451
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Leber AW, Knez A, Becker A, Becker C, von Ziegler F, Nikolaou K, Rist C, Reiser M, White C, Steinbeck G, Boekstegers P. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques. J Am Coll Cardiol 2004; 43:1241-7. [PMID: 15063437 DOI: 10.1016/j.jacc.2003.10.059] [Citation(s) in RCA: 552] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Revised: 10/09/2003] [Accepted: 10/20/2003] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We evaluated the accuracy of contrast-enhanced multidetector spiral computed tomography (MDCT) for the noninvasive detection and classification of coronary plaques and compared it with intracoronary ultrasound (ICUS). BACKGROUND Noninvasive determination of plaque composition and plaque burden may be important to improve risk stratification and to monitor progression of coronary atherosclerosis. METHODS We included 46 consecutive patients with a distinctive risk profile, who were investigated by ICUS (Goldvision, 20 MHz, Jomed Inc., Rancho Cordova, California). Due to the inability to slow the heart rate below 65 beats/min (n = 7) and due to renal insufficiency (n = 2), nine of 46 consecutive patients could not be studied by MDCT (Sensation 16, Siemens, Forchheim, Germany). RESULTS In the remaining 37 patients, 68 vessels were investigated by ICUS, and 58 of these vessels were visualized by MDCT with image quality sufficient for analysis. In these vessels that were divided in 3-mm sections, MDCT correctly classified 62 of 80 (78%) sections containing hypoechoic plaque areas, 87 of 112 (78%) sections containing hyperechoic plaque areas, and 150 of 158 (95%) sections containing calcified plaque tissue. In 484 of 525 (92%) sections, atherosclerotic lesions were correctly excluded. The MDCT-derived density measurements within coronary lesions revealed significantly different values for hypoechoic (49 HU [Hounsfield Units] +/- 22), hyperechoic (91 HU +/- 22), and calcified plaques (391 HU +/- 156, p < 0.02). CONCLUSIONS This study demonstrates that, in the case of diagnostic image quality, contrast-enhanced MDCT permits an accurate identification of coronary plaques and that computed tomography density values measured within plaques reflect echogenity and plaque composition.
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452
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Affiliation(s)
- Benoit Desjardins
- Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr., TC-2910A, Ann Arbor, MI 48109-0326, USA
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453
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Mochizuki T, Hosoi S, Higashino H, Koyama Y, Mima T, Murase K. Assessment of coronary artery and cardiac function using multidetector CT. Semin Ultrasound CT MR 2004; 25:99-112. [PMID: 15160792 DOI: 10.1016/j.sult.2003.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Multidetector CT is able to reconstruct artifact-less cardiac images due to improved temporal resolution. In this article, we review the potential benefits of the cardiac application of multidetector CT in the assessment of coronary artery and cardiac function, such as wall motion and systolic thickening. By applying retrospective ECG-gating, 10 phases throughout 1 cardiac cycle are extracted for functional analysis. Animated movies are generated by paging through these 2D and 3D images in cardiac phase order. Left ventricular end-diastolic volume, end-systolic volume, and ejection fraction can also be generated. Using the data acquired during a single breath hold, coronary artery and cardiac function can be assessed by multidetector CT.
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Affiliation(s)
- Teruhito Mochizuki
- Department of Radiology, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime 791-0295, Japan.
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454
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Kuettner A, Kopp AF, Schroeder S, Rieger T, Brunn J, Meisner C, Heuschmid M, Trabold T, Burgstahler C, Martensen J, Schoebel W, Selbmann HK, Claussen CD. Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 2004; 43:831-9. [PMID: 14998625 DOI: 10.1016/j.jacc.2003.05.015] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2002] [Revised: 05/04/2003] [Accepted: 05/06/2003] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the diagnostic accuracy in detecting high-grade coronary stenoses in patients with known coronary artery disease (CAD) using multidetector computed tomography (MDCT). BACKGROUND The MDCT systems with electrocardiographic (ECG)-gating permit visualization of the coronary arteries. However, severe calcifications and higher heart rates are known to degrade image quality and limit correct diagnosis. METHODS Sixty-six patients with proven CAD as assessed by conventional coronary angiography (CCA) were studied by MDCT (mean time 24 months postangiography). Total calcium score and all coronary arteries, including distal segments and side branches, were assessed with respect to evaluability, presence of high-grade coronary artery stenoses (>70%), and correct diagnosis. Results were compared to CCA. RESULTS A total of 105 lesions were detected by CCA. The MDCT correctly detected 39 lesions (sensitivity 37%, specificity 99%). The correct clinical diagnosis could be obtained in 24 patients (36%). Artifacts due to elevated heart rates or severe coronary artery calcification were the main cause of degraded image quality inhibiting correct diagnosis. In 21/66 patients (32%) all four major coronary vessel segments could be visualized. A threshold for maximum heart rate and a maximum calcification level were established (65 beats/min and an Agatston Score Equivalent of 335, respectively). A second analysis was made using these thresholds. Of all patients studied, 10/11 (91%) were correctly diagnosed when adhering to these thresholds. CONCLUSIONS When using MDCT as a noninvasive diagnostic modality to assess advanced CAD, it appears to be mandatory to preselect patients in order to achieve reliable results.
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Affiliation(s)
- Axel Kuettner
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tuebingen, Germany.
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455
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Maruyama T, Yoshizumi T, Tamura R, Takashima S, Toyoshima H, Konishi I, Yamashita S, Yamasaki K. Comparison of visibility and diagnostic capability of noninvasive coronary angiography by eight-slice multidetector-row computed tomography versus conventional coronary angiography. Am J Cardiol 2004; 93:537-42. [PMID: 14996575 DOI: 10.1016/j.amjcard.2003.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 11/12/2003] [Accepted: 11/12/2003] [Indexed: 10/26/2022]
Abstract
The usefulness of multidetector-row computed tomography (MDCT) for visualization of coronary arteries has been reported; however, little is known about the diagnostic capability of noninvasive coronary angiography (CA) using 8-detector row CT. We investigated the visualization and diagnostic values of 8-slice MDCT-CA. Twenty-five consecutive patients who underwent conventional CA were investigated. The entire heart was scanned for approximately 20 seconds. Images were created using different reconstruction methods (half-scan and multisectors) followed by image creation during different time windows of the cardiac cycle. The data set containing the fewest artifacts was selected, then reformatted images were created and evaluated. In 348 segments in 25 subjects as determined by conventional CA, 258 segments (74.1%) were judged visible by MDCT-CA. Lower visibility was observed in segments with smaller diameters. Visibility in segments with diameters of > or =2.0 mm was 85.8% (212 of 247 segments). Patients with higher mean heart rates and a larger range of heart rate alteration during the breath-holding scan time had lower visibility. The most frequent cause for invisibility was "adjacent structure" (47%), followed by "small diameter" (33%), and "motion artifact" (16%), suggesting that motion artifacts were reduced by multisector reconstruction and search for the best-optimized time window. MDCT-CA detected 27 of 37 significant stenotic lesions (73%) that had a diameter reduction of >50% and correctly judged 226 of 311 segments (72.7%) as normal. Sensitivity, specificity, and accuracy of the visualized segments by MDCT-CA was 90% (27 of 30 segments), 99.1% (226 of 228 segments), and 98.1% (253 of 258 segments), respectively. Low visibilities in the left circumflex artery and distal and small segments are limitations of 8-slice MDCT-CA because of limited spatial resolution.
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Affiliation(s)
- Takao Maruyama
- Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Suita, Japan.
