51
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SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 2009; 3:122-36. [DOI: 10.1016/j.jcct.2009.01.001] [Citation(s) in RCA: 609] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 01/23/2009] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE The aim of this study was to assess three different phase-selection methods for obtaining optimal CT coronary artery image quality. MATERIALS AND METHODS ECG-gated CT coronary angiography scans of 40 patients (23 men, 17 women; mean age, 56 years) were retrieved. The patient group was composed of 20 consecutive patients with heart rates < or = 65 beats per minute (bpm) and 20 consecutive patients with heart rates > 65 bpm. Three phase-selection methods were evaluated: fixed phase selection, manual phase selection, and automated phase selection. Two scoring systems were used to evaluate diagnostic quality: scoring of axial images on a 5-point scale and scoring of multiplanar reconstructions (MPRs) on a forced-choice 3-point preference scale. Differences were tested by Wilcoxon's signed rank test for the entire patient group and the two subgroups including patients with heart rates < or = 65 bpm and those with heart rates > 65 bpm. RESULTS Axial image evaluation of the entire patient group showed statistically significant superior image quality for the manual phase-selection method compared with the predefined phase-selection method and no statistically significant differences were found for the other comparisons. Analysis at heart rates < or = 65 bpm showed no significant differences between phase-selection methods. Analysis at heart rates > 65 bpm showed the best results for the automated phase-selection method, and image quality was significantly better for the automated and manual phase-selection methods than for the predefined phase-selection method. CONCLUSION The automated phase-selection method accurately detects the optimal diagnostic phase for CT coronary artery evaluation and has the potential to reduce operator time needed for image reconstruction.
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53
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Rixe J, Rolf A, Conradi G, Moellmann H, Nef H, Neumann T, Steiger H, Hamm CW, Dill T. Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography. Circ J 2009; 73:316-22. [DOI: 10.1253/circj.cj-08-0534] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart Centre
| | | | | | - Holger Nef
- Department of Cardiology, Kerckhoff Heart Centre
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54
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Lumia D, Carrafiello G, Laganà D, Musazzi A, Giorgianni A, Sala A, Fugazzola C. Diagnosis with ECG-gated MDCT of floating thrombus in aortic arch in a patient with type-A dissection. Vasc Health Risk Manag 2008; 4:735-9. [PMID: 18827925 PMCID: PMC2515435 DOI: 10.2147/vhrm.s2311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multidetector computed tomography has been shown to be accurate in noninvasive assessment of chest vascular disease. The motion artifacts of the thoracic aorta and the supra-aortic vessels were significantly reduced in the electrocardiogram (ECG)-gated data acquisition. This positive effect of ECG synchronization is more pronounced in the region of the ascending aorta, aortic arch, and proximal descending aorta.
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Affiliation(s)
- Domenico Lumia
- Department of Radiology, University of Insubria Varese, Italy.
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55
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Coronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography. Int J Cardiovasc Imaging 2008; 25:319-26. [PMID: 18853277 DOI: 10.1007/s10554-008-9375-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 09/23/2008] [Indexed: 12/21/2022]
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56
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Uva MS, Matias F, Mesquita A, Costa R, Baú J, Pedro A, Magalhães MP. Sixteen-slice multidetector computed tomography for graft patency evaluation after coronary artery bypass surgery. J Card Surg 2008; 23:17-22. [PMID: 18290881 DOI: 10.1111/j.1540-8191.2007.00479.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the ability of 16-slice multidetector computed tomography (MDCT) to assess coronary artery bypass graft patency and to detect bypass stenosis by comparison with coronary angiography. METHODS Thirty patients underwent both conventional coronary bypass angiography and retrospective ECG gated 16-slice multidetector computed tomography after surgery using 0.4 seconds rotation time and 1.25 mm slice thickness. RESULTS Among a total of 107 bypass grafts, 101 grafts (94.4%) were evaluable by MDCT. Thirteen patients were taking oral beta blockers. Mean heart rate was 73.6 (52-105). Of the 40 internal mammary arteries and two radial arteries examined, only one was occluded by coronary bypass angiography and MDCT, resulting in a sensitivity of 100% and a specificity of 100%. MDCT correctly diagnosed all patent venous grafts and missed two of the 14 venous grafts shown occluded by conventional angiography resulting in a sensitivity of 85.7% and specificity of 100%. When occluded grafts were excluded, MDCT did not detect two out of two anastomotic arterial graft stenosis >50% and resulted in one false positive result for a sensitivity and specificity of 0% and 97.4%, respectively. MDCT correctly diagnosed one out of three venous stenosis >50% and falsely diagnosed one venous graft stenosis >50% yielding a 33.3% and 97.6% sensitivity and specificity, respectively. CONCLUSION Sixteen-slice MDCT allows for noninvasive evaluation of coronary bypass grafts patency with high diagnostic accuracy. Assessment of distal anastomotic stenosis was deficient, particularly for arterial grafts, still limited by low resolution or artifacts. Improved accuracy may be obtained by more aggressive heart rate reduction.
