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AIM: To evaluate and compare the accuracy of volemic status determination by remote dielectric sensing with computed tomography (CT) in patients with acute decompensated heart failure. MATERIALS AND METHODS: In 28 patients volemic status was determined by ReDS (remote dielectric sensing), chest computed tomography (CCT), and chest X-ray twice during hospitalization (the day of admission and the day of discharge from the hospital). The ReDS measurements were then compared with CT data using software that allows the use of semi-automated tools to determine mean lung density (MLD). MLD results from Hounsfield Units [HU] were then converted to fluid levels (FU%), allowing them to be compared with ReDS values. In addition, to assess the effect of physical activity on the dynamics of pulmonary stasis there was performed 6-minute walk test (6MWT) followed by determination of volumic status by ReDS method. RESULTS: Correlation analysis revealed an average direct significant correlation (r=+0,5; p=0.001) between the CCT and ReDS data. Hypervolemia indexes according to the CCT revealed statistically significant decrease in the dynamics, which was also reflected in the ReDS index decrease. Lung fluid content according to ReDS averaged 38.2±4.6% on admission, and 34.5±3.9% on discharge (p=0.005). According to CT scan of the CCT, MLD at admission was 23.03±3.9%, at discharge 19.6±3.3% (p=0.003). The positive dynamics of the study methods was also reflected in the positive dynamics of NT-proBNP, which decreased by 46%. In the analysis of ReDS data before and after exercise, there was an increase in ReDS value after the performed 6MWT and it was 35.09±3.9% compared with the initial value of 34.5±3.9%. A strong direct significant correlation (r=+0.7; p=0.0001) was found between the ReDS before and after 6MWT at discharge.
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Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/diagnóstico , Pulmão/diagnóstico por imagem , Hospitalização , Tomografia Computadorizada por Raios XRESUMO
AIM: To study myocardial perfusion in patients with coronary artery disease (CAD) with and without type 2 diabetes mellitus (DM) using volumetric computed tomography (VCT) of the heart with a pharmacological test with adenosine triphosphate (ATP). MATERIALS AND METHODS: The study included 93 patients, of which 18 had CAD with DM, and 50 had CAD without DM. All patients underwent one of the stress tests, cardiac VCT with ATP test, invasive coronary angiography, or CT coronary angiography. Left ventricle (LV) myocardial perfusion was evaluated for hypoperfusion zones and the calculation of semi-quantitative indices: decrease of LV myocardial density, LV myocardial perfusion index, transmural perfusion coefficient, and our proposed new indicator - myocardial perfusion reserve (MPR). RESULTS: The MPR index value in the hypoperfusion zones in patients with CAD and DM was 0.64 [0.62-0.66], in patients with CAD without diabetes 0.65 [0.63-0.66]; p=0.4; the value of the transmural perfusion coefficient in the areas of abnormal LV myocardial perfusion in patients with CAD and DM was 0.81 [0.80-0.86] versus 0.83 [0.80-0.85] in patients with CAD without DM (p=0.6). More hypoperfusion segments were observed in patients with CAD and DM (33.3%) compared to those without DM (14%; p=0.029). The MPR index in the hypoperfusion zones in patients with CAD with intact coronary arteries (CA) and DM was 0.56 [0.54-0.60] versus 0.55 [0.54-0.62] in patients with CAD with intact CA without DM; p=0.2. CONCLUSION: In patients with CAD and type 2 DM, according to the VCT with ATP test, more foci hypoperfusion areas were detected, regardless of the severity of coronary artery involvement, compared with patients with CAD without DM, which may be due to the microangiopathy in the myocardium. The similarity of the MPR parameters in the hypoperfusion zones associated with hemodynamic stenosis of the CA and with intact CAs indicates the ischemic genesis of these zones. For citation: Soboleva GN, Minasyan AA, Gaman SA, Rogoza AN, Molina LP, Soboleva TV, Shariya MA, Ternovoy SK, Karpov YuA. Type 2 diabetes mellitus and coronary artery disease: features of perfusion volume computed tomography of the heart in a pharmacological test with adenosine triphosphate. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(4):309-315. DOI: 10.26442/00403660.2023.04.202158.