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456
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Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, Brady TJ, Pomerantsev E, Ludwig J, Flachskampf FA, Wicky S, Jang IK, Daniel WG. assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol 2004; 43:842-7. [PMID: 14998627 DOI: 10.1016/j.jacc.2003.09.053] [Citation(s) in RCA: 298] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Revised: 08/27/2003] [Accepted: 09/09/2003] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study was designed to investigate whether contrast-enhanced multidetector spiral CT (MDCT) permits assessment of remodeling in coronary atherosclerotic lesions. BACKGROUND With sufficient image quality, MDCT permits noninvasive visualization of the coronary arteries, but its ability to assess remodeling has not been evaluated. METHODS Out of 102 patients in whom MDCT (16-slice scanner, intravenous contrast, 0.75-mm collimation, 420 ms rotation) was performed before invasive coronary angiography, 44 patients with high-quality MDCT data sets showing atherosclerotic plaque in a proximal coronary artery segment were chosen for evaluation. In multiplanar reconstructions orthogonal to the coronary artery, the cross-sectional vessel area was measured for the respective lesion and for a reference segment proximal to the lesion. The "Remodeling Index" was calculated by dividing the vessel area in the lesion by the reference segment. Results were correlated to the presence of stenosis (>50% diameter reduction) in invasive angiography. In a subset of 13 patients, MDCT measurements were verified by IVUS. RESULTS Reference vessel area was not significantly different between nonstenotic versus stenotic lesions (20 +/- 8 mm(2), n = 23 vs. 22 +/- 8 mm(2), n = 21). The mean Remodeling Index was significantly higher in nonstenotic than in stenotic lesions (1.3 +/- 0.2 vs. 1.0 +/- 0.2, p < 0.001). In five stenotic lesions, "negative remodeling" (Remodeling Index < or = 0.95) was observed. Cross-sectional vessel areas and Remodeling Indices measured by MDCT correlated closely to IVUS (r(2) = 0.77 and r(2) = 0.82, respectively). CONCLUSIONS Multidetector spiral CT may permit assessment of remodeling of coronary atherosclerotic lesions in selected data sets of sufficient quality.
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Affiliation(s)
- Stephan Achenbach
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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457
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Nikolaou K, Poon M, Sirol M, Becker CR, Fayad ZA. Complementary results of computed tomography and magnetic resonance imaging of the heart and coronary arteries: a review and future outlook. Cardiol Clin 2004; 21:639-55. [PMID: 14719573 DOI: 10.1016/s0733-8651(03)00091-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
MR and CT imaging are emerging as promising complementary imaging modalities in the primary diagnosis of CAD and for the detection of subclinical atherosclerotic disease. For the detection or exclusion of significant CAD, both cardiac CT (including coronary calcium screening and non-invasive coronary angiography), and cardiac MRI (using stress function and stress perfusion imaging) are becoming widely available for routine clinical evaluation. Their high negative predictive value, especially when combining two or more of these modalities, allows the exclusion of significant CAD with high certainty, provided that patients are selected appropriately. The primary goal of current investigations using this combined imaging approach is to reduce the number of unnecessary diagnostic coronary catheterizations, and not to replace cardiac catheterization altogether. For the diagnosis of obstructive coronary atherosclerosis and for screening for subclinical disease, CT and MRI have shown potential to directly image the atherosclerotic lesion, measure atherosclerotic burden, and characterize the plaque components. The information obtained may be used to assess progression and regression of atherosclerosis and may open new areas for diagnosis, prevention, and treatment of coronary atherosclerosis. Further clinical investigation is needed to define the technical requirements for optimal imaging, develop accurate quantitative image analysis techniques, outline criteria for image interpretation, and define the clinical indications for both MR or CT imaging. Additional studies are also needed to address the cost effectiveness of such a combined approach versus other currently available imaging modalities.
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Affiliation(s)
- Konstantin Nikolaou
- Department of Clinical Radiology, Ludwig-Maximilians-University, Bavariaring 19, D-80336, Munich, Germany
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458
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Bae KT, Hong C, Takahashi N, Gutierrez F, Sharkey AM, Hirsch R, Canter CE. Multi-detector row computed tomographic angiography in pediatric heart transplant recipients: Initial observations. Transplantation 2004; 77:599-602. [PMID: 15084942 DOI: 10.1097/01.tp.0000112437.07994.46] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to assess the feasibility and limitation of multi-detector row computed tomographic (MDCT) imaging for evaluating coronary arteries in pediatric heart transplant patients. METHODS Coronary MDCT angiography was performed in eight pediatric heart transplant recipients. The presence of coronary calcification was evaluated. Luminal changes of the visualized coronary segments on MDCT images were compared with catheter angiographic findings and intravascular ultrasound. RESULTS Coronary calcification was present in one patient who had severe coronary arteriopathy documented by intravascular ultrasound. In 48 coronary segments visualized on MDCT images, 33, 7, and 4 segments each had normal, luminal irregularities, and moderate stenoses, respectively, which were confirmed by catheter angiography. Twelve coronary segments could not be assessed because of severe motion artifacts. Image quality degradation was more pronounced in patients with higher heart rates. CONCLUSIONS Noninvasive MDCT angiography is promising but requires further technical improvement to evaluate coronary arteries in pediatric heart transplant patients.
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Affiliation(s)
- Kyongtae T Bae
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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459
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Achenbach S, Moselewski F, Ropers D, Ferencik M, Hoffmann U, MacNeill B, Pohle K, Baum U, Anders K, Jang IK, Daniel WG, Brady TJ. Detection of Calcified and Noncalcified Coronary Atherosclerotic Plaque by Contrast-Enhanced, Submillimeter Multidetector Spiral Computed Tomography. Circulation 2004; 109:14-7. [PMID: 14691045 DOI: 10.1161/01.cir.0000111517.69230.0f] [Citation(s) in RCA: 590] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We investigated the ability of multidetector spiral computed tomography (MDCT) to detect atherosclerotic plaque in nonstenotic coronary arteries. METHODS AND RESULTS In 22 patients without significant coronary stenoses, contrast-enhanced MDCT (0.75-mm collimation, 420-ms rotation) and intravascular ultrasound (IVUS) of one coronary artery were performed. A total of 83 coronary segments were imaged by IVUS (left main, 19; left anterior descending, 51; left circumflex, 4; right coronary, 9). MDCT data sets were evaluated for the presence and volume of plaque in the coronary artery segments. Results were compared with IVUS in a blinded fashion. For the detection of segments with any plaque, MDCT had a sensitivity of 82% (41 of 50) and specificity of 88% (29 of 33). For calcified plaque, sensitivity was 94% (33 of 36) and specificity 94% (45 of 47). Coronary segments containing noncalcified plaque were detected with a sensitivity of 78% (35 of 45) and specificity of 87% (33 of 38), but presence of exclusively noncalcified plaque was detected with only 53% sensitivity (8 of 15). If analysis was limited to the 41 proximal segments (segments 1, 5, 6, and 11 according to American Heart Association classification), sensitivity and specificity were 92% and 88% for any plaque, 95% and 91% for calcified plaque, and 91% and 89% for noncalcified plaque. MDCT substantially underestimated plaque volume per segment as compared with IVUS (24+/-35 mm3 versus 43+/-60 mm3, P<0.001). CONCLUSIONS The results indicate the potential of MDCT to detect coronary atherosclerotic plaque in patients without significant coronary stenoses. However, further improvements in image quality will be necessary to achieve reliable assessment, especially of noncalcified plaque throughout the coronary tree.
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Affiliation(s)
- Stephan Achenbach
- Department of Radiology, Massachusetts General Hospital, Boston, USA.
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460
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Inoue F, Sato Y, Matsumoto N, Tani S, Uchiyama T. Evaluation of Plaque Texture by Means of Multislice Computed Tomography in Patients With Acute Coronary Syndrome and Stable Angina. Circ J 2004; 68:840-4. [PMID: 15329505 DOI: 10.1253/circj.68.840] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In the present study, multislice spiral computed tomography (MSCT), which allows non-invasive assessment of coronary artery plaque, was used to compare the CT density of plaque between patients with acute coronary syndrome (acs) and those with stable angina (sa). METHODS AND RESULTS MSCT was performed in 20 patients with ACS (17 with acute myocardial infarction, 3 with unstable angina) and 22 patients with SA. The presence of the plaque was defined on the basis of multiplanar reformation and axial images. At least 4 regions of interest were then placed within the plaque and the minimum CT density was measured and expressed as Hounsfield units (HU). The number of plaques did not differ between the 2 groups, but the minimum CT density was significantly lower in patients with ACS (25+/-15 HU) than in those with SA (71+/-16 HU, range 46-101 HU, p<0.001). Similarly, the minimum plaque density was significantly lower in the culprit coronary segment (26+/-16 HU) than in the non-culprit segment (48+/-17 HU) in 15 ACS patients with multiple plaques. CONCLUSION MSCT can potentially differentiate vulnerable from stable plaque in patients with coronary artery disease, although long-term, prospective analysis is needed to establish the conclusion.
