冠状动脉CTA管壁观察及临床意义.pptVIP

Different types of vulnerable plaque as underlying cause of acute coronary events (ACS) and sudden cardiac death (SCD). A,Rupture-prone plaque with large lipid core and thin fibrous cap infiltrated by macrophages. B, Ruptured plaque with subocclusivethrombus and early organization. C, Erosion-prone plaque with proteoglycan matrix in a smooth muscle cell-rich plaque. D, Erodedplaque with subocclusive thrombus. E, Intraplaque hemorrhage secondary to leaking vasa vasorum. F, Calcific nodule protruding intothe vessel lumen. G, Chronically stenotic plaque with severe calcification, old thrombus, and eccentric lumen. The CT characteristics of a culprit lesion in a 40-year-old male patient presenting with acute coronary syndrome. (A) Volume rendering. (B) Curved MPR. (C) Magnifiedview of the region of interest from (C). (D) Coronary angiogram. The white arrows in (A) and (D) show the site of luminal obstruction or culprit lesion. As shown by thesolid yellow arrows at 2 sites in the culprit lesion in (C), the lesion is positively remodeled as compared with the normal coronary segment proximal to the lesion(denoted by interrupted arrows). Remodeling index in this patient was 1.43. An NCP 30 HU represents the probability of a soft plaque (red circles are placed alongthe course of low attenuation), and 30 HU NCP 150 HU denotes a fibrous plaque (green squares). CT computed tomography; LAD left anterior descendingartery; MPR multiplanar reformation; NCP noncalcified plaque. The CT characteristics of a stable plaque from a 77-year-old male patient. The image shows negatively remodeled severely obstructive lesion almost entirely made up of30 HU NCP 150 HU (green squares). No NCP 30 HU or spotty calcification is observed. Remodeling index in this patient was 0.87. The circumferential outer rim (red dashed line) of the noncalcified plaque has a higher CT attenuation in both the noncontrast(A) and contrast-enhanced (B) images (44.0 8.8 HU, range 23.0 to 61.0 HU v