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Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Imagem de Perfusão do Miocárdio , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Trifosfato de Adenosina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Angiografia Coronária/métodos , Tomografia Computadorizada por Raios X , Tomografia Computadorizada de Feixe Cônico , Perfusão , Imagem de Perfusão do Miocárdio/métodos , Valor Preditivo dos TestesRESUMO
Magnetic resonance imaging - is high precision method for diagnosing cardiovascular diseases. Simultaneously with the anatomy and function of the right ventricle, magnetic resonance imaging allows to assess the pulmonary circulation, which leads to the widespread use of this method in the diagnosis and dynamic monitoring of patients with pulmonary arterial hypertension. The article is devoted to the assessment of cardiac remodeling and risk stratification of this group of patients. Special attention is given to new prognostic parameters included in the scale for risk stratification of patients with pulmonary hypertension of the European Society of Cardiology/European Respiratory Society 2022.
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Hipertensão Arterial Pulmonar , Humanos , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Remodelação Ventricular , Imageamento por Ressonância Magnética/métodos , Hipertensão Pulmonar Primária Familiar , Espectroscopia de Ressonância Magnética , Medição de Risco/métodosRESUMO
Aim To identify risk factors for recurrence of atrial fibrillation (AF) following cryoballoon ablation (CBA).Material and methods This prospective study included patients with paroxysmal AF who had undergone CBA (141 patients, median age 60 years, 3% men). The evaluation prior to CBA included clinical instrumental parameters (electrocardiography (ECG), 24-h ECG monitoring, echocardiography, contrast-enhanced cardiac multispiral computed tomography). Also, possible intraoperative indexes that could affect the CBA effectivity, were evaluated. The postoperative follow-up duration was 12âmonths. Effectivity was assessed during in-person visits at 3, 6, and 12 months, when questioning of patients and 24-h ECG monitoring were performed. CBA was considered ineffective if the patient had recurrences of any atrial tachyarrhythmia longer than 30 sec after the end of the 3-month "blind" period.Results During the 12-month follow-up, recurrences of atrial tachyarrhythmia were observed in 46 (32.6â%) patients. Patients with ineffective CBA more frequently had AF during the first 3 months (71.7â% vs. 11.6â%; Ñ<0.001). Such patients had a history of multiple ineffective treatments with antiarrhythmic drugs (AAD), common pulmonary venous (PV) collector (41.3â% vs. 20.0â%; Ñ=0.008), and stroke/recurrent ischemic attacks (15.2â% vs. 5.2â%; Ñ=0.047). Multifactorial regression analysis showed that the factors of AF recurrence included common PV collector (relative risk (RR) 2.35; 95â% confidence interval (CI) 1.29-4.25; Ñ=0.005), multiple ineffective AADs (RR 1.42; 95â% CI 1.08-1.86; Ñ=0.011), and early AF recurrence (RR 7.57; 95â% CI 3.84-14.90; Ñ<0.001).Conclusion Common PV collector and multiple ineffective AADs are risk factors of ineffective CBA. Early recurrences during the first 3 postoperative months are a significant risk factor of long-term AF recurrences.
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Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgia , Recidiva , Fatores de Risco , Resultado do TratamentoRESUMO
The emergence of more effective methods for treatment of pulmonary arterial hypertension (PAH) has called for more reliable methods of diagnostics, monitoring, and evaluating responses to the treatment. More reports have become available about the relevance of using magnetic resonance imaging (MRI) for examination of patients with PAH. This review provides data on the significance of MRI for noninvasive evaluation of the heart structure and function in patients with PAH, as well as for visualization and evaluation of the remodeling of the pulmonary circulation. According to the data presented in this review, the results obtained with various, modern MRI technologies can be used for monitoring the effect of treatment and for risk stratification in patients with PAH.
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Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Hipertensão Pulmonar Primária Familiar , Humanos , Hipertensão Pulmonar/diagnóstico , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
Aim To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3â% of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6â% of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9â% of UASP and 46.1â% of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3â% of UASP and 46.1â% of SASP (Ñ=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95â% confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95â% CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.
