Distribution, frequency and clinical implications of napkin-ring sign assessed by multidetector computed tomography

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• 作者：Manabu Kashiwagi ; MD^a ; ^{mkashi@wakayama-med.ac.jp} ; Atsushi Tanaka ; MD^a ; Kenei Shimada ; MD ; FJCC^b ; Hironori Kitabata ; MD^a ; Kenichi Komukai ; MD^a ; Tsuyoshi Nishiguchi ; MD^a ; Yuichi Ozaki ; MD^a ; Takashi Tanimoto ; MD^a ; Takashi Kubo ; MD^a ; Kumiko Hirata ; MD^a ; Masato Mizukoshi ; MD^a ; Takashi Akasaka ; MD ; FJCC^a
• 关键词：Imaging ; Plaque ; Multidetector computed tomography ; Napkin-ring sign
• 刊名：Journal of Cardiology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：61
• 期：6
• 页码：399-403
• 全文大小：828 K

文摘

Background

Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). Plaques showing the napkin-ring sign in multidetector computed tomography (MDCT) have been reported as thin-cap fibroatheroma that is recognized as a precursor lesion for plaque rupture. The purpose of this study was to investigate distribution and frequency of napkin-ring sign and its relationship to features indicating coronary plaque vulnerability on MDCT in patients with coronary artery disease.

Methods

We enrolled 273 patients with ACS (n = 61) or stable angina pectoris (SAP, n = 212) who were assessed by MDCT. The definition of the napkin-ring sign was the presence of a ring of high attenuation and the CT attenuation of a ring presenting higher than those of the adjacent plaque and no greater than 130 HU.

Results

The culprit plaques with the napkin-ring sign show higher remodeling index and lower CT attenuation (1.15 ¡À 0.12 vs. 1.02 ¡À 0.12, p < 0.01 and 39.9 ¡À 22.8 vs. 72.7 ¡À 26.6, p < 0.01, respectively). Napkin-ring sign at culprit lesions was more frequent in patients with ACS than those with SAP (49.0 % vs. 11.2 % , p < 0.01). Moreover, napkin-ring sign at non-culprit lesions was more frequently observed in ACS patients compared with SAP patients (12.7 % vs. 2.8 % , p < 0.01). The distribution of the napkin-ring sign in the right coronary arteries and left circumflex arteries of our population was relatively even, whereas the napkin-ring sign in the left anterior descending artery was common in the proximal sites (p < 0.01).

Conclusions

The napkin-ring sign assessed by MDCT represents similar clinical features of fibroatheroma. MDCT could contribute to the search for fibroatheroma.