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

• Main Authors: Wisnumurti Kristanto, Peter M A van Ooijen, Marijke C Jansen-van der Weide, Rozemarijn Vliegenthart, Matthijs Oudkerk
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2013-01-01
• Series: PLoS ONE
• Online Access: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24019924/?tool=EBI

<h4>Background</h4>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.<h4>Material and methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.