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A meta analysis and hierarchical classification of HU-based atherosclerotic plaque characterization criteria.

Kristanto W, van Ooijen PM, Jansen-van der Weide MC, Vliegenthart R, Oudkerk M - PLoS ONE (2013)

Bottom Line: No correlation was found between HU-criteria and the reported lumen contrast-enhancement.Significant differences were found for HU-criteria when pooled according to the respective study characteristics: examination type, vessel type, CT-vendor, detector-rows, voltage-setting, and collimation-width.In conclusion, variations in the reported CT attenuation values for lipid-rich and fibrous plaque are so large that generalized values are unreliable for clinical use.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Center for Medical Imaging - North East, Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

ABSTRACT

Background: Many computed tomography (CT) studies have reported that lipid-rich, presumably rupture-prone atherosclerotic plaques can be characterized according to their Hounsfield Unit (HU) value. However, the published HU-based characterization criteria vary considerably. The present study aims to systematically analyze these values and empirically derive a hierarchical classification of the HU-based criteria which can be referred in clinical situation.

Material and methods: A systematic search in PubMed and Embase for publications with HU-criteria to characterize lipid-rich and fibrous atherosclerotic plaques resulted in 36 publications, published between 1998 and 2011. The HU-criteria were systematically analyzed based on the characteristics of the reporting study. Significant differences between HU-criteria were checked using Student's t-test. Subsequently, a hierarchical classification of HU-criteria was developed based on the respective study characteristics.

Results: No correlation was found between HU-criteria and the reported lumen contrast-enhancement. Significant differences were found for HU-criteria when pooled according to the respective study characteristics: examination type, vessel type, CT-vendor, detector-rows, voltage-setting, and collimation-width. The hierarchical classification resulted in 21 and 22 CT attenuation value categories, for lipid-rich and fibrous plaque, respectively. More than 50% of the hierarchically classified HU-criteria were significantly different.

Conclusion: In conclusion, variations in the reported CT attenuation values for lipid-rich and fibrous plaque are so large that generalized values are unreliable for clinical use. The proposed hierarchical classification can be used to determine reference CT attenuation values of lipid-rich and fibrous plaques for the local setting.

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Related in: MedlinePlus

The hierarchically grouped HU-criteria for lipid-rich and fibrous plaques along with their +/-1 standard deviation.The blue and purple rounded-boxes bound the groups that give non-significant different HU-criteria and therefore pooled, for lipid-rich and fibrous plaque, respectively.
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pone-0073460-g005: The hierarchically grouped HU-criteria for lipid-rich and fibrous plaques along with their +/-1 standard deviation.The blue and purple rounded-boxes bound the groups that give non-significant different HU-criteria and therefore pooled, for lipid-rich and fibrous plaque, respectively.

Mentions: Extending the analysis, a hierarchical classification of the published HU-criteria was performed, resulting in 27 distinct HU-criteria groupings (Figures 3 and 4). No further classification based on collimation-width was performed because the studies included in each of these 27 groups had the same collimation-width or did not provide the collimation-width information. The criteria at the lowest tree branches, which were not significantly different, were pooled (boxed groups in Figures 3 and 4), resulting in 21 and 22 distinct HU-criteria groupings for lipid-rich and fibrous plaques, respectively. Comparing the HU-criteria for lipid-rich plaque of each group to each other, 34% (52 out of 153 comparisons) were significantly different, of which 51.9% (27 out of 52 comparisons) were significantly different at p < 0.001 (Table 3). For fibrous plaque, 22.2% (38 out of 171 comparisons) of the HU-criteria were significantly different, of which 57.9% (22 out of 38 comparisons) were significantly different at p < 0.001 (Table 4). A visual representation of the hierarchically grouped HU-criteria along with their range (+/- 1 standard deviation) is given in Figure 5.


A meta analysis and hierarchical classification of HU-based atherosclerotic plaque characterization criteria.

Kristanto W, van Ooijen PM, Jansen-van der Weide MC, Vliegenthart R, Oudkerk M - PLoS ONE (2013)

The hierarchically grouped HU-criteria for lipid-rich and fibrous plaques along with their +/-1 standard deviation.The blue and purple rounded-boxes bound the groups that give non-significant different HU-criteria and therefore pooled, for lipid-rich and fibrous plaque, respectively.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3760884&req=5

pone-0073460-g005: The hierarchically grouped HU-criteria for lipid-rich and fibrous plaques along with their +/-1 standard deviation.The blue and purple rounded-boxes bound the groups that give non-significant different HU-criteria and therefore pooled, for lipid-rich and fibrous plaque, respectively.
Mentions: Extending the analysis, a hierarchical classification of the published HU-criteria was performed, resulting in 27 distinct HU-criteria groupings (Figures 3 and 4). No further classification based on collimation-width was performed because the studies included in each of these 27 groups had the same collimation-width or did not provide the collimation-width information. The criteria at the lowest tree branches, which were not significantly different, were pooled (boxed groups in Figures 3 and 4), resulting in 21 and 22 distinct HU-criteria groupings for lipid-rich and fibrous plaques, respectively. Comparing the HU-criteria for lipid-rich plaque of each group to each other, 34% (52 out of 153 comparisons) were significantly different, of which 51.9% (27 out of 52 comparisons) were significantly different at p < 0.001 (Table 3). For fibrous plaque, 22.2% (38 out of 171 comparisons) of the HU-criteria were significantly different, of which 57.9% (22 out of 38 comparisons) were significantly different at p < 0.001 (Table 4). A visual representation of the hierarchically grouped HU-criteria along with their range (+/- 1 standard deviation) is given in Figure 5.

Bottom Line: No correlation was found between HU-criteria and the reported lumen contrast-enhancement.Significant differences were found for HU-criteria when pooled according to the respective study characteristics: examination type, vessel type, CT-vendor, detector-rows, voltage-setting, and collimation-width.In conclusion, variations in the reported CT attenuation values for lipid-rich and fibrous plaque are so large that generalized values are unreliable for clinical use.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Center for Medical Imaging - North East, Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

ABSTRACT

Background: Many computed tomography (CT) studies have reported that lipid-rich, presumably rupture-prone atherosclerotic plaques can be characterized according to their Hounsfield Unit (HU) value. However, the published HU-based characterization criteria vary considerably. The present study aims to systematically analyze these values and empirically derive a hierarchical classification of the HU-based criteria which can be referred in clinical situation.

Material and methods: A systematic search in PubMed and Embase for publications with HU-criteria to characterize lipid-rich and fibrous atherosclerotic plaques resulted in 36 publications, published between 1998 and 2011. The HU-criteria were systematically analyzed based on the characteristics of the reporting study. Significant differences between HU-criteria were checked using Student's t-test. Subsequently, a hierarchical classification of HU-criteria was developed based on the respective study characteristics.

Results: No correlation was found between HU-criteria and the reported lumen contrast-enhancement. Significant differences were found for HU-criteria when pooled according to the respective study characteristics: examination type, vessel type, CT-vendor, detector-rows, voltage-setting, and collimation-width. The hierarchical classification resulted in 21 and 22 CT attenuation value categories, for lipid-rich and fibrous plaque, respectively. More than 50% of the hierarchically classified HU-criteria were significantly different.

Conclusion: In conclusion, variations in the reported CT attenuation values for lipid-rich and fibrous plaque are so large that generalized values are unreliable for clinical use. The proposed hierarchical classification can be used to determine reference CT attenuation values of lipid-rich and fibrous plaques for the local setting.

Show MeSH
Related in: MedlinePlus