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Affiliation(s)
- Fumio Inoue
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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461
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Leta R, Carreras F, Alomar X, Monell J, García-Picart J, Augé JM, Salvador A, Pons-Lladó G. Coronariografía no invasiva mediante tomografía computarizada con 16 detectores: estudio comparativo con la angiografía coronaria invasiva. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77093-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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462
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Thompson BH, Stanford W. Imaging of coronary calcification by computed tomography. J Magn Reson Imaging 2004; 19:720-33. [PMID: 15170779 DOI: 10.1002/jmri.20066] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
As an unequivocal biomarker for arteriosclerosis, the presence of coronary calcium serves as a qualitative reflection of the severity of coronary artery disease (CAD). Greater calcium burdens correlate with more advanced disease, a higher likelihood of coronary stenoses, and a higher risk for coronary heart disease (CHD). Empirically, the quantification of coronary calcium not only provides an accurate reflection of disease severity, but also has great potential as a screening tool for CHD. Computed tomography (CT) has been shown to be capable of providing accurate, noninvasive measurements of coronary calcification. Evidence shows that calcium measurements by CT correlate well with histological plaque analyses, and that calcium burdens accurately reflect disease severity and can be used to assess individual risk for CHD. The purpose of this review article is to examine the accumulated evidence that has attempted to validate CT as a diagnostic tool for CAD and as a screening exam for CHD.
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Affiliation(s)
- Brad H Thompson
- Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52246, USA.
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463
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Becker CR, Knez A. Past, present, and future perspective of cardiac computed tomography. J Magn Reson Imaging 2004; 19:676-85. [PMID: 15170776 DOI: 10.1002/jmri.20072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In the United States, more than 1 million diagnostic invasive coronary angiograms are performed annually, and in about 50% the investigation is followed by an interventional procedure. The remaining symptomatic patients after angiography are treated conservatively or by bypass graft surgery. In recent decades coronary angiography has advanced to a fast and safe investigation. Nevertheless, in particular, patients are well aware of the small but not negligible risk of complications and the discomfort of the invasive procedure. In addition to electrocardiogram (EKG) or ultrasound stress test and thallium scintigraphy, there is further need for another noninvasive method that displays the morphology of the coronary arteries in a way that would allow the triage of patients with suspicion of coronary artery disease (CAD) for a conservative, interventional, or surgical treatment.
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Affiliation(s)
- Christoph R Becker
- Department of Clinical Radiology and Cardiology, Klinikum Grobetahadern, Munich, Germany.
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464
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Pannu HK, Flohr TG, Corl FM, Fishman EK. Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy. Radiographics 2003; 23 Spec No:S111-25. [PMID: 14557506 DOI: 10.1148/rg.23si035514] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac imaging is becoming a practical application of mechanical computed tomography (CT) with the availability of four, eight, and 16 detector row scanners. The role of imaging is progressing from simple determination of the presence of arterial calcifications on nonenhanced scans to demonstration of vascular stenoses on coronary CT angiograms. Optimization of the imaging technique and knowledge of coronary artery anatomy are both important for the development of CT of the heart. Technical factors such as a slow heart rate, a short scanning time, subcentimeter spatial resolution, high temporal resolution, and reconstruction of multiple image data sets at various intervals in the cardiac cycle result in optimal visualization of the coronary arteries. Axial, thin-slab maximum intensity projection, and volume-rendered images are used to display the normal anatomy and anomalies of the coronary arteries. The challenges of CT angiography of the coronary arteries have been partially met and will likely be overcome with continued evolution of the technology.
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Affiliation(s)
- Harpreet K Pannu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Md, USA.
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465
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Schroeder S, Kuettner A, Kopp AF, Heuschmidt M, Burgstahler C, Herdeg C, Claussen CD. Noninvasive evaluation of the prevalence of noncalcified atherosclerotic plaques by multi-slice detector computed tomography: results of a pilot study. Int J Cardiol 2003; 92:151-5. [PMID: 14659846 DOI: 10.1016/s0167-5273(03)00104-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multi-slice detector computed tomography (MDCT) not only allows for the determination of coronary calcifications, but also for the noninvasive visualization of noncalcified plaques. Thus, coronary artery disease (CAD) can be detected at a fairly early stage. Since data on the prevalence of potentially rupture prone noncalcified coronary lesions are still missing, it was aim of the present investigation to study this in patients with a distinct cardiovascular risk profile, but without known CAD. METHODS 68 patients with clinical suspicion of CAD and multiple cardiovascular risk factors were included in this prospective study. Calcium scoring, as well as the detection of noncalcified plaques were performed using a Somatom VZ scanner (Siemens, Forchheim, Germany). RESULTS Calcium scoring could be performed in all patients on native scans; 63/68 (96%) of contrast enhanced scans showed sufficient image quality to perform a screening for noncalcified plaques. The three scans without diagnostic image quality had been performed at heart rates of 95 +/- 18/min. Coronary calcifications were found in 36/65 (55%) patients (Agatston score: 247 +/- 358). Additional noncalcified plaques were detected in 16/36 (45%) of these patients; 29/65 (45%) patients had no coronary calcifications (Agatston score: 0), but noncalcified plaques could be detected in 3/29 (10%) of these patients. CONCLUSIONS The prevalence of noncalcified plaques was 29% in the whole study group, and even in 10% of patients without coronary calcifications. Further prospective large scale studies are required to confirm these data, and to evaluate the clinical implication of this finding.
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Affiliation(s)
- Stephen Schroeder
- Department of Internal Medicine, Division of Cardiology, Otfried-Mueller-Str 10, 72076 Tuebingen, Germany.
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466
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Abstract
Magnetic resonance imaging and computed tomography (CT) have recently emerged as two techniques that can noninvasively visualize the coronary arteries. The latest generation 16-row detector multislice CT scanner is now considered the most reliable technique to visualize the coronaries. The sensitivity and specificity to detect a significant (>50% diameter stenosis) coronary stenosis is +/-94% and +/-90%, respectively. Further technical improvements are necessary to make CT a clinically reliable diagnostic tool.
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Affiliation(s)
- Pim de Feyter
- University Hospital Rotterdam, Thorax Center, Rotterdam, The Netherlands.
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467
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Koos R, Mahnken AH, Sinha AM, Wildberger JE, Hoffmann R. ECG-gated multislice spiral computed tomography to clarify lesion severity in a case of left main stenosis. Multislice spiral computed tomography to clarify lesion severity. Int J Cardiovasc Imaging 2003; 19:349-53. [PMID: 14598905 DOI: 10.1023/a:1025468722596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This case report describes the use of retrospectively ECG-gated multislice spiral computed tomography (MSCT) for evaluation of lesion severity in a patient with relevant left main stenosis by visual analysis of the coronary angiogram. For further diagnostic evaluation the patient underwent intravascular ultrasound (IVUS) imaging, which showed a maximal 30% area stenosis, and MSCT, which demonstrated a maximal 48% area stenosis. MSCT was useful in this case to defer cardiac surgery and might be used as a noninvasive alternative to IVUS imaging in case of doubtful lesion severity.
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Affiliation(s)
- Ralf Koos
- Medical Clinic I, University Hospital RWTH Aachen, Germany.
