Atherosclerotic Plaque Detection by Multi-detector Computed Tomography

Coronary artery disease (CAD) remains a leading cause of death worldwide. In order to reduce the mortality from CAD, early detection and intervention prior to adverse events is likely to yield the most benefit. This however necessitates reliable prediction of high-risk patients. The current prediction schemes that incorporate traditional risk factors like hypertension and dyslipidemia are not very sensitive and improvements in risk stratification schemes are urgently needed. Pathophysiologically, CAD represents a spectrum of abnormalities starting from endothelial dysfunction to early fatty streaks, progressing to actual atherosclerotic plaque formation and subsequent stenosis. Detection of calcified plaques by electron beam computed tomography has been associated with a higher risk for coronary events. However, studies have shown that the rupture prone vulnerable plaques are composed of a thin fibrous cap with a large lipid pool; many of these plaques are non-calcified. The detection and characterization of non-calcified plaque is therefore of especial interest. Coronary multi-detector computed tomography (MDCT) can detect both calcified and non-calcified plaques and is emerging as a non-invasive tool that may significantly impact on how we detect and define high-risk population. MDCT provides a unique opportunity to study the natural history and response to therapy of coronary plaques. In this review, we discuss the use of MDCT to detect coronary plaques and its potential clinical implications.