Classification of noncalcified coronary atherosclerotic plaque components on CT coronary angiography: impact of vascular attenuation and density thresholds

Purpose. The authors assessed the effect of vascular attenuation and density thresholds on the classification of noncalcified plaque by computed tomography coronary angiography (CTCA). Materials and methods. Thirty patients (men 25; age 59 +/- 8 years) with stable angina underwent arterial and delayed CTCA. At sites of atherosclerotic plaque, attenuation values (HU) were measured within the coronary lumen, noncalcified and calcified plaque material and the surrounding epicardial fat. Based on the measured CT attenuation values, coronary plaques were classified as lipid rich (attenuation value below the threshold) or fibrous (attenuation value above the threshold) using 30-HU, 50-HU and 70-HU density thresholds. Results. One hundred and sixty-seven plaques (117 mixed and 50 noncalcified) were detected and assessed. The attenuation values of mixed plaques were higher than those of exclusively noncalcified plaques in both the arterial (148.3 +/- 73.1 HU vs. 106.2 +/- 57.9 HU) and delayed (111.4 +/- 50.5 HU vs. 64.4 +/- 43.4 HU) phases (p