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Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Placa Aterosclerótica , Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Placa Aterosclerótica/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia de IntervençãoRESUMO
Risk stratification among patients with aortic stenosis remains inadequate, and there is a clinical need for the correct identification of high-risk patients who would benefit from aortic valve intervention before developing left ventricular decompensation. Since the publication of the results of the PARTNER study, transcatheter aortic valve implantation (TAVI) has become the method of choice for aortic valve stenosis in inoperable patients and is a real alternative to conventional surgical replacement of the aortic valve in high-risk patients. In planning TAVI and postoperative monitoring of a patient from imaging methods, the leading role is played by echocardiography and multispiral computed tomography. However, in recent years, the interest of researchers in the use of magnetic resonance imaging in this category of patients has increased. The review article examines the potential role of magnetic resonance imaging in patients with aortic stenosis before and after TAVI.
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Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Ecocardiografia , Humanos , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
The presented clinical observation demonstrates the diagnostic capabilities of cardiac volumetric computed tomography (CT) with a pharmacological test by a vasodilator adenosine triphosphate (ATP) in the simultaneous assessment of coronary anatomy and changes in left ventricular myocardial perfusion (LV) in a patient with painless myocardial ischemia and coronary atherosclerosis. A 68-year-old patient with coronary heart disease (CHD) and atherosclerotic changes in the coronary arteries underwent cardiac volumetric CT in combination with a ATP pharmacological test. The study was performed on a Aquilion ONE 640 Vision Edition computer tomograph (Toshiba, Japan). Assessment of LV myocardial perfusion was carried out in comparison with other clinical, laboratory and instrumental examination methods. The results of clinical and instrumental examination of a patient with a low pre-test probability of coronary heart disease are presented. From the standpoint of modern recommendations on stable coronary heart disease, false-negative results of single-photon emission computed tomography of the heart and stress-echocardiography are discussed. Clinical observation demonstrates the feasibility of diagnosing LV myocardial ischemia by cardiac volumetric CT combined with ATP pharmacological test, confirmed by an invasive determination of the fractional flow reserve. The given clinical example represents the advantage of cardiac volumetric CT, combined with the ATP pharmacological test, as a method for visualizing LV myocardial perfusion in detecting myocardial ischemia.
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Aterosclerose , Doença da Artéria Coronariana , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Trifosfato de Adenosina , Idoso , Tomografia Computadorizada de Feixe Cônico , Angiografia Coronária , Vasos Coronários , Humanos , Valor Preditivo dos Testes , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Aim To evaluate safety and efficacy of sodium adenosine triphosphate (ATP) as a vasodilator in assessment of left ventricular (LV) myocardial perfusion and in verification of ischemia by cardiac volumetric computed tomography (CT).Material and methods The study included 58 patients with suspected ischemic heart disease (IHD). For all included patients, cardiac volumetric CT with a pharmacological ATP test was performed. The rate of adverse effects was analyzed during the ATP infusion. Results of the study were compared with data from using other noninvasive methods for IHD diagnosis by calculating Cohen's kappa, the measure of agreement between two variables.Results The test performed during CT showed good tolerability of the ATP infusion, a low rate of moderate adverse reactions (8.6â%), and the absence of severe side effects. Results of diagnosing IHD with cardiac volumetric CT with the ATP pharmacological test were comparable with data from using other methods for noninvasive verification of LV myocardial ischemia (bicycle ergometry, treadmill test, stress echocardiography) in combination with coronarography or CT coronarography.Conclusion ATP appears a safe pharmacological agent for diagnosing transient LV myocardial ischemia. ATP can be recommended as a vasodilator for evaluation of perfusion using cardiac volumetric CT.
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Trifosfato de Adenosina , Doença das Coronárias , Tomografia Computadorizada de Feixe Cônico , Angiografia Coronária , Coração , Humanos , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
AIM: To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. MATERIALS AND METHODS: We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. RESULTS: Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. CONCLUSION: The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.
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Fibrilação Atrial , Insuficiência Cardíaca , Aminobutiratos , Humanos , Peptídeo Natriurético Encefálico , Neprilisina , Receptores de Angiotensina , TetrazóisRESUMO
An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.
