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Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps

Daniel Obaid Orcid Logo, Ike Okonji, Suk F Cheng, Argyrios A Giannopoulos, Pragash Kamalathevan, Julian Halcox Orcid Logo, Manuel Rodriguez-Justo, Toby Richards

The British Journal of Radiology, Volume: 96, Issue: 1147

Swansea University Authors: Daniel Obaid Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1259/bjr.20220982

Abstract

Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histological...

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Published in: The British Journal of Radiology
ISSN: 0007-1285 1748-880X
Published: Oxford University Press (OUP) 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63850
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We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histologically proven vulnerable plaques. Methods: Seventy patients underwent carotid CT angiography and carotid endarterectomy. A derivation cohort of 20 patients had CT images matched with histology and carotid plaque components attenuation defined. In a validation cohort of 50 patients, CT-derived plaque maps were compared in 43 symptomatic vs 40 asymptomatic carotid plaques and accuracy detecting vulnerable plaques calculated. Results: In 250 plaque areas co-registered with histology, the median attenuation (HU) of necrotic core 43(26-63), fibrous plaque 127(110-162) and calcified plaque 964 (816-1207) created significantly different ratios of plaque/contrast attenuation. CT-derived plaque maps revealed symptomatic plaques had larger necrotic core than asymptomatic (13.5%(5.9-33.3) vs 7.4%(2.3-14.3), p = 0.004) with large necrotic core predicting symptoms (area under ROC curve 0.68, p = 0.004). Twenty-four of 47 carotid plaques were histologically classified as most vulnerable (Starry-Type VI). Plaque maps revealed Type VI plaques had a greater necrotic core volume than Type IV/V plaques and a necrotic core/fibrous plaque ratio &gt;0.5 distinguished Type VI plaques with sensitivity 75.0% (55.1-88.0) and specificity of 39.1% (22.2-59.2). Conclusions: Carotid plaque components can be differentiated by CT using a ratio of plaque/contrast attenuation. CT-derived plaque map volumes of necrotic core help distinguished the most vulnerable plaques. 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spelling v2 63850 2023-07-10 Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps 1cb4b49224d4f3f2b546ed0f39e13ea8 0000-0002-3891-1403 Daniel Obaid Daniel Obaid true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2023-07-10 BMS Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histologically proven vulnerable plaques. Methods: Seventy patients underwent carotid CT angiography and carotid endarterectomy. A derivation cohort of 20 patients had CT images matched with histology and carotid plaque components attenuation defined. In a validation cohort of 50 patients, CT-derived plaque maps were compared in 43 symptomatic vs 40 asymptomatic carotid plaques and accuracy detecting vulnerable plaques calculated. Results: In 250 plaque areas co-registered with histology, the median attenuation (HU) of necrotic core 43(26-63), fibrous plaque 127(110-162) and calcified plaque 964 (816-1207) created significantly different ratios of plaque/contrast attenuation. CT-derived plaque maps revealed symptomatic plaques had larger necrotic core than asymptomatic (13.5%(5.9-33.3) vs 7.4%(2.3-14.3), p = 0.004) with large necrotic core predicting symptoms (area under ROC curve 0.68, p = 0.004). Twenty-four of 47 carotid plaques were histologically classified as most vulnerable (Starry-Type VI). Plaque maps revealed Type VI plaques had a greater necrotic core volume than Type IV/V plaques and a necrotic core/fibrous plaque ratio >0.5 distinguished Type VI plaques with sensitivity 75.0% (55.1-88.0) and specificity of 39.1% (22.2-59.2). Conclusions: Carotid plaque components can be differentiated by CT using a ratio of plaque/contrast attenuation. CT-derived plaque map volumes of necrotic core help distinguished the most vulnerable plaques. Advances in knowledge: CT-derived plaque maps based on plaque/contrast attenuation may provide new markers of carotid plaque vulnerability. Journal Article The British Journal of Radiology 96 1147 Oxford University Press (OUP) 0007-1285 1748-880X Carotid plaque, carotid CT angiography, carotid endarterectomy 15 5 2023 2023-05-15 10.1259/bjr.20220982 http://dx.doi.org/10.1259/bjr.20220982 COLLEGE NANME Biomedical Sciences COLLEGE CODE BMS Swansea University SU Library paid the OA fee (TA Institutional Deal) Swansea University. 2024-01-08T10:39:22.5069421 2023-07-10T14:14:12.2706249 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Daniel Obaid 0000-0002-3891-1403 1 Ike Okonji 2 Suk F Cheng 3 Argyrios A Giannopoulos 4 Pragash Kamalathevan 5 Julian Halcox 0000-0001-6926-2947 6 Manuel Rodriguez-Justo 7 Toby Richards 8 63850__28069__e460b6de218d4fe7a9075f6d39f07fe5.pdf 63850.VOR.pdf 2023-07-10T14:18:28.1759365 Output 1267810 application/pdf Version of Record true © 2023 The Authors. Published by the British Institute of Radiology. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0). true eng https://creativecommons.org/licenses/by/4.0/
title Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
spellingShingle Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
Daniel Obaid
Julian Halcox
title_short Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
title_full Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
title_fullStr Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
title_full_unstemmed Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
title_sort Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps
author_id_str_mv 1cb4b49224d4f3f2b546ed0f39e13ea8
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv 1cb4b49224d4f3f2b546ed0f39e13ea8_***_Daniel Obaid
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Daniel Obaid
Julian Halcox
author2 Daniel Obaid
Ike Okonji
Suk F Cheng
Argyrios A Giannopoulos
Pragash Kamalathevan
Julian Halcox
Manuel Rodriguez-Justo
Toby Richards
format Journal article
container_title The British Journal of Radiology
container_volume 96
container_issue 1147
publishDate 2023
institution Swansea University
issn 0007-1285
1748-880X
doi_str_mv 10.1259/bjr.20220982
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1259/bjr.20220982
document_store_str 1
active_str 0
description Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histologically proven vulnerable plaques. Methods: Seventy patients underwent carotid CT angiography and carotid endarterectomy. A derivation cohort of 20 patients had CT images matched with histology and carotid plaque components attenuation defined. In a validation cohort of 50 patients, CT-derived plaque maps were compared in 43 symptomatic vs 40 asymptomatic carotid plaques and accuracy detecting vulnerable plaques calculated. Results: In 250 plaque areas co-registered with histology, the median attenuation (HU) of necrotic core 43(26-63), fibrous plaque 127(110-162) and calcified plaque 964 (816-1207) created significantly different ratios of plaque/contrast attenuation. CT-derived plaque maps revealed symptomatic plaques had larger necrotic core than asymptomatic (13.5%(5.9-33.3) vs 7.4%(2.3-14.3), p = 0.004) with large necrotic core predicting symptoms (area under ROC curve 0.68, p = 0.004). Twenty-four of 47 carotid plaques were histologically classified as most vulnerable (Starry-Type VI). Plaque maps revealed Type VI plaques had a greater necrotic core volume than Type IV/V plaques and a necrotic core/fibrous plaque ratio >0.5 distinguished Type VI plaques with sensitivity 75.0% (55.1-88.0) and specificity of 39.1% (22.2-59.2). Conclusions: Carotid plaque components can be differentiated by CT using a ratio of plaque/contrast attenuation. CT-derived plaque map volumes of necrotic core help distinguished the most vulnerable plaques. Advances in knowledge: CT-derived plaque maps based on plaque/contrast attenuation may provide new markers of carotid plaque vulnerability.
published_date 2023-05-15T10:39:24Z
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