Distinguishing Iron and Calcium using MARS Spectral CT

This study aims to demonstrate that spectral CT imaging can identify and quantify inflammatory components of unstable plaque such as iron, calcium and lipid in phantoms and excised human atherosclerotic plaques. Spectral CT acquisition protocol was optimised using the MARS spectral scanner. A phantom with multiple concentrations of ferric nitrate (25, 50, 100, 200 and 400 mg/ml), hydroxyapatite (104.3, 402.3, and 603.3 mg/cm3), iodine (9 and 18 mg/ml), lipid and water was scanned followed by blood clots and excised human plaques using energy thresholds 20, 28, 36 and 44 keV at 80 kVp, 55 µA tube current and 100 ms exposure time. CT images were reconstructed in narrow energy bins. Differences in linear attenuation coefficients between different concentrations of ferric nitrate and hydroxyapatite were compared using the receiver operating characteristic (ROC) curve and considered successful if AUC≥0.8. Differentiation between iron and calcium was successful at 400mg/ml ferric nitrate and 100mg/ml hydroxyapatite (AUC≥0.9; 99% correct material identification). The optimised calibrations were implemented in blood clots and plaque scans, which successfully identified iron signal within the clots, and areas of intraplaque haemorrhage and calcification in the carotid plaque specimens.