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Imageamento por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/diagnóstico por imagem , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias da Próstata/patologiaRESUMO
AIM: to assess the diagnostic meaning of cardiac magnetic resonance imaging (CMR) in various clinical forms of myocarditis. MATERIALS AND METHODS: 11 (8 men, mean age 32.8±11.1 years) patients (pts), hospitalized with suspected acute coronary syndrome, while an acute myocardial infarction was excluded during the examination (group I); 48 pts (31 men, 43.1±12.7 years), with clinical and instrumental signs of dilated cardiomyopathy (DCM) - group II; and 20 patients (12 men, 39.5±14 years), with episodes of ventricular tachycardia (group III) underwent cardiac magnetic resonance imaging (CMRI). In 38 patients endomyocardial biopsy (EMB) was performed. RESULTS: According to EMB, signs of active myocarditis were revealed in 10 (34.5%) group II pts and in 3 (37.5%) group III pts; signs of resolved myocarditis - in 8 (27.6%) patients in group II and in 3 (37.5%); minimal morphological changes - in 11 (37.9%) patients of group II and in 2 (25%) patients of group III. In 9 (81.9%) patients of group I MRI data allowed to establish the diagnosis of acute myocarditis. Signs of active inflammation from MRI data were detected in myocardium 5 (10.4%) in group II pts and 7 (35%) in group III pts. In 22 (45.8%) pts in group II and 10 (50%), CMR data corresponded to the picture of resolved myocarditis. In 21 (43.8%) cases of group II and 3 (15%) of group III, MRI revealed minimal structural changes. In pts with clinical and instrumental signs of DCM and/or ventricular tachycardia MRI allows to identify signs of "active myocarditis" with a sensitivity of 37.5% with a specificity of 83.4%. At the same time, in cases of resolved myocarditis and minimal morphological changes MRI has high sensitivity (70 and 71.5%) and specificity (71.5 and 75%, respectively). CONCLUSION: CMR has high diagnostic significance in patients with infarct-like course of myocarditis. In patients with clinical syndrome of dilated cardiomyopathy or arrhythmias, the sensitivity of MRI in detecting active myocarditis is low (37.5%) with high specificity (83.4%). In cases of minimal structural changes in the myocardium and resolved inflammation, CMR is a good alternative to EMB.
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Cardiomiopatia Dilatada/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Adulto , Biópsia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Miocárdio , Adulto JovemRESUMO
Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.
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Aterosclerose , Doença da Artéria Coronariana , Placa Aterosclerótica , Aterosclerose/diagnóstico por imagem , Vasos Coronários , Humanos , Tomografia Computadorizada MultidetectoresRESUMO
AIM: To study the relationship between the severity of erectile dysfunction and the anthropometric parameters of obesity in patients with arterial hypertension. MATERIALS AND METHODS: The study included 71 patients with different severity of erectile dysfunction, overweight and grade 1obesity and arterial hypertension. The anthropometric parameters were analyzed, the degree and characteristics of obesity were assessed according to data of multispiral computed tomography (MSCT), a preliminary assessment of erectile function was performed using the IIEF-5 questionnaire. Later the data of the questionnaire was compared with the in-depth urological study: the collection of anamnesis, examination and conduction of the pharmacodopplerography of the penis vessels. RESULTS: Comparative analysis revealed statistically significant links between anthropometric data and the degree of abdominal obesity based on MSCT results (p<0.005), anthropometric indicators of obesity with parameters of penile arterial blood flow, as well as severity of erectile dysfunction by degree of erection and dopplerography with an estimation of the rate of penile blood flow (p<0.05). In addition, a statistically significant negative relationship between the quality of penile blood flow and the degree of arterial hypertension was revealed (p=0.02). As a result of multifactorial linear regression, it is shown that with an increased the ratio of the waist circumference to the hip circumference and a higher level of systolic blood pressure, the condition of penile arterial blood flow worsens, namely, the peak systolic velocity (PSV) decreases (ß=-0.377, p=0.05; ß=-0.478, p=0.02, respectively). In a comparative analysis of the subjective evaluation of erectile function according to the data of the IIEF-5 questionnaire, we showed no statistically significant association with the results of an objective examination (p=0.07).There were also no statistically significant links between objective data of erectile function and obesity parameters in MSCT. CONCLUSION: The combination of overweight or obesity with arterial hypertension gives ground to suspect the presence of different severity of erectile dysfunction.
