Cardiac computed tomography (CCT) can be used in acute chest pain settings and can identify some features of plaque vulnerability. The ones that can be considered somehow reliable to date are low or no calcification of the plaque, a large focal plaque burden that translates into the concept of positive remodelling, low density of the non-calcific component, and the ‘napkin ring’ sign. The last two features are more difficult to reproduce and to address.
The concept of plaque disruption is a specific one; something that has to do with a certain imaging pattern where a rupture, a fissure, an intimal tear is visible. It relates with the ‘napkin ring’ sign since it entails that the contrast material penetrates into the layers of the plaque. Off course, intracoronary imaging would be the best approach. [...]