Pál Maurovich-Horvat et al. JIMG 2010;3:

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Pál Maurovich-Horvat et al. JIMG 2010;3:440-444 Cross Sections of a Coronary Atherosclerotic Plaque With Napkin-Ring Sign The CT images show a larger noncalcified coronary plaque with more pronounced napkin-ring–like attenuation pattern as compared to Figure 3. The circumferential outer rim (red dashed line) of the plaque has a higher CT attenuation in both the noncontrast (A) and contrast-enhanced (B) images (57.2 ± 8.8 HU, range 40.0 to 81.0 HU vs. 57.9 ± 8.7 HU, range 35.0 to 76.0 HU; respectively) as compared to the attenuation within the central part of the plaque (21.8 ± 4.3 HU, range 13.5 to 31.6 HU and 26.0 ± 2.0 HU, range 22.0 to 31.0 HU on noncontrast and contrast-enhanced images; respectively). The average plaque attenuation on nonenhanced CT was 48.1 ± 14.2 HU versus 52.2 ± 14.0 HU on the contrast-enhanced CT. The corresponding histopathological section (C) demonstrates a late fibroatheroma. Again, the plaque contains a necrotic core (stars), which correlates to the low attenuation plaque core on the CT images. Notably, the necrotic core is larger than in the plaque shown in figure 3, which is in line with the CT morphology. Similar to Figure 3, the outer portion of the plaque (red dashed line) contains a significant amount of fibrous plaque tissue correlating to the high attenuation CT rim. Moreover, the histopathological analysis revealed significant vasa vasorum (C; arrowheads) accompanied by macrophage infiltration in the basal plaque area. Abbreviations as in Figures 1 and 3. Pál Maurovich-Horvat et al. JIMG 2010;3:440-444 American College of Cardiology Foundation