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Affiliation(s)
- Miguel Sousa Uva
- Division of Cardiac Surgery, Hospital da Cruz Vermelha Portuguesa, Lisbon, Portugal.
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57
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Runza G, La Grutta L, Alaimo V, Damiani L, La Fata A, Alberghina F, Galia M, Lo Re G, Luccichenti G, Bartolotta T, Cademartiri F, Midiri M, De Maria M, Lagalla R. Influence of heart rate in the selection of the optimal reconstruction window in routine clinical multislice coronary angiography. Radiol Med 2008; 113:644-57. [DOI: 10.1007/s11547-008-0303-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 10/31/2007] [Indexed: 10/21/2022]
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58
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Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, Hundley WG, Manning WJ, Printz BF, Stuber M, Woodard PK. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation 2008; 118:586-606. [PMID: 18586979 DOI: 10.1161/circulationaha.108.189695] [Citation(s) in RCA: 351] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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59
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Affiliation(s)
- Smita Patel
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-5868, USA.
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60
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Rixe J, Rolf A, Conradi G, Elsaesser A, Moellmann H, Nef HM, Bachmann G, Hamm CW, Dill T. Image quality on dual-source computed-tomographic coronary angiography. Eur Radiol 2008; 18:1857-62. [PMID: 18418605 DOI: 10.1007/s00330-008-0947-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 01/22/2008] [Accepted: 02/09/2008] [Indexed: 10/22/2022]
Abstract
Multi-detector CT reliably permits visualization of coronary arteries, but due to the occurrence of motion artefacts at heart rates >65 bpm caused by a temporal resolution of 165 ms, its utilisation has so far been limited to patients with a preferably low heart rate. We investigated the assessment of image quality on computed tomography of coronary arteries in a large series of patients without additional heart rate control using dual-source computed tomography (DSCT). DSCT (Siemens Somatom Definition, 83-ms temporal resolution) was performed in 165 consecutive patients (mean age 64 +/- 11.4 years) after injection of 60-80 ml of contrast. Data sets were reconstructed in 5% intervals of the cardiac cycle and evaluated by two readers in consensus concerning evaluability of the coronary arteries and presence of motion and beam-hardening artefacts using the AHA 16-segment coronary model. Mean heart rate during CT was 65 +/- 10.5 bpm; visualisation without artefacts was possible in 98.7% of 2,541 coronary segments. Only two segments were considered unevaluable due to cardiac motion; 30 segments were unassessable due to poor signal-to-noise ratio or coronary calcifications (both n = 15). Data reconstruction at 65-70% of the cardiac cycle provided for the best image quality. For heart rates >85 bpm, a systolic reconstruction at 45% revealed satisfactory results. Compared with earlier CT generations, DSCT provides for non-invasive coronary angiography with diagnostic image quality even at heart rates >65 bpm and thus may broaden the spectrum of patients that can be investigated non-invasively.
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Affiliation(s)
- Johannes Rixe
- Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2 - 8, 61231, Bad Nauheim, Germany.