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468
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Achenbach S, Ropers D, Pohle K, Anders K, Baum U, Hoffmann U, Moselewski F, Ferencik M, Brady TJ. Clinical results of minimally invasive coronary angiography using computed tomography. Cardiol Clin 2003; 21:549-59. [PMID: 14719568 DOI: 10.1016/s0733-8651(03)00090-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fast, high-resolution CT techniques, such as EBCT and MDCT permit imaging of the coronary arteries. Continuous improvements in the capabilities of both technologies for visualization of the coronary lumen and detection of coronary artery stenoses are being made. Image quality currently is not robust enough in all patients to consider non-invasive coronary angiography by EBCT and MDCT a routine clinical tool. In selected patients and carefully performed, however, they show promise as means to exclude the presence of coronary artery stenoses in a non-invasive fashion. This may become a beneficial and important application of these technologies. Other possible applications pertain to smaller patient subsets, such as patients with anomalous coronary arteries, fistulas or aneurysms. The development of techniques to visualize non-calcified plaque is interesting with respect to assessment of coronary risk, but this requires further investigation.
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Affiliation(s)
- Stephan Achenbach
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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469
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Gurevitch J, Gaspar T, Orlov B, Amar R, Dvir D, Peled N, Aravot DJ. Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography. Ann Thorac Surg 2003; 76:1523-7. [PMID: 14602280 DOI: 10.1016/s0003-4975(03)00955-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-quality postoperative imaging of bypass conduits is essential when evaluating different types of conduits, anastomoses, and surgical techniques. We investigated the potential value of the newest generation of multidetector-row computer tomographic scanners in assessing bypass grafts. METHODS From June to September 2002, 14 patients underwent scanning with a newly released 16-slice computed tomographic scanner (Mx8000 IDT; Philips Medical Systems) after coronary artery bypass grafting. Four patients had had minimally invasive direct coronary artery bypass grafting and 3, redo coronary artery revascularization. Contrast-enhanced computed tomographic angiography was performed using retrospective electrocardiographic gating. Scan length was 22 to 30 cm, and total scan time was 27 to 37 seconds. RESULTS Of the 14 patients, 8 were scanned within 1 week after operation and 6, 1 month to 12 months postoperatively. Average heart rate during the scan was 82 beats per minute (range, 60 to 97 beats per minute), and all patients were able to hold their breath for the required time. Thirty conduits were studied: 26 arterial (18 in situ left and right internal mammary artery grafts, five free right internal mammary and radial artery grafts, and three in situ right gastroepiploic artery grafts) and four vein grafts. Excellent visualization of all 30 grafts was achieved. Thirty-four of the 35 distal anastomoses were patent; one vein graft was occluded. CONCLUSIONS This new technology is a promising noninvasive measure to evaluate patency of bypass conduits, including the gastroepiploic artery where catheterization is usually difficult. The ability to display the vessel wall as well as its lumen might distinguish radial artery spasm from intimal hyperplasia. The superb resolution and increased scan length required to cover the entire internal mammary artery grafts-from origin to distal anastomoses-can be achieved easily in a single breath-holding owing to the increased number of slices per rotation and shortening of the gantry rotation time.
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Affiliation(s)
- Jacob Gurevitch
- Department of Thoracic and Cardiovascular Surgery, The Lady Davis Carmel Medical Center, affiliated to the Rappaport Faculty of Medicine, Technion-Haifa, Israel.
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470
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Schoenhagen P, Stone GW, Nissen SE, Grines CL, Griffin J, Clemson BS, Vince DG, Ziada K, Crowe T, Apperson-Hanson C, Kapadia SR, Tuzcu EM. Coronary plaque morphology and frequency of ulceration distant from culprit lesions in patients with unstable and stable presentation. Arterioscler Thromb Vasc Biol 2003; 23:1895-900. [PMID: 12842842 DOI: 10.1161/01.atv.0000084811.73196.1c] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intravascular ultrasound studies describe ruptured coronary plaques at sites remote from the culprit lesion in patients with acute myocardial infarction (MI), suggesting multifocal plaque vulnerability. However, the role of intravascular ultrasound in the diagnosis of lesion vulnerability before rupture is unclear. METHODS AND RESULTS We compared morphology and frequency of ulceration of additional plaques proximal to the culprit lesion in 105 patients treated with emergent stenting during an evolving, acute MI in the CADILLAC study and 92 patients with stable/subacute presentation who underwent elective stenting. Additional plaques proximal to the culprit lesion were found in 52 (50%) and 54 (59%) patients in the acute MI and stable/subacute group, respectively. The prevalence of ulceration was significantly higher in the acute MI than in the stable/subacute group (19% versus 4%; P=0.014). However, there was no significant difference in other morphological lesion characteristics. CONCLUSIONS Additional plaques are frequently found adjacent to the culprit lesions in patients undergoing percutaneous coronary intervention independent of clinical presentation. The increased prevalence of plaque ulceration but otherwise similar morphology of additional lesions in patients with acute MI versus stable/subacute presentation demonstrates the limitations of imaging in the assessment of plaque vulnerability.
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Affiliation(s)
- Paul Schoenhagen
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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471
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Caussin C, Ohanessian A, Lancelin B, Rahal S, Hennequin R, Dambrin G, Brenot P, Angel CY, Paul JF. Coronary plaque burden detected by multislice computed tomography after acute myocardial infarction with near-normal coronary arteries by angiography. Am J Cardiol 2003; 92:849-52. [PMID: 14516892 DOI: 10.1016/s0002-9149(03)00899-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nonsignificant coronary artery plaque rupture or erosion may be the origin of acute myocardial infarction (AMI). The aim of our study was to assess the ability of multislice computed tomography (MSCT) to detect coronary plaques responsible for near normal coronary angiography AMI. Eight patients with presentation of AMI and no significant coronary narrowing by angiography were enrolled. Two groups were defined: (1) true AMI and (2) myocarditis. MSCT was able to detect nonsignificant coronary soft plaques responsible for AMI and has provided information on plaque volume, eccentricity, and density. In patients with myocarditis, there was no evidence of plaque.
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472
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Affiliation(s)
- Frandics P Chan
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, S-066, Stanford, CA 94305-5105, USA
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473
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Flohr T, Ohnesorge B, Bruder H, Stierstorfer K, Simon J, Suess C, Schaller S. Image reconstruction and performance evaluation for ECG-gated spiral scanning with a 16-slice CT system. Med Phys 2003; 30:2650-62. [PMID: 14596302 DOI: 10.1118/1.1593637] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We present an image reconstruction approach and a performance evaluation for ECG-gate cardiac spiral scanning with recently introduced 16-slice CT equipment. We present an extension of the Adaptive Cardio Volume (ACV) reconstruction approach for ECG-gated multislice spiral scanning. We discuss the image z reformation introduced to control the spiral slice width of the final images and give an overview of the reformation functions chosen. We investigate image quality and discuss the maximum number of slices that can be reconstructed without severe cone-beam artifacts. Slice sensitivity profiles (SSPs) and transverse resolution are evaluated as a function of the patient's heart rate. We demonstrate the influence of slice width on the visualization of stents and plaques and show the impact of reduced gantry rotation time (0.42 s) on temporal resolution. Deviating from general purpose spiral scanning cone-beam reconstruction is not required for ECG-gated cardiac CT with up to 16 slices. Using the ACV approach with image reformation, SSPs are well defined and independent of the patient's heart rate. With 0.75 mm collimated slice width, the measured full width at half-maximum (FWHM) of the smallest reconstructed slice is about 0.83 mm. Using this slice width and overlapping image reconstruction, cylindrical holes 0.6-0.7 mm in diameter can be resolved in a z-resolution phantom. Adequate visualization of the coronary arteries requires reconstruction slice widths not larger than 1.5 mm. Visualization of stents and severe calcifications is significantly improved with sub-mm slice width. Experimental evidence for the theoretically predicted temporal resolution and for the variation of temporal resolution depending on the position in the field of measurement (FOM) is presented. With 0.42 s gantry rotation temporal resolution reaches its optimum of 105 ms in the center of the FOM at 81 bpm. First scans on human subjects demonstrate the potential to expand the range of heart rates accessible to routine clinical examinations. A 16-slice platform can cover the heart with sub-mm slices within short breath-hold times, allowing for improved cardiac imaging due to isotropic sub-mm spatial resolution.
