Background

Using computed tomography angiography to differentiate between components of carotid atherosclerotic lesions remains largely elusive. This study sought to validate a semi-automated software for computed tomography angiography plaque analysis using histologic comparisons.

Materials and Methods

A retrospective review was performed of consecutive patients that underwent a carotid endarterectomy, with pre-procedural computed tomography angiography imaging of the cervical arterial vasculature available for review. Images were evaluated using a commercially-available software package, which produced segmented analyses of intraplaque components (e.g. intraplaque hemorrhage, lipid-rich necrotic core, and calcifications). On imaging, each component was assessed in terms of its (1) presence or absence, and (2) both volume and proportion of the total plaque volume (if present). On histological evaluation of carotid endarterectomy specimens, each component was evaluated as an estimated proportion of total plaque volume.

Results

Of 80 included patients, 30 (37.5%) were female. The average age was 69.7 years (SD = 9.1). Based on imaging, intraplaque hemorrhage was the smallest contributor to plaque composition (1.2% of volumes on average). Statistically significant linear associations were noted between the proportion of intraplaque hemorrhage, lipid-rich necrotic core, and calcifications on histology and the volume of each component on imaging (p values ranged from 0.0008 to 0.01). Area under curve were poor for intraplaque hemorrhage and lipid-rich necrotic core (0.59 and 0.61, respectively) and acceptable for calcifications (0.73).

Conclusion

Semi-automated analyses of computed tomography angiography have limited diagnostic accuracy in the detection of intraplaque hemorrhage and lipid-rich necrotic core in carotid artery plaques. However, volumetric imaging measurements of different components corresponded with histologic analysis.

中文翻译：

---

计算机断层扫描血管造影与颈动脉粥样硬化组织学之间的相关性：半自动成像软件能否预测斑块的成分？

背景

使用计算机断层扫描血管造影来区分颈动脉粥样硬化病变的成分在很大程度上仍然难以捉摸。本研究旨在使用组织学比较来验证用于计算机断层扫描血管造影斑块分析的半自动化软件。

材料和方法

对接受颈动脉内膜切除术的连续患者进行回顾性审查，并提供颈动脉血管系统的术前计算机断层扫描血管造影成像以供审查。使用市售软件包对图像进行评估，该软件包对斑块内成分（例如斑块内出血、富含脂质的坏死核和钙化）进行分段分析。在影像学上，根据其 (1) 存在与否，以及 (2) 体积和占总斑块体积的比例（如果存在）对每个成分进行评估。在颈动脉内膜切除术标本的组织学评估中，每个成分都被评估为总斑块体积的估计比例。

结果

在纳入的 80 名患者中，30 名 (37.5%) 为女性。平均年龄为 69.7 岁 (SD = 9.1)。根据成像，斑块内出血是斑块组成的最小贡献者（平均占体积的 1.2%）。在组织学上斑块内出血、富含脂质的坏死核和钙化的比例与成像上每个成分的体积之间存在统计学上显着的线性关联（p值范围为 0.0008 至 0.01）。斑块内出血和富含脂质的坏死核的曲线下面积较差（分别为 0.59 和 0.61），钙化的曲线下面积可以接受（0.73）。

结论

计算机断层扫描血管造影的半自动分析在检测颈动脉斑块中的斑块内出血和富含脂质的坏死核心方面的诊断准确性有限。然而，不同成分的体积成像测量与组织学分析相对应。