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61
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Shapiro MD, Pena AJ, Nichols JH, Worrell S, Bamberg F, Dannemann N, Abbara S, Cury RC, Brady TJ, Hoffmann U. Efficacy of pre-scan beta-blockade and impact of heart rate on image quality in patients undergoing coronary multidetector computed tomography angiography. Eur J Radiol 2008; 66:37-41. [PMID: 17587526 DOI: 10.1016/j.ejrad.2007.05.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 05/07/2007] [Accepted: 05/09/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE While beta-blockers are routinely administered to patients prior to coronary computed tomography angiography (CTA), their effectiveness is unknown. We therefore assessed the efficacy of beta-blockade with regards to heart rate (HR) control and image quality in an unselected patient cohort. METHODS We studied 150 consecutive patients (104 men/46 female; mean age, 56+/-13 years) referred for coronary CTA. Intravenous metoprolol (5-20mg) was administered to patients with a HR >65 beats per minute (bpm). The goal HR was defined as an average HR <65 bpm without a single measurement above 68 bpm. RESULTS Overall, 45% (68/150) of patients met the HR criteria for beta-blocker administration of which 76% (52/68) received metoprolol (mean dose 12+/-10mg). Of the 52 patients who received beta-blocker versus the 98 who did not, 18 (35%) versus 62 (64%) patients achieved the goal HR, respectively. All patients who achieved the target HR had an evaluable CTA while five patients who did not achieve the target HR had at least one non-evaluable coronary artery due to motion artifact. There was also a significant reduction in any motion artifact among those who achieved the goal HR as compared to those who did not (p=0.001). Logistic regression revealed an increase in the odds of stair step artifact of 11.6% (95% CI: 2.4% decrease, 27.5% increase) per 1 bpm increase in the standard deviation of scan HR. CONCLUSION Overall, efficacy of beta-blocker administration to reach target HR is limited. Improvements in CT scanner temporal resolution are mandatory to achieve consistently high image quality independent of HR and beta-blocker administration.
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Affiliation(s)
- Michael D Shapiro
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114, USA
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62
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Chen Y, Han P, Liang B, Liang H, Lei Z, Tian Z, Feng G, Xiao J. Comparative study on 16-slice CT coronary angiography vs conventional coronary angiography--a report of 38 cases. ACTA ACUST UNITED AC 2008; 28:110-3. [PMID: 18278472 DOI: 10.1007/s11596-008-0128-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Indexed: 10/19/2022]
Abstract
The clinical application of 16-slice CT coronary angiography (CTCA) and the impact of plaques differently characterized on assessing coronary artery stenosis were evaluated. Thirty-eight patients with coronary artery disease diagnosed by conventional coronary angiography (CAG) underwent 16-slice CTCA (collimation: 16x0.75 mm; rotation time: 420 msec; kernel: 35f; effective current: 500 mAs; tube voltage: 120 kV). The interval between CTCA and CAG was within one month. CTCA was evaluated by consensus of two independent experienced radiologists unknowing CAG findings. Original images, maximum intensity projections and multiplanar reconstructions were used to assess coronary artery stenosis. For a determined plaque an attenuation value > or = 130 HU was considered as calcified, and <130 HU noncalcified. The plaques were then classified into significant calcification (extensive calcification), medium calcification (small isolated calcification) and noncalcification. The diagnostic accuracy of 16-slice CTCA findings as well as to detect > or = 50% stenoses caused by plaques was evaluated respectively regarding CAG as the standard of reference. In comparison with CAG findings, the sensitivity, specificity, positive and negative predictive value derived from CTCA for mild stenosis (<50%) were 72.7%, 38.5%, 50%, 62.5%, respectively; for moderate stenosis (50%-75%) 82.4%, 72.7%, 70%, 84.2%, respectively; and for severe coronary stenosis (>75%) 85%, 90.5%, 81%, 92.7% respectively. With the increase of stenoses degree, the value of CTCA was greater. For the classification of the plaque calcification with > or = 50% stenosis CTCA attained the sensitivity, specificity, positive and negative predictive value for severe calcification 73.3%, 22.2%, 61.1% and 33.3%, respectively; for moderate calcification 70%, 55.6%, 63.6% and 62.5%, respectively; for noncalcification 93.8%, 85.7%, 93.8% and 85.7% respectively. CTCA was restricted in assessing coronary artery stenosis in the presence of calcification, but CTCA value was much improved in assessing non-calcified stenosis. It was concluded that 16-slice CTCA could provide useful information about coronary artery stenosis, especially for severe stenosis > or = 50%) and non-calcified plaque. Since CTCA is a noninvasive technique, it may be useful in screening coronary artery disease.