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Affiliation(s)
- Th Flohr
- Siemens Medical Solutions, Computed Tomography, Forchheim, Germany.
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474
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Becker CR, Nikolaou K, Muders M, Babaryka G, Crispin A, Schoepf UJ, Loehrs U, Reiser MF. Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT. Eur Radiol 2003; 13:2094-8. [PMID: 12692681 DOI: 10.1007/s00330-003-1889-5] [Citation(s) in RCA: 205] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2002] [Accepted: 03/18/2003] [Indexed: 02/07/2023]
Abstract
Multi-detector-row CT angiography (CTA) is a new technology that allows for non-invasive investigation of coronary atherosclerosis in patients. The relation between the morphology of atherosclerotic plaques assessed by CTA and histopathology is unknown. We investigated 11 human cadaver heart specimens. A mixture of methylcellulose and CT contrast media was injected into the coronary arteries to achieve in-vivo-like contrast enhancement within the coronary artery lumen. The morphologic pattern of atherosclerotic lesions found on CTA images and the tissue attenuation of non-calcified plaques were determined. After CTA imaging, atherosclerotic lesions in the coronary arteries were macroscopically identified and characterized histopathologically according to American Heart Association criteria. A total of 50 and 40 lesions were found macroscopically and by CTA, respectively. Thirty-three lesions could have been compared directly. The sensitivity of CTA compared with macroscopic detection of atheromas, fibroatheromas, fibrocalcified, and calcified lesions was 73, 70, 86, and 100%, respectively. The mean CT attenuation of predominantly lipid-rich and fibrous-rich plaques was significantly different (47+/-9 and 104+/-28 HU, respectively; p<0.01). Atherosclerotic coronary plaques detected by CTA may represent different stages of coronary atherosclerosis. The tissue attenuation of non-calcified plaques may allow for assessment of their predominant component.
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Affiliation(s)
- Christoph R Becker
- Department of Clinical Radiology, University of Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
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475
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Schoenhagen P, Tuzcu EM, Stillman AE, Moliterno DJ, Halliburton SS, Kuzmiak SA, Kasper JM, Magyar WA, Lieber ML, Nissen SE, White RD. Non-invasive assessment of plaque morphology and remodeling in mildly stenotic coronary segments: comparison of 16-slice computed tomography and intravascular ultrasound. Coron Artery Dis 2003; 14:459-62. [PMID: 12966267 DOI: 10.1097/00019501-200309000-00007] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-invasive identification and characterization of mildly stenotic atherosclerotic lesions is an increasingly important focus of coronary imaging. DESIGN We examined the accuracy of multi (16)-slice computed tomography (MSCT) for imaging of these lesions in comparison with intravascular ultrasound (IVUS). MATERIALS Mildly stenotic segments of the left coronary artery were identified by coronary angiography and analyzed using IVUS and contrast-enhanced MSCT. Independent reviewers evaluated the accuracy of MSCT for presence, composition and distribution of atherosclerotic plaque and remodeling response in comparison to IVUS using receiver operating characteristic (ROC) data analysis. RESULTS Of 46 segments in 14 patients, diagnostic characterization by MSCT was possible in 37 (80.4%) segments. In these segments the accuracy of MSCT for identifying plaque presence, calcification, distribution and positive remodeling was consistently greater than 0.90 (reader 1) and 0.87 (reader 2). CONCLUSION State-of-the-art MSCT can accurately identify mildly stenotic coronary atherosclerosis and provide an assessment of morphology and remodeling response.
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Affiliation(s)
- Paul Schoenhagen
- Department of Radiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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476
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Halliburton SS, Petersilka M, Schvartzman PR, Obuchowski N, White RD. Evaluation of left ventricular dysfunction using multiphasic reconstructions of coronary multi-slice computed tomography data in patients with chronic ischemic heart disease: validation against cine magnetic resonance imaging. Int J Cardiovasc Imaging 2003. [PMID: 12602485 DOI: 10.1023/a: 1021793420007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Multi-slice computed tomography (MSCT) is an emerging technique for the angiographic assessment of coronary artery disease (CAD). The purpose of this work was to determine if multiphasic reconstructions of the same data used for the assessment of CAD could also be used for global functional evaluation of the left ventricle (LV). MATERIALS AND METHODS Fifteen patients with chronic ischemic heart disease (CIHD) were imaged for CAD using a contrast-enhanced retrospective electrocardiographic-gated spiral technique on a MSCT scanner. The same data were reconstructed at both end-diastole and end-systole in order to measure left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). The results were compared to values obtained using a cine true-fast imaging with steady-state precession technique on a magnetic resonance imaging (MRI) scanner. Interobserver variability in the measurement from MSCT images was also evaluated. RESULTS For LVEF, there was substantial agreement between MSCT and MRI (intraclass correlation coefficient of 0.825); the intermodality reproducibility for LVEF (5%) was within an acceptable clinical range. However, mean values of LVEDV and LVESV with MSCT compared to cine MRI (LVEDV: 262.0 +/- 85.6 ml and 297.2 +/- 98.8 ml, LVESV: 196.2 +/- 75.6 ml and 218.6 +/- 90.99 ml, respectively) were significantly less for both volumes (p < 0.015). Intermodality variabilities for these measurements were high (15 and 13% for LVEDV and LVESV, respectively). Readers' mean measurements of LVESV from MSCT images were significantly different (p = 0.003) resulting in differences in calculation of LVEF (p < 0.024). Still, interobserver variabilities for all values were acceptable (6, 8, and 5% for LVEDV, LVESV, and LVEF, respectively). CONCLUSION Although values for LVEDV and LVESV were less with MSCT than with MRI, LVEF values were in agreement. This suggests that combined imaging of CAD and the evaluation of global LV dysfunction due to CIHD is feasible with the same MSCT acquisition.
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Affiliation(s)
- Sandra S Halliburton
- Section of Cardiovascular Imaging, Division of Radiology Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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477
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Abstract
Atherosclerosis is a progressive systemic disorder that, in the initial stages, is often asymptomatic. The measurement of atherosclerotic burden using imaging techniques enables the clinical benefits of lipid-modifying therapies to be assessed in early atherosclerosis and facilitates more rapid evaluation of interventions in clinical trials compared with the measurement of clinical outcome. The effect of HMG-CoA reductase inhibitors, commonly referred to as 'statins', on disease progression has been assessed in a number of imaging studies both in patients with established coronary heart disease (CHD) and in those with subclinical atherosclerosis. Statins slow plaque progression and, in early atherosclerosis, they have been demonstrated to promote regression of atherosclerotic lesions. The benefits of statin therapy on soft atherosclerotic plaques that are still developing support the use of vascular measures to detect subclinical atherosclerosis, and the subsequent early intervention with statin therapy. Moreover, given that the effects of statins on atherosclerosis progression are evident even in normocholesterolaemic patients at increased risk of developing CHD, early intervention with statin therapy may be effective in preventing CHD, irrespective of lipid level.
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Affiliation(s)
- Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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478
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479
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Sato Y, Kato M, Inoue F, Fukui T, Imazeki T, Mitsui M, Matsumoto N, Takahashi M, Karasawa K, Ayusawa M, Kanamaru H, Harada K, Kanmatsuse K. Detection of coronary artery aneurysms, stenoses and occlusions by multislice spiral computed tomography in adolescents with kawasaki disease. Circ J 2003; 67:427-30. [PMID: 12736482 DOI: 10.1253/circj.67.427] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In patients with Kawasaki disease (KD), serial evaluation of coronary artery aneurysms (CAAs) and luminal narrowing is essential for risk stratification and therapeutic management. Therefore, non-invasive assessment of the status of the coronary artery is of utmost importance in patient management. Multislice spiral computed tomography (MSCT) permits non-invasive visualization of the entire coronary artery system and was used in the evaluation of 4 patients with KD. CAAs and high-grade coronary artery stenoses were detected by MSCT and corroborated the findings of coronary angiograms performed within the previous 2 years. MSCT has the potential to be the standard diagnostic tool in adolescents with KD.
