Computed Tomography Biomarkers of Vulnerable Coronary Plaques

Open access


An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Schaar JA Muller JE Falk E et al. Terminology for high-risk and vulnerable coronary artery plaques. Report of a meeting on the vulnerable plaque June 17 and 18 2003 Santorini Greece. Eur Heart J. 2004;25:1077-1082.

  • 2. Opolski MP Kępka C Rużyłło W. Computed tomography for detection of vulnerable coronary plaque – A Cassandra’s dream? Postępy w Kardiologii Interwencyjnej/Advances in Interventional Cardiology. 2014;10:147-152.

  • 3. Motoyama S Masayoshi S Harigaya H et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54:49-57.

  • 4. Maurovich-Horvat P Schlett CL Alkadhi H et al. The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging. 2012;5:1243-1252.

  • 5. van Velzen JE de Graaf FR de Graaf MA et al. Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis. J Nucl Cardiol. 2011;18:893-903.

  • 6. Motoyama S Kondo T Sarai M et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319-326.

  • 7. Cilla M Pena E Martinez MA Kelly DJ. Comparison of the vulnerability risk for positive versus negative atheroma plaque morphology. J Biomech. 2013;46:1248-1254.

  • 8. Benedek T Gyöngyösi M Benedek I. Multislice computed tomographic coronary angiography for quantitative assessment of culprit lesions in acute coronary syndromes. Can J Cardiol. 2013;29:364-371.

  • 9. Batty JA Subba S Luke P Gigi LWC Sinclair H Kunadian V. Intracoronary imaging in the detection of vulnerable plaques. Curr Cardiol Rep. 2016;18:28.

  • 10. Huynh K. Imaging: Combining IVUS and NIRS improves accuracy of fibroatheroma detection. Nat Rev Cardiol. 2015;12:130.

  • 11. Sinclair H Bourantas C Bagnall A Mintz GS Kunadian V. OCT for identification of Vulnerable Plaque in Acute Coronary Syndrome. JACC Cardiovasc Imaging. 2015;8:198-209.

  • 12. Rasouli ML Shavelle DM French WJ McKay CR Budoff MJ. Assessment of coronary plaque morphology by contrast enhanced computed tomographic angiography: CT Imaging of Coronary Artery Plaque 313 comparison with intravascular ultrasound. Coron Artery Dis. 2006;17:359-364.

  • 13. Nance JW Jr Schlett CL Schoepf UJ et al. Incremental prognostic value of different components of coronary atherosclerotic plaque at cardiac CT angiography beyond coronary calcification in patients with acute chest pain. Radiology. 2012;264:679-690.

  • 14. Achenbach S Moselewski F Ropers D et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced submillimeter multidetector spiral computed tomography: a segment based comparison with intravascular ultrasound. Circulation. 2004;109:14-17.

  • 15. Kim SY Kim KS Lee SY et al. Assessment of non-calcified plaques Using 64-Slice Computed Tomography: Comparison with Intravascular Ultrasound. Korean Circ J. 2009;39:95-99.

  • 16. Sato A. Coronary plaque imaging by coronary computed tomography angiography. World J Radiol. 2014;6:148-159.

  • 17. Conte E Annoni A Pontone G et al. Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study. Eur Heart J Cardiovasc Imaging. 2016;pii:jew200. [Epub ahead of print]

  • 18. Benedek T Jako B Benedek I. Plaque quantification by coronary CT and intravascular ultrasound identifies a low CT density core as a marker for plaque instability in acute coronary syndromes. Int Heart J. 2014;55:22-28.

  • 19. Nadjiri J Hausleiter J Jähnichen C et al. Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up. J Cardiovasc Comput Tomogr. 2016;10:97-104.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 254 92 3
PDF Downloads 109 63 2