There is a new online first article in JACC (Journal of Americal College of Cardiology) by Leber AW et al, where they have used 64-slice CT to evaluate plaques in the proximal coronary arteries, as compared to IVUS. Also see another post on the accompanying editorial by Rumberger.
Their results showed that "64-slice CT enabled a correct detection of plaque in 54 of 65 (83%) sections containing noncalcified plaques, 50 of 53 (94%) sections containing mixed plaques, and 41 of 43 (95%) sections containing calcified plaques. In 192 of 204 (94%) sections, atherosclerotic lesions were excluded correctly. In addition, 64-slice CT enabled the visualization of 7 of 10 (70%) sections revealing a lipid pool and could identify a spotty calcification pattern in 27 of 30 (90%) sections."
Though these were only in the proximal coronary arteries, and though the sensitivity is low, the ability to pick up potentially vulnerable plaques if they reveal spotty calcification and lipid cores, exists.
This is a 62-years old man scanned some time back who shows two plaques in the proximal and mid-LAD (Fig. 1), one showing a clear lipid core (Fig. 2) in the larger, proximal plaque, with a tiny lipid core also seen in the distal smaller plaque (Fig. 3), which also shows spotty calcification.
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