Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death

Donghee Han, Sho Torii, Kazuyuki Yahagi, Fay Y. Lin, Ji Hyun Lee, Asim Rizvi, Heidi Gransar, Mahn Won Park, Hadi Mirhedayati Roudsari, Wijnand J. Stuijfzand, Lohendran Baskaran, Bríain ó Hartaigh, Hyung bok Park, Sang eun Lee, Zabiullah Ali, Robert Kutys, Hyuk Jae Chang, James P. Earls, David Fowler, Renu VirmaniJames K. Min

Research output: Contribution to journalArticlepeer-review


Background and aims: Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque. Methods: 8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque (LAP) was defined as any pixel < 30, 45, 60, 75, and 90 HU cut-offs within a coronary plaque. The area of LAP was calculated in each cross-section. Results: Among 105 cross-sections, 37 (35.2%) cross-sectional histology images contained lipid rich plaque. Although the highest specificity for identifying lipid rich plaque was shown with <30 HU cut-off (88.2%), sensitivity (e.g. 55.6% for <75 HU, 16.2% for <30 HU) and negative predictive value (e.g. 75.9% for <75 HU, 65.9% for <30 HU) tended to increase with higher HU cut-offs. For quantitative measurement, <75 HU showed the highest correlation coefficient (0.292, p = 0.003) and no significant differences were observed between lipid rich plaque area and LAP area between histology and CT analysis (Histology: 0.34 ± 0.73 mm 2 , QCT: 0.37 ± 0.71 mm 2 , p = 0.701). Conclusions: LAP area by CCTA using a <75 HU cut-off value demonstrated high sensitivity and quantitative agreement with lipid rich plaque area by histology analysis.

Original languageEnglish (US)
Pages (from-to)426-433
Number of pages8
StatePublished - Aug 2018
Externally publishedYes


  • Atherosclerosis
  • Coronary computed tomography angiography
  • Histology
  • Lipid rich plaque
  • Necrotic core

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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