Article Figures & Data
Figures
- Fig 1.
In vivo CTA image of the common carotid artery, and matching ex vivo micro-CT and histologic sections. Automated classification computer algorithm-derived overlay shows lipid-rich necrotic core (yellow), calcification (blue), blood products (red), and remaining connective tissue (green). CTA overlay demonstrates a plaque with a large lipid core, small calcifications, and an ulceration, making it a VIa lesion according to the AHA classification, in agreement with histologic examination, the gold standard for noncalcified carotid wall components, and with ex vivo micro-CT, the reference for carotid wall calcium (specimens were decalcified before histologic sectioning).
- Fig 2.
In vivo CTA image of the ICA, and matching ex vivo micro-CT and histologic sections. Automated classification computer algorithm-derived overlay demonstrates a plaque with sparse “lipid” pixels (yellow) and an ulceration, making it a VIa lesion according to the AHA classification, in agreement with histologic examination.
- Fig 3.
In vivo CTA image of the ICA, and matching ex vivo histologic section. Automated classification computer algorithm-derived overlay demonstrates a plaque with a superficial calcification (blue), making it a Vc lesion according to the AHA classification, in agreement with histologic examination.
- Fig 4.
In vivo CTA image of the ICA, and matching ex vivo histologic section. Automated classification computer algorithm-derived overlay demonstrates a plaque with a large hemorrhage (red), making it a VIb lesion according to the AHA classification, in agreement with histologic examination.
Tables
- Table 1:
Original American Heart Association (AHA) classification for atherosclerotic plaques, and modified classification adapted for CT
Type of Plaque AHA Histologic Classification of Atherosclerotic Plaques Classification of Atherosclerotic Plaques Adapted for CT 0 No intimal thickening No intimal thickening 1 Initial lesion; not grossly apparent plaque; foam cells Thin plaque with no calcification 2 Fatty streak; lesion grossly apparent; foam cells and smooth muscle cells contain lipid droplets 3 Preatheroma; foam cells contain lipid droplets and increased number of smooth muscle cells; raised fatty streak Plaque with small lipid cores and no calcification 4 Atheroma; massive extracellular lipid pool (lipid core); grossly visible; infiltrated with foam cells and smooth muscle cells Plaque with a large lipid core, covered by a fibrous cap, possible small calcifications 5a Fibroatheroma; type IV with a fibrous cap 5b Calcified plaque; lesion with a lipid core or fibrotic tissue, with large calcifications Plaque with a lipid core or fibrotic tissue, with large calcifications 5c Fibrotic plaque: fibrous connective tissue, no lipid core Plaque with fibrous tissue, no lipid core, possible small calcifications 6a Ulcerations Ulcerations 6b Wide hemorrhage Wide hemorrhage 6c Thrombosis Thrombosis - Table 2:
Mean in-vivo CT Hounsfield density, SD, and 95% confidence interval for each histologic component*
Histologic Component Mean (HU) SD (HU) 95% Confidence Interval (HU) Lipid-rich necrotic core 32.6 20.0 −7.4 72.5 Connective tissue 46.4 19.9 6.6 86.2 Hemorrhage 97.5 22.0 53.5 141.6 Calcifications 256.7 30.2 216.3 297.1 Note:—HU indicates Hounsfield units.
* Determined by comparison of each 2 × 2-mm square electronically drawn on the in vivo CT reformatted images with corresponding histologic and micro-CT squares.
- Table 3:
Comparison of CTA classification and gold standard histologic classification of type of atherosclerotic plaque and stage of lesion development according to the system derived from the American Heart Association (AHA) classification system
Histologic Classification Total Type of Plaque 0 I–II III IV–Va Vb Vc VIa VIb VIc 0 12 2 14 I–II 4 16 8 28 III 8 35 9 6 1 59 IV–Va 29 29 CTA Classification Vb 26 26 Vc 9 2 15 1 5 32 VIa 1 1 13 15 VIb 1 8 9 VIc 0 Total 16 26 52 41 26 23 15 13 0 212 Note:—CTA indicates CT angiography.
- Table 4:
Comparison of CTA and gold standard histologic examination for large calcifications (Vb plaques)
Large Calcifications (Vb Lesions) Histologic Examination No Yes CTA No 186 0 Yes 0 26 Note:—CTA indicates CT angiography.
- Table 5:
Comparison of CTA and gold standard histologic examination for small and large lipid cores (III, IV–Va,Vb plaques)
Small and Large Lipid Cores (III, IV–Va, Vb Lesions) Histologic Examination No Yes CTA No 69 29 Yes 24 90 Note:—CTA indicates CT angiography.
- Table 6:
Comparison of CTA and gold standard histologic examination for large lipid cores only (IV–Va plaques)
Large Lipid Cores (IV–Va Lesions) Histologic Examination No Yes CTA No 171 12 Yes 0 29 Note:—CTA indicates CT angiography.
- Table 7:
Comparison of CTA and gold standard histologic examination for wide hemorrhages (VIb plaques)
Wide Hemorrhages (VIb Plaques) Histologic Examination No Yes CTA No 186 5 Yes 1 8 Note:—CTA indicates CT angiography.
- Table 8:
Comparison of CTA and gold standard histologic examination for ulcerations (VIa plaques)
Ulcerations (VIa Plaques) Histologic Examination No Yes CTA No 171 2 Yes 2 13 Note:—CTA indicates CT angiography.
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