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Affiliation(s)
- Yan Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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63
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Ohlmann S, Nowak R, Daliri A, Michulla R, Froelich JJ. [Refined staging in Hilar bronchial neoplasms with ECG-gated multislice-CT---case report]. ACTA ACUST UNITED AC 2008; 56:185-90. [PMID: 19294876 DOI: 10.1016/j.rontge.2007.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Equivocal initial CT-based staging in 2 patients with hilar bronchial neoplasms was reassessed with retrospective ECG-gated Multislice-CT and optimized examination parameters prior to definition of treatment. An initially suspected irresectable T4 tumor with mediastinal infiltration was downstaged to T2 in one case, while tumor infiltration into the left atrium could be confirmed in the other case. In doubtful conditions, ECG-gated multislice CT with optimized examination parameters may be helpful for refined staging in patients with hilar bronchial neoplasms, thus possibly influencing treatment strategies.
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Affiliation(s)
- Susanne Ohlmann
- Klinik für Radiologie und Nuklearmedizin, Klinikum Bad Hersfeld, Seilerweg 29, D-36251 Bad Hersfeld
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64
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65
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Cardiac dual-source computed tomography in patients with severe coronary calcifications and a high prevalence of coronary artery disease. J Cardiovasc Comput Tomogr 2007; 1:143-51. [DOI: 10.1016/j.jcct.2007.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 08/20/2007] [Accepted: 09/11/2007] [Indexed: 01/22/2023]
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66
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Bogot NR, Durst R, Shaham D, Admon D. Cardiac CT of the transplanted heart: indications, technique, appearance, and complications. Radiographics 2007; 27:1297-309. [PMID: 17848692 DOI: 10.1148/rg.275065107] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Effective antirejection therapy and infection control have significantly improved the long-term survival of heart transplant recipients, but coronary allograft vasculopathy remains an important limiting factor. Most heart transplant recipients undergo annual coronary angiography for the detection of allograft vasculopathy, which is often clinically silent. Angiography allows detection of vasculopathy only indirectly, with depiction of the lumen, and does not depict the wall thickening and intimal hyperplasia that typify this disease; the procedure also is invasive and is associated with a 1%-2% risk of complication. In contrast, electrocardiographically gated multidetector computed tomography (CT) can provide a comprehensive and noninvasive evaluation of the transplanted heart in a single study. Cardiac CT enables evaluation of the coronary artery lumen and wall and thus may be used for screening, diagnosis, grading, and follow-up of coronary allograft vasculopathy. It also may be used to detect other posttransplantation complications, such as malignancy and infection, and to assess cardiac and vascular anastomoses and cardiac function. However, special strategies may be needed to reduce the transplant heart rate so as to obtain images of diagnostic quality.
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Affiliation(s)
- Naama R Bogot
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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67
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Abstract
In-stent restenosis reflects the interaction of a cascade of molecular and cellular events occurring within the vessel wall. Coronary stenting induces localized injury to the vessel wall, which leads to the release of thrombogenic, vasoactive, and lymphocytes mitogenic factors that result in processes causing re-narrowing at the injured site. Three major processes have been identified that lead to the in-stent restenosis: neointimal hyperplasia, elastic recoil, and negative arterial remodeling. The most important one is intimal hyperplasia. As the time course of neointimal hyperplasia is unknown, a causal relationship between the development of new blood vessels and clinical restenosis cannot be firmly established.
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Affiliation(s)
- A Kibos
- Army Emergency Cardiovascular Hospital Centre, Bucharesti, Romania.
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68
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Vogel-Claussen J, Fishman EK, Bluemke DA. Novel cardiovascular MRI and CT methods for evaluation of ischemic heart disease. Expert Rev Cardiovasc Ther 2007; 5:791-802. [PMID: 17605656 DOI: 10.1586/14779072.5.4.791] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
New developments in cardiac MRI and multidetector CT (MDCT) have generated tremendous excitement for both physicians and the general public. Their roles in the diagnostic algorithm of patients with suspected coronary artery disease are rapidly evolving. In addition to cardiac catheterization, nuclear imaging techniques and cardiac echocardiography, MDCT and MRI will play increasing roles in the diagnosis of ischemic heart disease. In this review we outline imaging techniques and illustrate the various applications of cardiac MRI and MDCT in the assessment of myocardial ischemia.
