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The napkin-ring sign is described on CCTA in cross-sectional images of coronary arteries as a central low-attenuation area surrounded by an open ring area of high attenuation, having a high specificity and positive predictive value for the presence of advanced lesions.
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It is not to be confused with the napkin ring sign of the bowel (apple core sign) . Radiographic features The sign refers to a rupture-prone plaque in a coronary artery, comprising a necrotic core covered by a thin cap (cap thickness <65 μm), also referred to as so-called thin-cap fibroatheroma.
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Our report suggests that the napkin-ring sign, which is considered a CT signature of high-risk coronary atherosclerotic plaque, may be caused by the difference in attenuation between a lipid-rich necrotic core (corresponding to the central low attenuation area in CT) and fibrous plaque tissue (corresponding to the rim of high CT attenuation).
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Based on the CT appearance, it was specified whether a napkin-ring sign could be identified within the plaque. The NRS was defined by a low-attenuation plaque core surrounded by a circumferential area of higher attenuation. Early lesions (AIT, PIT and Fib) were found in 472 slices (77.3%). In CT angiography, the napkin-ring sign was observed.
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The incidence of a napkin ring sign was around ten times greater in those found to have ACS than those without (32.4% vs 3.2%). However, the napkin ring sign is not a particularly common finding on CTCA. In the SCOT-HEART trial the napkin ring occurred in 0.3% (78 of 26,525) of vessel segments analysed (7).
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Recently, several small studies suggested that a certain morphological pattern in CT, a hyperdense ring-like structure surrounding a hypodense center, described as "napkin-ring" sign, (NRS) is associated with advanced coronary plaque as defined by the AHA classification [9], [10], [11].
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Download scientific diagram | Representative images of the Napkin-ring sign assessed by coronary computed tomography angiography (CCTA) in a 55-year-old man with worsening-type chest pain. A.
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The MGH team found that CT depiction of the so-called napkin-ring sign (NRS) was independently linked to the size of the necrotic or lipid plaque core and the noncore plaque, as well as the vessel area based on histology.. (OR = 0.9) were independent predictors of the napkin-ring appearance in CCTA (all p < 0.007). "These three criteria.
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The authors speculated whether this appearance could indicate the presence of deep micro-calcifications, intramural thrombus, intraplaque contrast enhance-ment due to the presence of neovascularization, or represent a large central lipid core surrounded by. The cross-sectional CT images show a coronary plaque with napkin-ring-like.
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The napkin-ring sign (NRS) represents a ring-like attenuation of the non-calcified portion of the coronary lesion and has a high specificity (96-100%) for the identification of thin cap.
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The napkin-ring sign was defined by the following criteria: 1) the presence of a ring of high attenuation around certain coronary artery plaques; and 2) attenuation of the ring presenting higher than those of the adjacent plaque and no >130 Hounsfield units.
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The napkin ring, occasionally called a Christening bangle, was originally used to identify the napkins of a household between weekly wash days.