombus. • Improved plaque photon-counting CT evaluation may refine risk stratification accuracy to prevent strokes. Graphical Abstract: [Figure not available: see fulltext.].

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atherosclerosis, Carotid arteries, Carotid stenosis, Plaque (atherosclerotic), Tomography (x-ray computed)
in
European Radiology Experimental
volume
8
issue
1
article number
14
publisher
Springer
external identifiers
  • pmid:38286959
  • scopus:85184256148
ISSN
2509-9280
DOI
10.1186/s41747-023-00410-4
language
English
LU publication?
yes
id
4dfb67ed-c8a9-4f8f-bea5-5d04f237f443
date added to LUP
2024-03-05 12:02:01
date last changed
2024-04-17 17:49:04
@article{4dfb67ed-c8a9-4f8f-bea5-5d04f237f443,
  abstract     = {{<p>Background: To identify subjects with rupture-prone atherosclerotic plaques before thrombotic events occur is an unmet clinical need. Thus, this proof-of-concept study aims to determine which rupture-prone plaque features can be detected using clinically available photon-counting computed tomography (PCCT). Methods: In this retrospective study, advanced atherosclerotic plaques (ex vivo, paraffin-embedded) from the Carotid Plaque Imaging Project were scanned by PCCT with reconstructed energy levels (45, 70, 120, 190 keV). Density in HU was measured in 97 regions of interest (ROIs) representing rupture-prone plaque features as demonstrated by histopathology (thrombus, lipid core, necrosis, fibrosis, intraplaque haemorrhage, calcium). The relationship between HU and energy was then assessed using a mixed-effects model for each plaque feature. Results: Plaques from five men (age 79 ± 8 [mean ± standard deviation]) were included in the study. Comparing differences in coefficients (b <sub>1diff</sub>) of matched ROIs on plaque images obtained by PCCT and histology confirmed that calcium was distinguishable from all other analysed features. Of greater novelty, additional rupture-prone plaque features proved discernible from each other, particularly when comparing haemorrhage with fibrous cap (p = 0.017), lipids (p = 0.003) and necrosis (p = 0.004) and thrombus compared to fibrosis (p = 0.048), fibrous cap (p = 0.028), lipids (p = 0.015) and necrosis (p = 0.017). Conclusions: Clinically available PCCT detects not only calcification, but also other rupture-prone features of human carotid plaques ex vivo. Relevance statement: Improved atherosclerotic plaque characterisation by photon-counting CT provides the ability to distinguish not only calcium, but also rupture-prone plaque features such as haemorrhage and thrombus. This may potentially improve monitoring and risk stratification of atherosclerotic patients in order to prevent strokes. Key points: • CT of atherosclerotic plaques mainly detects calcium. • Many components, such as intra-plaque haemorrhage and lipids, determine increased plaque rupture risk. • Ex vivo carotid plaque photon-counting CT distinguishes haemorrhage and thrombus. • Improved plaque photon-counting CT evaluation may refine risk stratification accuracy to prevent strokes. Graphical Abstract: [Figure not available: see fulltext.].</p>}},
  author       = {{Shami, Annelie and Sun, Jiangming and Gialeli, Chrysostomi and Markstad, Hanna and Edsfeldt, Andreas and Aurumskjöld, Marie Louise and Gonçalves, Isabel}},
  issn         = {{2509-9280}},
  keywords     = {{Atherosclerosis; Carotid arteries; Carotid stenosis; Plaque (atherosclerotic); Tomography (x-ray computed)}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer}},
  series       = {{European Radiology Experimental}},
  title        = {{Atherosclerotic plaque features relevant to rupture-risk detected by clinical photon-counting CT ex vivo : a proof-of-concept study}},
  url          = {{http://dx.doi.org/10.1186/s41747-023-00410-4}},
  doi          = {{10.1186/s41747-023-00410-4}},
  volume       = {{8}},
  year         = {{2024}},
}