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Affiliation(s)
- Jens Vogel-Claussen
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA.
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69
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Onuma Y, Tanabe K, Chihara R, Yamamoto H, Miura Y, Kigawa I, Fukuda S, Miyairi T, Nakajima H, Hara K. Evaluation of coronary artery bypass grafts and native coronary arteries using 64-slice multidetector computed tomography. Am Heart J 2007; 154:519-26. [PMID: 17719300 DOI: 10.1016/j.ahj.2007.04.054] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 04/29/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND The conventional use of 16-slice multidetector computed tomography (MDCT) remains somewhat limited for evaluating stenoses in vein graft distal anastomotic sites and in coronary arteries. We investigated the diagnostic accuracy of 64-slice MDCT for assessment of both grafts and coronary arteries in patients with coronary artery bypass grafts. METHOD The study group included 54 consecutive patients. One patient had to be excluded from the study because of arrhythmia. The remaining 53 patients with coronary artery bypass grafts underwent both 64-slice MDCT angiography and invasive coronary angiography. The MDCTs were analyzed for presence of significant stenosis (>50%) or occlusion in grafts and coronary arteries. The results were compared with those of invasive coronary angiography. RESULTS Overall, 138 of 146 (94.5%) grafts including distal anastomoses were evaluable with MDCT. Evaluability of arterial grafts, venous grafts, distal runoff arteries, and nongrafted arteries was 90.3%, 98.6%, 84.0%, and 97.3%, respectively. After censoring nonevaluable grafts or arteries and considering them to be positive, the sensitivity to detect significant stenosis or occlusion in arterial grafts was 100% and specificity was 91.4%. In venous graft, sensitivity was 100% and specificity was 98.1%. In distal runoff arteries, sensitivity to detect significant stenoses was 83.3% and specificity was 80.2%. In nongrafted arteries, sensitivity was 100% and specificity was 87.5%. CONCLUSIONS Sixty-four-slice MDCT showed improved ability to assess bypass grafts and coronary arteries. However, there were still difficulties in assessment of distal runoff arteries in which relatively low diagnostic accuracy was observed that might limit clinical implementation of MDCT.
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Affiliation(s)
- Yoshinobu Onuma
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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70
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Kroft LJM, de Roos A, Geleijns J. Artifacts in ECG-Synchronized MDCT Coronary Angiography. AJR Am J Roentgenol 2007; 189:581-91. [PMID: 17715104 DOI: 10.2214/ajr.07.2138] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In MDCT coronary angiography, image artifacts are the major cause of false-positive and false-negative interpretations regarding the presence of coronary artery stenoses. Hence, it is important that observers reporting these investigations are aware of the potential presence of image artifacts and that these artifacts are recognized. CONCLUSION The article explores the technical causes for various artifacts in MDCT coronary angiography imaging and clinical examples are given.
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Affiliation(s)
- L J M Kroft
- Department of Radiology, C2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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71
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Jacobs JE, Boxt LM, Desjardins B, Fishman EK, Larson PA, Schoepf J. ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol 2007; 3:677-85. [PMID: 17412148 DOI: 10.1016/j.jacr.2006.06.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Indexed: 10/24/2022]
Abstract
Cardiac computed tomography (CT) is an evolving modality that includes a variety of examinations to assess the anatomy and pathology of the cardiac chambers, valves, myocardium, coronary arteries and veins, pericardium, aortic root, and central great vessels. The development of multidetector CT scanners with increasing numbers of detector rows, narrow section thicknesses, increasing scanner speeds, the ability for electrocardiographic gating, and radiation dose modulation allows the performance of CT coronary arteriography. Computed tomography coronary arteriography enables the assessment of multiple types of cardiac pathology, including intraluminal coronary arterial plaque formation, coronary artery stenosis, congenital anomalies, coronary artery aneurysms, sequelae of cardiac ischemia, and the assessment of prior vascular interventions, while providing information about cardiac and valvular function. Noncardiac structures included in cardiac CT examinations must also be evaluated. This guideline attempts to maximize the probability of detecting cardiac abnormalities with cardiac CT. American College of Radiology requirements for physicians and personnel performing examinations are also addressed and will become applicable by July 1, 2008.
