Sixty-Four–Multislice Computed Tomography Image of a Ruptured Coronary Plaque
Noninvasive investigation with 64-multislice computed tomography (MSCT) was performed in a 57-year-old patient with a history of diabetes mellitus and hypertension because of suspected ischemic heart disease. A severe short stenosis of the distal right coronary artery was visualized. A density parallel to the true lumen was observed at the region (Figure 1). On the cross-sectional image, the plaque appeared eccentric with a complex signal-density pattern: a low-density lesion, which is compatible with lipid-rich plaque, and a crescent moon–like isodensity region, which probably represents contrast filling (Figure 2). These findings were interpreted as contrast filling in an ulcerated cavity after plaque rupture. Elective invasive coronary angiography was performed. Baseline angiographic images confirmed the severe narrowing, but the ulcerated cavity was not seen (Figure 3). To further clarify the significance of those MSCT findings, we performed preintervention invasive imaging with optical coherence tomography. On the optical coherence tomography images, a ruptured plaque was clearly identified, and the circumferential low signal intensity behind the rupture site was compatible with an ulcerated cavity (Figure 4).
This case illustrates the potential of 64-MSCT for detecting complex plaque morphology, thus allowing noninvasive plaque characterization.