| [objective]The purpose of this study was to compare the accuracy of DSCT with intravascular ultrasound(IVUS) for the identification and quantitative analysis of coronary atherosclerotic plaques.[Material and Methods]21 patients(14 male,7 female;mean age 64 years) with coronary heart disease(CHD) in the First Affiliated Hospital of Kunming Medical College from March 2008 to March 2009 were enrolled.After DSCT examination, All patients received percutaneous coronary intervention(PCI) and intravascular ultrasound examination.When analysis,each segmental vessels are to determine whether the plaque,as well as the nature of plaque,the degree of vascular stenosis, and were measured the mean minimal lumen area(MLA),the vessel CSA,the mean plaque area,the mean lumen stenosis,the eccentric index,the remodeling index(RI). IVUS was reference standard when assess DSCT in the coronary atherosclerotic lesion value.[Results]A total of 107 segments in 28 vessels of 21 patients(LAD:17,LCX: 5,RCA:6) were investigated by DSCT and IVUS,102 segments were assess,5 segments were ruled out because of poor CT image quality.Compare with IVUS,sensitivity for the detection of＜50%,50～75%,and＞75%stenosis in DSCT was 80.8%(21/26),90.5%(19/21),100%(8/8)respectively.On the segment basis,the sensitivity,specificity,positive predict value and negative predict value of DSCT were96.0%(48/50),86.5%(45/52),87.3%(48/55),95.7%(45/47)respectively.Compared with IVUS,DSCT enabled correct detection in 34 of 37(91.9%) segments containing noncalcified plaques,12 of 13(92.3%) segments containing calcified plaques,and 45 of 52(86.5%) segments without atherosclerotic plaques.The sensitivity in detecting noncalcified,calcified plaques was 91.9%(34/37),92.3%(12/13)respectively,and the specifity was12/13(92.3%),34/35(97.1%).The sensitivity of calcified plaques was higher,but the sensitivity of noncalcified plaque was lower relatively.The minimal lumen area(MLA),the vessel external elastic membrane area,the remodeling index(RI),the eccentric index determined by DSCT and IVUS were 8.53±0.88mm~2 versus 9.01±0.84mm~2;16.91±2.54mm~2versus 17.49±2.34mm~2; 8.5±1.82mm~2versus7.5±1.31 mm~2;65.4±9.12%versus56.3±9.43%;1.04±0.13versus1.0 7±0.15;0.49±0.08 versus0.53±0.07.There was a good correlation between DSCT and IVUS in the vessel CSA,mean lumen stenosis,mean plaque area,the remodeling index and the eccentric index.Mean while that the DSCT overestimated the minimal lumen area and underestimated the plaque area and remodeling index were observed.In DSCT,mean contrast concentration enhancement in the coronary lumen was 363±59HU in proximal segments(AHA 1,5,6,and 11).The mean CT density values for soft(hypoechoic),fibrous,fibroussoft,and calcified(hyperechoic) plaques were 74±12 H(45-103H),134±28 H(78-187H),89±17H(75-104 H),和762±66 H(563-897 H) respectively.The differences of the mean CT density values between soft,fibrous,fibrous-soft,and calcified plaques were significant,with a p value＜0.01;however,the differences between soft and fibrous,and between soft and fibrous-soft,were not significant,p＞0.05.[Conclusion]1,Both IVUS and DSCT can identify and quantify coronary atherosclerotic plaques,IVUS can more accurate detect plaque than DSCT.2,DSCT can accurately diagnose severe stenosis in the middle of coronary with high sensitivity and negative predictive value.3,There was good correlation between DSCT and IVUS in mean lumen stenosis,mean plaque area.DSCT can accurately detect the plaque morphology and configuration.4,The reliable differentiation of the composition of noncalcified plaques and accurate measurement plaque is still limited in DSCT.
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