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Computer-Aided Detection and Evaluation of Lipid-Rich Plaque on Noncontrast Cardiac CT

¹ Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Rm. 1258, Los Angeles, CA 90048.
² Tennessee Heart and Vascular Institute and EBT Research Foundation, Nashville, TN.
³ Department of Medicine, Division of Cardiology, University of California, Los Angeles, CA.
⁴ Heart Disease Prevention Program, University of California, Irvine, CA.

OBJECTIVE. Noncontrast electron beam CT (EBCT) and MDCT are established for the assessment of calcified plaque, but not lipid-rich plaque. We developed software to identify lipid-rich plaque with noncontrast electron beam tomography (EBT) and MDCT.

MATERIALS AND METHODS. A computer algorithm was developed to automatically find contiguous lipid-rich lesions with voxel intensities below a calculated patient-specific lipid threshold. Lipid density and lipid inhomogeneity in Hounsfield units were calculated in the proximal left coronaries of three populations: 34 low-risk patients (low-risk group < 6% Framingham risk score, no calcium), 31 high-risk patients (high-risk group > 20% Framingham risk score, no calcium), and 37 patients with calcified plaque (calcium group).

RESULTS. The mean lipid density was -19.6 ± 3.0 (SD) H in the low-risk group, -25.3 ± 8.2 H in the high-risk group, and -34.3 ± 13.0 H in the calcium group (p < 0.05). The mean lipid inhomogeneity was 17.7 ± 3.6 H in the low-risk group, 21.5 ± 5.5 H in the high-risk group, and 29.0 ± 7.6 H in the calcium group (p < 0.05). The mean interscan variability in lipid density and lipid inhomogeneity were 2.0 ± 3.3 H and 2.1 ± 3.6 H, respectively. In five patients, the locations of lipid-rich plaque correlated well with available intravascular sonography findings.

CONCLUSION. Our method may be able to identify lipid-rich plaque on noncontrast cardiac CT.

Keywords: cardiac CT • cardiac imaging • cardiovascular disease • CT • electron beam tomography

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