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Affiliation(s)
- Yuichi Sato
- Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan.
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480
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Abstract
Despite worldwide efforts aimed at primary and secondary prevention, heart disease is still the leading cause of death in the western world. There is great interest in developing tools for noninvasive assessment of the presence and degree of coronary artery disease. The advent of multidetector-row CT allows high-resolution volume coverage of the entire thorax and motion-free imaging of the heart and adjacent vessels within one breathhold. An exciting application with significant potential for cardiac risk stratification, which may overcome the obvious limitations of coronary calcium imaging in the future, is the use of the cross-sectional nature of contrast-enhanced multidetector-row CT coronary angiography for assessment of total coronary artery plaque burden.
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Affiliation(s)
- U Joseph Schoepf
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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481
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Nieman K, van der Lugt A, Pattynama PM, de Feyter PJ. Noninvasive visualization of atherosclerotic plaque with electron beam and multislice spiral computed tomography. J Interv Cardiol 2003; 16:123-8. [PMID: 12768915 DOI: 10.1046/j.1540-8183.2003.08023.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As an alternative to intracoronary modalities, electron beam computed tomography (EBCT) and multislice spiral computed tomography (MSCT) are able to noninvasively image the coronary arteries. In addition to stenosis detection by imaging the vessel lumen, MSCT has the ability to visualize the coronary artery wall. By using computed tomography (CT), the various components of atherosclerotic plaque may be distinguished and characterized, which holds the promise of, eventually, identifying vulnerable plaque.
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Affiliation(s)
- Koen Nieman
- Department of Cardiology, Erasmus Medical Center, Thoraxcenter Bd 410, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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482
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Affiliation(s)
- Lars K Hofmann
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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483
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Flohr TG, Schoepf UJ, Kuettner A, Halliburton S, Bruder H, Suess C, Schmidt B, Hofmann L, Yucel EK, Schaller S, Ohnesorge BM. Advances in cardiac imaging with 16-section CT systems. Acad Radiol 2003; 10:386-401. [PMID: 12678178 DOI: 10.1016/s1076-6332(03)80027-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES The authors present advances in electrocardiographically (ECG) gated cardiac spiral scanning with recently introduced 16-section computed tomographic (CT) equipment. MATERIALS AND METHODS The authors discuss the technical principles of ECG-gated cardiac scanning. They give an overview on system properties and on the detector design. They describe ECG-gated scan- and image-reconstruction techniques and ECG-controlled dose modulation ("ECG pulsing") for a reduction of the patient dose. They discuss key parameters for image quality and present simulation and phantom studies and they give preliminary values for the patient dose. RESULTS An extension of the adaptive cardiac volume reconstruction for ECG-gated spiral CT provides adequate image quality for up to 16 sections. With the smallest reconstructed section width (about 0.83 mm) and overlapping image reconstruction, cylindrical holes 0.6-0.7 mm in diameter can be resolved in a transverse resolution phantom independent of the heart rate. For coronary CT angiography, the influence of transverse resolution is most pronounced for coronary segments that are only slightly tilted relative to the scan plane. In this case, visualization of stents and plaques is considerably improved with 1.0-mm or smaller section width. For 0.42-second gantry rotation time, temporal resolution reaches its optimum (105 msec) at a heart rate of 81 beats per minute. Effective patient dose for the standard protocols recommended by the manufacturer ranges from 0.45 mSv (male) for ECG-triggered calcium scoring to 7.1 mSv (male) for high-resolution ECG-gated coronary CT angiography. With ECG pulsing, the dose is reduced by 30%-50% depending on the patient's heart rate. CONCLUSION Clinical experience will be needed to evaluate fully the potential of 16-section technology for cardiac imaging.
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Affiliation(s)
- Thomas G Flohr
- Siemens Medical Solutions, CTC CF, Siemensstrasse 1, D-91301 Forchheim, Germany
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484
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Schoenhagen P, Nissen SE. Assessing Coronary Plaque Burden and Plaque Vulnerability:Atherosclerosis Imaging With IVUS and Emerging Noninvasive Modalities. ACTA ACUST UNITED AC 2003; 1:164-9. [PMID: 15815137 DOI: 10.1111/j.1541-9215.2003.02108.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite significantly improved preventive and therapeutic options, coronary artery disease remains the major cause of mortality in North America. A large number of acute coronary events, including acute myocardial infarction and sudden cardiac death, occur in patients without prior symptoms because these events are initiated by sudden rupture of mildly stenotic but vulnerable lesions. Recent results demonstrate a high prevalence of such plaques many years before clinical events occur. Because these lesions are mildly stenotic before the event, the angiographic evaluation of the lumen is not sufficient for their detection. Therefore, direct observation of coronary plaque burden and plaque vulnerability with in vivo tomographic imaging modalities is increasingly utilized. Intravascular ultrasound is the most established invasive method with a long clinical track record. More recently, noninvasive modalities including computed tomography and magnetic resonance imaging are emerging.
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Affiliation(s)
- Paul Schoenhagen
- Department of Cardiovascular Medicine and Radiology, Section of Cardiovascular Imaging, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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485
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Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol 2003; 91:714-8. [PMID: 12633805 DOI: 10.1016/s0002-9149(02)03411-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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486
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Abstract
Coronary arterial remodeling describes changes of vessel size at the site of atherosclerotic lesions. Positive remodeling (expansion) of early lesions maintains lumen size despite plaque accumulation. In contrast, negative remodeling (shrinkage) contributes to luminal stenosis independent of plaque accumulation. Because of these adaptive changes, plaque progression/regression is not closely reflected in luminal size. Histologic studies have demonstrated that the pathophysiologic role of arterial remodeling is more complex than a mere compensatory process. Surprisingly, there is a consistent association between positive arterial remodeling, local inflammatory response, and plaque vulnerability. In vivo tomographic imaging techniques, in particular intravascular ultrasound, and potentially computed tomography and magnetic resonance imaging, allow the observation of remodeling in clinical settings. The integration of basic knowledge about arterial remodeling with clinical observations from in vivo imaging could lead to a better understanding of plaque progression, regression, and vulnerability and may eventually have implications for disease prevention.
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Affiliation(s)
- Paul Schoenhagen
- The Cleveland Clinic Foundation, F-25, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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487
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Abstract
Despite a multitude of different medical and interventional strategies to treat coronary artery disease (CAD), the natural course of CAD is a relentless progression. The current gold-standard to assess the degree of stenosis is coronary angiography. In Germany alone, the total number of angiographic procedures rose by 45% from 1995 to 2000, while the fraction of interventional procedures remained almost constantly low at about 30% [Z. Kardiol. 90 (2001) 665]. Although coronary angiography has become a safe procedure with only a small risk associated, the inconvenience for the patient as well as the economic burden have fueled the quest to find an alternative, non-invasive method to visualize and assess coronary arteries. The following article will explore the application of computed tomography (CT) coronary angiography for detection of stenoses, and the issue of imaging of non-calcified and unstable plaques with MDCT.
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488
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Neunteufl T, Maurer G. Noninvasive ultrasound techniques for the assessment of atherosclerosis in coronary artery disease. Circ J 2003; 67:177-86. [PMID: 12604862 DOI: 10.1253/circj.67.177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Thomas Neunteufl
- Department of Cardiology, University of Vienna Medical School, Austria.