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Disfunção Erétil , Hipertensão , Obesidade , Disfunção Erétil/etiologia , Humanos , Hipertensão/complicações , Masculino , Obesidade/complicações , Ereção Peniana , Pênis/irrigação sanguíneaRESUMO
The article reviews the domestic and international literature on local recurrence of prostate cancer both after surgery and non-invasive treatments. The authors describe modern high-precision techniques used in magnetic resonance imaging that are used today in clinical practice for the most accurate detection of recurrent prostate cancer lesions.
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Prostatectomia , Neoplasias da Próstata , Humanos , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , RecidivaRESUMO
The purpose of our study was analysis of myocardial hypoenhancement areas (MHAs) found by multidetector computed tomography (MDCT) in patients with non-ST elevation acute coronary syndrome (NSTEACS) and comparison of these findings with results of standard methods of diagnostics of myocardial infarction and ischemia [electrocardiography (ECG) and echocardiography (ECHO)]. METHODS: MHAs were found in 18 of 21 patients with non-ST segment elevation myocardial infarction (NSTEMI) (85.7%) and only in 3 of 22 patients with unstable angina (UA) (13.6%, p.
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Síndrome Coronariana Aguda , Infarto do Miocárdio , Síndrome Coronariana Aguda/diagnóstico por imagem , Eletrocardiografia , Humanos , Tomografia Computadorizada MultidetectoresRESUMO
OBJECTIVE: to elaborate the magnetic resonance imaging (MRI) signs of prostate cancer (PC) in accordance with the PI-RADS classification during multiparametric MRI (mpMRI). MATERIAL AND METHODS: A total of 89 men aged 20 to 82 years were examined. A control group consisted of 8 (9%) healthy volunteers younger than 30 years of age with no urological history to obtain control images and MRI plots and 20 (22.5%) men aged 26-76 years, whose morphological changes were inflammatory and hyperplastic. The second age-matched group included 61 (68.5%) patients diagnosed with prostate cancer at morphological examination. A set of studies included digital rectal examination, serum prostate-specific antigen, and transrectal ultrasound-guided prostate biopsy. All the patients underwent prostate mpMRI applying a 3.0 T Achieva MRI scanner (Philips, the Netherlands). RESULTS: The patients have been found to have mpMRI signs that were typical of PC; its MRI semiotics according to the PI-RADS classification is presented. Each mpMRI procedure has been determined to be of importance and informative value in detecting PC. CONCLUSION: The comprehensive mpMRI approach to diagnosing PC improves the quality and diagnostic value of prostate MRI.
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Próstata/patologia , Neoplasias da Próstata , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Biópsia/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/classificação , Neoplasias da Próstata/diagnóstico , Reprodutibilidade dos Testes , Ultrassonografia de Intervenção/métodosRESUMO
AIM: to analyze morphological features of atherosclerotic plaques in culprit and non-culprit coronary lesions in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) by multidetector spiral computed tomography (MDCT). RESULTS. In culprit lesions (n = 70) compared to non-culprit lesions (n = 144) frequency of soft plaques (60 vs 43%, p = 0.003), positive remodeling (70.2 vs 54.3%, p = 0.03) and uneven contour (91.7 vs 68.7%, p = 0.0002) were significantly higher. Minimal plaque density was significantly lower and length of plaque was significantly higher in culprit coronary segments (40.1 ± 25.3 vs 74.1 ± 116.8 Hounsfield units [HU], p = 0.02 and 16.8 ± 13.4 vs 13.2 ± 6.9 mm, p = 0.01, respectively). Receiver-operator characteristic curve analysis identified optimal cutoff value of minimum plaque density and length for discrimination between culprit and non-culprit lesion as 40 HU and 13.5 mm, respectively. The combination of soft plaque with a minimal density < 40 HU and uneven contour occurred in one third of culprit lesions and almost two times less in non-culprit (31.67 and 17.91%, respectively, p = 0.04) and was characterized by high specificity (82.1%) and negative predictive value (72.7%). CONCLUSION: The most specific features of culprit lesions in patients with NSTE-ACS were positive vascular remodeling, length > 13.5 mm, minimal CT-density < 40 HU, soft plaque's type and presence of uneven contour, as well as a combination of the last 3 features.