integrating plaque composition with stenosis assessment for better functional and prognostic interpretation. Emerging evidence supports CT-based plaque quantification enhanced by artificial intelligen

The gap

Consensus across the literature

Supporting evidence — 4 representative gaps

• Development and assessment of a histopathological stability score for atheroma plaques (2025) · doi

  Our investigation is subject to a few constraints that warrant recognition. The backward-looking methodology and sparse clinical information limit the applicability of our results, as the sample group may not adequately reflect the variability of atherosclerotic conditions across broader demographic groups. Furthermore, while the HSS performed robustly in postmortem examinations, its applicability to living patients remains untested. Translating the score to clinical settings will require validation in prospective studies with larger, more diverse cohorts, coupled with correlations to clinical outcomes such as myocardial infarction or stroke. Such studies could also refine the score by identifying additional histological or molecular markers that enhance its predictive value. Another avenue for future research is integrating the HSS with advanced imaging techniques, such as IVUS and OCT. These techniques could provide a non-invasive complement to histological assessment, potentially allowing the HSS to be adapted for real-time evaluation of plaque stability in vivo. This integration could bridge the gap between postmortem pathology and clinical management, offering a pathway to identify and treat high-risk patients before adverse events occur. Additionally, exploring the molecular underpinnings of the histological features captured by the HSS, such as the role of specific inflammatory cytokines or angiogenic factors, could further refine its diagnostic and prognostic capabilities.  Conclusions This study provides a detailed profile of CV pathology in SCD patients, highlighting gender disparities, key macroscopic and histological features, and a predominance of unstable atherosclerotic plaques. Notably, 75.4% of cases were male, reflecting a significant predominance consistent with the global literature, which indicates higher male risks due to biological and behavioral factors, thus underscoring the need for targeted prevention. Macroscopically, diffuse cardiosclerosis was highly prevalent (94.9%), exceeding typical rates in ischemic cohorts, with healed and acute myocardial infarcts in 26.4% and 13.6% of cases, respectively – patterns aligning with SCD autopsies where ischemic lesions trigger fatal events. Lower rates of myocardial hypertrophy (7.8%) and lipomatosis (2.5%) emphasize fibrotic over hypertrophic changes, consistent with broader series. Histologically, vulnerable plaque features included elevated intraplaque hemorrhage (76.0%), necrotic cores (92.6%), cholesterol crystals (61.7%), inflammation (39.2%), erosion (42.7%), and rupture (15.3%). Notably, 98.5% of plaques were unstable. These surpass prevalences in other studies, signaling advanced disease and SCD risk via thrombosis and ischemia. The median FCT of 150 μm suggests partial stability; however, coexisting risks indicate a mixed vulnerability, with weak correlations to plaque severity. A key innovation is the HSS, a reproducible metric that integrates thin caps, lipid cores, macrophages, and hemorrhage, thereby enhancing forensic and research applications beyond qualitative assessments. These findings 498 Daniela Cristina Pavel Mironescu et al. support intensified screening, risk modification (e.g., statins, anti-inflammatory agents), and antithrombotic therapy, particularly for high-risk males, while underscoring the cohort-specific burdens that necessitate tailored healthcare.

  Keywords: clinical histological risk patients myocardial plaque features applicability atherosclerotic broader postmortem score cohorts correlations refine
• High scan-rescan repeatability of AI-enabled coronary plaque quantification from coronary CT angiography (2026) · doi

  This study has limitations to address. First, the sample size is limited, which prevents reliable assessments of variations in plaque metrics across a wider range of pla- que volumes. This limitation is related to the scarcity of existing serial contrast studies within a short time range, as demonstrated by the need for pooled data from two institutions to achieve this sample size of 30 participants. This study demonstrates high reproducibility of serial plaque quantifications using side-by-side readings, but there is no comparator arm, which prevents any assess- ment of incremental benefit from this approach compared to other methods. We do, however, demonstrate the superior reproducibility of scan-specific thresholds com- pared to fixed thresholds. It should also be noted that the side-by-side plaque quantification approach is more time-consuming than solely quantifying plaque in the latest scan and com- paring the findings to the previous scan report. How- ever, the side-by-side practice is more in line with clinical practice, with AI-enabled plaque analysis allowing an acceptable workflow [22]. This study investigated the reproducibility of plaque volumes across serial acquisitions on the same scanner using consistent scanning protocols. In real-world practice, this consistency may be difficult to achieve as older scan- ners are upgraded over time and patients change their geographical location, leading to serial scans at dif- ferent sites with varying hardware and protocols. Hence, future scientific efforts should aim to improve the repro- ducibility of plaque volumes also across inconsistent scanning modes. Lenell et al. European Radiology Page 9 of 10

  Keywords: plaque side serial scan across volumes time reproducibility practice sample size prevents range achieve quanti
• Carotid plaque vulnerability and circle of Willis anatomy predict ipsilateral brain infarcts and long-term mortality in carotid endarterectomy patients (2026) · doi

  This study has several limitations. CT is less sensitive in detecting small recent or chronic infarcts, which may result in underestimation of infarct burden. Only the presence and type of infarcts were evalu- ated; infarct volume was not assessed, and volume- based analyses stratified by symptomatic status were not performed. Plaque thickness was used instead of volumetric plaque assessment, and qualitative plaque characterization was applied rather than automated segmentation, which may underestimate vulnerable plaque components due to overlapping attenuation values. Photon counting CT technology could have improved plaque component differentiation. As a retrospective cohort study, our analysis is subject to potential treatment indication bias and variability in imaging timing relative to symptom onset; however, adjustment for symptomatic status likely mitigates these effects. Cause-specific mortality data were unavailable, necessitating reliance on overall mor- tality. These limitations reflect real-world clinical constraints but do not diminish the robustness of the observed associations.

  Keywords: plaque limitations infarcts infarct volume symptomatic status several less sensitive detecting small recent chronic result
• Coronary plaque characteristics on CT Angiography: Associations with risk factors and stenosis burden (2026) · doi

  integrating plaque composition with stenosis assessment for better functional and prognostic interpretation. Emerging evidence supports CT-based plaque quantification enhanced by artificial intelligence for individualized risk stratification (19). Our results are consistent with this approach and highlight the diagnostic synergy between non-invasive and invasive imaging. Analysis of CAC scores showed that mixed plaques predominated at higher CAC categories, while non- calcified and calcific types persisted even at low or intermediate calcium levels. This illustrates CAC’s limitation as a sole marker of atherosclerotic activity. A recent review emphasized that quantitative plaque in predicting evaluation outperforms CAC alone for outcomes

  Keywords: plaque invasive integrating composition stenosis assessment better functional prognostic interpretation emerging evidence supports based quantification