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489
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Achenbach S, Giesler T, Ropers D, Ulzheimer S, Anders K, Wenkel E, Pohle K, Kachelriess M, Derlien H, Kalender WA, Daniel WG, Bautz W, Baum U. Comparison of image quality in contrast-enhanced coronary-artery visualization by electron beam tomography and retrospectively electrocardiogram-gated multislice spiral computed tomography. Invest Radiol 2003; 38:119-28. [PMID: 12544075 DOI: 10.1097/00004424-200302000-00007] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To compare the image quality of electron beam tomography (EBT) and multislice spiral CT (MSCT) for coronary artery visualization. MATERIALS AND METHODS Two groups of 30 patients without coronary stenoses were studied by MSCT (4 x 1 mm collimation) or EBT (3 mm slice thickness). Contrast-to-noise ratio (CNR), overall length of the visualized arteries and vessel length free of motion artifacts were measured. RESULTS Length of visualized arteries was equal in MSCT and EBT. In EBT, longer segments were depicted free of motion artifacts (MSCT: 73%, EBT: 92% of visualized length, P< 0.001) and CNR was significantly higher than in MSCT (15.4 vs. 9.0; P< 0.001). In both modalities, vessel diameters correlated closely to quantitative coronary angiography. CONCLUSIONS EBT and MSCT permit reliable coronary artery visualization and measurement of vessel diameters. For the used scan protocol, MSCT images had a lower CNR and were more frequently affected by motion.
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Affiliation(s)
- Stephan Achenbach
- Department of Internal Medicine II, Institute of Diagnostic Radiology, University of Erlangen-Nürnberg, Erlangen, Germany.
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490
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Sato Y, Kanmatsuse K, Inoue F, Horie T, Kato M, Kusama J, Yoshimura A, Imazeki T, Furuhashi S, Takahashi M. Noninvasive coronary artery imaging by multislice spiral computed tomography. Circ J 2003; 67:107-11. [PMID: 12547989 DOI: 10.1253/circj.67.107] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although the excellent spatial resolution of multislice spiral computed tomography (MSCT) enables the coronary arteries to be visualized, its limited temporal resolution results in poor image reproducibility because of cardiac motion artifact (CMA) and hence limits its widespread clinical use. A novel retrospectively ECG-gated reconstruction method has been developed to minimize CMA. In 88 consecutive patients, the scan data were reconstructed using 2 retrospectively ECG-gated reconstruction methods. Method 1: the end of the reconstruction window (250 ms) was positioned at the peak of the P wave on ECG, which corresponded to the end of the slow filling phase during diastole immediately before atrial contraction. Method 2 (conventional method): relative retrospective gating with 50% referred to the R-R interval was performed so that the beginning of the reconstruction window (250 ms) was positioned at the halfway point between the R-R intervals of the heart cycle. The quality of the coronary artery images was evaluated according to the presence or absence of CMA. The assessment was applied to the left main coronary artery (LMCA), the left anterior descending artery (LAD, segments #6, #7 and #8), the left circumflex artery (LCx, segments #11 and #13) and the right coronary artery (RCA, segments #1, #2 and #3). The first diagonal artery (#9-1), the obtuse marginal artery (#12-1), the posterior descending artery (#4-PD), the atrioventricular node branch (#4-AV) and the first right ventricular branch (RV) were also evaluated. Of the 88 patients, 85 were eligible for image evaluation. Method 1 allowed visualization of the major coronary arteries without CMA in the majority of patients. The LCA system (segments #5-7, #11 and #13) and the proximal portion of the RCA were visualized in more than 94% of patients. Artifact-free visualization of the distal portion of the LAD (segment #8) and RCA (#4PD and #4AV), and side branches (#9-1, #12-1 and RV) was also achieved in more than 80% of patients. On the other hand, CMA occurred frequently on images obtained by Method 2. The LCx and RCA systems were the most affected by CMA, revealing only 41% artifact-free visualization of the segment #13, 39% of #1, 15% of #2 and 32% of #3. Thus, Method 1, which avoids the ventricular motion occurring during the rapid filling and atrial contraction phases, gives superior image quality over the conventional ECG-gated reconstruction method.
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Affiliation(s)
- Yuichi Sato
- Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan.
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491
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Halliburton SS, Petersilka M, Schvartzman PR, Obuchowski N, White RD. Evaluation of left ventricular dysfunction using multiphasic reconstructions of coronary multi-slice computed tomography data in patients with chronic ischemic heart disease: validation against cine magnetic resonance imaging. Int J Cardiovasc Imaging 2003; 19:73-83. [PMID: 12602485 DOI: 10.1023/a:1021793420007] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Multi-slice computed tomography (MSCT) is an emerging technique for the angiographic assessment of coronary artery disease (CAD). The purpose of this work was to determine if multiphasic reconstructions of the same data used for the assessment of CAD could also be used for global functional evaluation of the left ventricle (LV). MATERIALS AND METHODS Fifteen patients with chronic ischemic heart disease (CIHD) were imaged for CAD using a contrast-enhanced retrospective electrocardiographic-gated spiral technique on a MSCT scanner. The same data were reconstructed at both end-diastole and end-systole in order to measure left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). The results were compared to values obtained using a cine true-fast imaging with steady-state precession technique on a magnetic resonance imaging (MRI) scanner. Interobserver variability in the measurement from MSCT images was also evaluated. RESULTS For LVEF, there was substantial agreement between MSCT and MRI (intraclass correlation coefficient of 0.825); the intermodality reproducibility for LVEF (5%) was within an acceptable clinical range. However, mean values of LVEDV and LVESV with MSCT compared to cine MRI (LVEDV: 262.0 +/- 85.6 ml and 297.2 +/- 98.8 ml, LVESV: 196.2 +/- 75.6 ml and 218.6 +/- 90.99 ml, respectively) were significantly less for both volumes (p < 0.015). Intermodality variabilities for these measurements were high (15 and 13% for LVEDV and LVESV, respectively). Readers' mean measurements of LVESV from MSCT images were significantly different (p = 0.003) resulting in differences in calculation of LVEF (p < 0.024). Still, interobserver variabilities for all values were acceptable (6, 8, and 5% for LVEDV, LVESV, and LVEF, respectively). CONCLUSION Although values for LVEDV and LVESV were less with MSCT than with MRI, LVEF values were in agreement. This suggests that combined imaging of CAD and the evaluation of global LV dysfunction due to CIHD is feasible with the same MSCT acquisition.
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Affiliation(s)
- Sandra S Halliburton
- Section of Cardiovascular Imaging, Division of Radiology Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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492
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Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography. Am J Cardiol 2002; 90:1416-9. [PMID: 12480062 DOI: 10.1016/s0002-9149(02)02890-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Louis Evan Teichholz
- Division of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA.
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493
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Nieman K, Rensing BJ, van Geuns RJM, Vos J, Pattynama PMT, Krestin GP, Serruys PW, de Feyter PJ. Non-invasive coronary angiography with multislice spiral computed tomography: impact of heart rate. Heart 2002; 88:470-4. [PMID: 12381635 PMCID: PMC1767415 DOI: 10.1136/heart.88.5.470] [Citation(s) in RCA: 176] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the impact of heart rate on the diagnostic accuracy of coronary angiography by multislice spiral computed tomography (MSCT). DESIGN Prospective observational study. PATIENTS 78 patients who underwent both conventional and MSCT coronary angiography for suspicion of de novo coronary artery disease (n=53) or recurrent coronary artery disease after percutaneous intervention (n=25). SETTING Tertiary referral centre. METHODS Intravenously contrast enhanced MSCT coronary angiography was done during a single breath hold, and ECG synchronised images were reconstructed retrospectively. All coronary segments of > or = 2.0 mm without stents were evaluated by two investigators and compared with quantitative coronary angiography. Patients were classified according to the average heart rate (mean (SD)) into three equally sized groups: group 1, 55.8 (4.1) beats/min; group 2, 66.6 (2.8) beats/min; group 3, 81.7 (8.8) beats/min. RESULTS Image quality was sufficient for analysis in 78% of the coronary segments in patients in group 1, 73% in group 2, and 54% in group 3 (p < 0.01). The sensitivity and specificity for detecting significant stenoses (> or = 50% lumen reduction) in these assessable segments were: 97% (95% confidence interval (CI) 84% to 100%) and 96% in group 1; 74% (52% to 89%) and 94% in group 2; and 67% (33% to 90%) and 94% in group 3 (p < 0.05). Accounting for all segments of > or = 2.0 mm, including lesions in non-assessable segments as false negatives, the sensitivity decreased to 82% (28/34 lesions, 95% CI 69% to 91%), 61% (14/23 lesions, 42% to 77%), and 32% (6/19 lesions, 15% to 50%), respectively (p < 0.01). CONCLUSIONS MSCT allows reliable coronary angiography in patients with low heart rates.
