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

Abstract 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...

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Published in:Journal of cardiology 2013-06, Vol.61 (6), p.399-403
Main Authors: Kashiwagi, Manabu, MD, Tanaka, Atsushi, MD, Shimada, Kenei, MD, FJCC, Kitabata, Hironori, MD, Komukai, Kenichi, MD, Nishiguchi, Tsuyoshi, MD, Ozaki, Yuichi, MD, Tanimoto, Takashi, MD, Kubo, Takashi, MD, Hirata, Kumiko, MD, Mizukoshi, Masato, MD, Akasaka, Takashi, MD, FJCC
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnostic imaging
Aged
Angina, Stable - diagnostic imaging
Cardiovascular
Coronary Vessels - diagnostic imaging
Female
Humans
Imaging
Male
Middle Aged
Multidetector Computed Tomography
Napkin-ring sign
Plaque
Plaque, Atherosclerotic - diagnostic imaging
Plaque, Atherosclerotic - epidemiology
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Summary:Abstract 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 ± 0.12 vs. 1.02 ± 0.12, p < 0.01 and 39.9 ± 22.8 vs. 72.7 ± 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.
ISSN:0914-5087
1876-4738
DOI:10.1016/j.jjcc.2013.01.004