Plaque Analysis by Coronary CT - Scholarly Debate

1. Quantitative Coronary Plaque Analysis (QCPA) – Is It Ready for Primetime?

Source: American College of Cardiology

• QCPA via coronary computed tomography angiography (CCTA) enables noninvasive quantification of plaque burden and composition.
• SCCT released a consensus document standardizing acquisition, analysis, and reporting.
• AI and computational advances have improved reproducibility, but challenges remain.
• Low-attenuation plaque (LAP) is prognostically important but less reproducible than calcified plaque.
• CAD-RADS 2.0 recommends reporting total plaque burden in every CCTA.

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2. Advances in CCTA-Derived Plaque Analysis for Ischemic Heart Disease

Source: Romanian Journal of Cardiology

• Traditional scores are being replaced by quantitative plaque volume analysis.
• New tools allow plaque composition analysis, identifying high-risk features.
• Photon-counting CT and pericoronary fat attenuation index (pFAI) are emerging technologies.
• Perfusion CT complements anatomical imaging by assessing myocardial blood flow and fibrosis.

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3. Influencing Factors and Improvement Methods in CT-Based Plaque Evaluation

Source: Frontiers in Cardiovascular Medicine

• CT-based plaque analysis is affected by luminal attenuation, tube voltage, ROI selection, and partial volume effects.
• Inconsistencies in Hounsfield Unit (HU) thresholds for lipid vs. fibrous plaque.
• Lower tube voltage increases HU values, complicating interpretation.
• Phantom models and adaptive algorithms are used to refine plaque component classification.

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