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Affiliation(s)
- K Nieman
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands.
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494
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van Ooijen PMA, Nieman K, de Feyter PJ, Oudkerk M. Noninvasive coronary angioscopy using electron beam computed tomography and multidetector computed tomography. Am J Cardiol 2002; 90:998-1002. [PMID: 12398971 DOI: 10.1016/s0002-9149(02)02686-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Peter M A van Ooijen
- Department of Radiology, University Hospital Groningen, Groningen, The Netherlands.
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495
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Fayad ZA, Fuster V, Nikolaou K, Becker C. Computed tomography and magnetic resonance imaging for noninvasive coronary angiography and plaque imaging: current and potential future concepts. Circulation 2002; 106:2026-34. [PMID: 12370230 DOI: 10.1161/01.cir.0000034392.34211.fc] [Citation(s) in RCA: 209] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zahi A Fayad
- Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.
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496
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Morgan-Hughes GJ, Marshall AJ, Roobottom CA. Multislice computed tomography cardiac imaging: current status. Clin Radiol 2002; 57:872-82. [PMID: 12413910 DOI: 10.1053/crad.2002.1072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-invasive CT coronary artery imaging has previously had little relevance to most UK radiologists due to the limited availability of electron beam CT scanners. Major advances in CT technology have promoted new applications for helical CT, which include cardiac imaging. Widespread installation of 'multislice' helical CT scanners will make CT coronary artery imaging available for the first time in many UK hospitals. The technical advances and early clinical trial data are reviewed and multislice helical CT cardiac imaging in general is discussed.
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497
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Willmann JK, Weishaupt D, Lachat M, Kobza R, Roos JE, Seifert B, Lüscher TF, Marincek B, Hilfiker PR. Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis. Radiology 2002; 225:120-8. [PMID: 12354994 DOI: 10.1148/radiol.2251011703] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the applicability and image quality of nonenhanced and contrast material-enhanced multi-detector row computed tomography (CT) combined with retrospective electrocardiographic (ECG) gating for visualization of the aortic valve, determination of aortic valve morphology and diameter of the aortic valve annulus, and assessment of the degree of valvular calcification in patients with aortic valve stenosis, as compared with results of surgery and echocardiography. MATERIALS AND METHODS Prior to surgical valve replacement, 25 patients with aortic valve stenosis and sinus rhythm underwent nonenhanced (n = 15) and contrast-enhanced (n = 25) retrospectively ECG-gated multi-detector row CT. Two readers working in consensus evaluated image quality and assessed valvular morphology and the degree of valvular calcification. In addition, the diameter of the aortic valve annulus was measured. Results were compared with surgical and echocardiographic findings by using the paired sign test, kappa statistics, and the method of Bland and Altman. RESULTS The aortic valve could be visualized nearly free of motion artifacts on all multi-detector row CT images. Image quality and diagnostic confidence for classification of aortic valve morphology were significantly superior on contrast-enhanced rather than nonenhanced images (P =.004 and P =.006, respectively). Nonenhanced and contrast-enhanced CT showed good agreement with surgical findings with regard to quantification of the degree of aortic valve calcification (kappa = 0.77 and kappa = 0.74, respectively). Measurement of the diameter of the aortic valve annulus was more reliable on contrast-enhanced images. CONCLUSION Contrast-enhanced retrospectively ECG-gated multi-detector row CT allows determination of aortic valve morphology, measurement of the diameter of the aortic valve annulus, and assessment of the degree of aortic valve calcification in patients with aortic stenosis.
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Affiliation(s)
- Jürgen K Willmann
- Institute of Diagnostic Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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498
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Abstract
The assessment of atherothrombotic plaques by imaging techniques is essential for the in vivo identification of vulnerable plaques. Several invasive and noninvasive imaging techniques are available to assess atherothrombotic disease. The use of some of the available imaging modalities for the study of regression and progression of atherothrombosis are described in more detail in the subsequent articles.
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Affiliation(s)
- Zahi A Fayad
- Department of Radiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, Imaging Science Laboratories, Box 1234, New York, NY 10029, USA.
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499
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Sosnovik DE, Muller JE, Kathiresan S, Brady TJ. Non-invasive imaging of plaque vulnerability: an important tool for the assessment of agents to stabilise atherosclerotic plaques. Expert Opin Investig Drugs 2002; 11:693-704. [PMID: 11996650 DOI: 10.1517/13543784.11.5.693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Disruption of a vulnerable atherosclerotic plaque is well-recognised as the primary cause of stroke, non-fatal myocardial infarction and sudden cardiac death. Novel therapeutic agents are being developed to stabilise such plaques. The initial evaluation of these drugs would be facilitated by the use of non-invasive imaging techniques to identify vulnerable plaque and document serial changes in plaque stability. The aim of this review is to explain the characteristics of the leading non-invasive imaging modalities and discuss their role in examining the vulnerable plaque. This knowledge will be extremely important for physicians and scientists involved in the clinical evaluation of novel agents to stabilise the vulnerable plaque.
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Affiliation(s)
- David E Sosnovik
- Division of Cardiology, CIMIT Massachusetts General Hospital, Boston, MA 02114, USA.
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500
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Schroeder S, Kopp AF, Ohnesorge B, Loke-Gie H, Kuettner A, Baumbach A, Herdeg C, Claussen CD, Karsch KR. Virtual coronary angioscopy using multislice computed tomography. Heart 2002; 87:205-9. [PMID: 11847152 PMCID: PMC1767040 DOI: 10.1136/heart.87.3.205] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND With faster image acquisition times and thinner slice widths, multislice detector computed tomography (MSCT) allows visualisation of human coronary arteries with diagnostic image quality. In addition to conventional axial slices, virtual coronary angioscopies (VCA) can be reconstructed using MSCT datasets. OBJECTIVE To evaluate the feasibility of reconstructing VCA and to determine the clinical value of this new application in detecting atherosclerotic coronary artery lesions. METHODS Datasets obtained by contrast enhanced non-invasive coronary angiography using MSCT (Somatom VZ) were analysed from 14 consecutive patients. VCA were simulated in 14 coronary arteries (left anterior descending, n = 7; right coronary, n = 7). Lesion detection was undertaken on conventional contrast enhanced axial slices, as well as by VCA. Intracoronary ultrasound (ICUS) was used as the gold standard for in vivo plaque detection. RESULTS 38 lesions were detected both on ICUS and on axial slices: 14 severe target lesions of > 75% area stenosis (11 calcified, three non-calcified), and 24 intermediate lesions of < or = 75% area stenosis (seven calcified, 17 non-calcified). Using VCA, all severe lesions (n = 14) and all calcified intermediate plaques (n = 7) could clearly be identified. However, non-calcified intermediate lesions (n = 17) could not be accurately distinguished from the vessel wall; they were recognised as vessel wall alterations without significant luminal narrowing. CONCLUSIONS Current MSCT technology allows reconstruction of VCA with good image quality. Despite a more anatomical view of heart and coronary vessels on three dimensional reconstruction, conventional axial slices were found to be superior for detecting coronary lesions. Thus further technical innovations are required before VCA can become a useful technique in clinical cardiology.
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Affiliation(s)
- S Schroeder
- Department of Internal Medicine, Division of Cardiology Eberhard-Karls-University, Tuebingen, Germany.
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