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Affiliation(s)
- Jill E Jacobs
- New York University Medical Center, New York, NY, USA
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72
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Leschka S, Scheffel H, Desbiolles L, Plass A, Gaemperli O, Valenta I, Husmann L, Flohr TG, Genoni M, Marincek B, Kaufmann PA, Alkadhi H. Image Quality and Reconstruction Intervals of Dual-Source CT Coronary Angiography. Invest Radiol 2007; 42:543-9. [PMID: 17620936 DOI: 10.1097/rli.0b013e31803b93cf] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate reconstruction intervals and image quality in dual-source computed tomography (DSCT) coronary angiography for optimal placement of the ECG-pulsing window. MATERIALS AND METHODS DSCT coronary angiography was performed in 60 patients. Thirteen datasets were reconstructed in 5% increments from 20-80%. Two readers independently assessed image quality of each segment in each percentage-interval, using scores ranging from 1 (no motion artifacts) to 4 (nonevaluable). RESULTS Mean heart rate (HR) was 69.0 +/- 18.9 beats per minute (bpm) (range, 35-117 bpm). Diagnostic image quality (scores 1-3) was found in 97.8% of all segments (763 of 780). The 70% RR-interval provided best image quality in all patients and all HRs. The narrowest reconstruction window providing diagnostic image quality was 60-70% for HR <60 bpm, 60-80% for 60-70 bpm, 55-80% for 70-80 bpm, and 30-80% for HR >80 bpm. CONCLUSIONS DSCT coronary angiography provides best image quality for various HRs at 70%. The ECG-pulsing window can be adapted according to the HR while maintaining diagnostic image quality.
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Affiliation(s)
- Sebastian Leschka
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
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73
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Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, Hunink MGM. Diagnostic Performance of Multidetector CT Angiography for Assessment of Coronary Artery Disease: Meta-analysis. Radiology 2007; 244:419-28. [PMID: 17641365 DOI: 10.1148/radiol.2442061218] [Citation(s) in RCA: 346] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To review the literature on the diagnostic performance of multidetector computed tomographic (CT) angiography for assessment of symptomatic coronary artery disease, with conventional coronary angiography as the reference standard. MATERIALS AND METHODS A PubMed and manual search of the literature published between January 1998 and May 2006 on use of multidetector CT angiography compared with coronary angiography in patients with symptomatic coronary artery disease was performed. Summary estimates of diagnostic odds ratio, sensitivity, and specificity were calculated. Random-effects models were used to compare the diagnostic performance of four-, 16-, and 64-detector CT angiographic units, and the proportion of nonassessable coronary arterial segments was evaluated. RESULTS Fifty-four studies were included in the meta-analysis: 22 studies with four-detector CT angiography, 26 with 16-detector CT angiography, and six with 64-detector CT angiography. The pooled sensitivity and specificity for detecting a greater than 50% stenosis per segment were 0.93 (95% confidence interval [CI]: 0.88, 0.97) and 0.96 (95% CI: 0.96, 0.97) for 64-detector CT angiography, 0.83 (95% CI: 0.76, 0.90) and 0.96 (95% CI: 0.95, 0.97) for 16-detector CT angiography, and 0.84 (95% CI: 0.81, 0.88) and 0.93 (95% CI: 0.91, 0.95) for four-detector CT angiography, respectively. Results of regression analysis indicated that the diagnostic performance significantly improved with the newer generations of multidetector CT scanners (64- and 16-detector vs four-detector units), adjusted for exclusion of nonassessable segments, and contrast agent concentration used (P < .05). Simultaneously, the nonassessable proportion of segments significantly decreased with the newer generations of multidetector CT scanners, adjusted for heart rate, prevalence of significant disease, and mean age. CONCLUSION With the newer generations of multidetector CT scanners, the diagnostic performance for the assessment of coronary artery disease has significantly improved, and the proportion of nonassessable segments has decreased.
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Affiliation(s)
- Piet K Vanhoenacker
- Department of Radiology and Medical Imaging, OLV Ziekenhuis Aalst, Moorselbaan 164, 9300 Aalst, Belgium.
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Dewey M, Teige F, Laule M, Hamm B. Influence of heart rate on diagnostic accuracy and image quality of 16-slice CT coronary angiography: comparison of multisegment and halfscan reconstruction approaches. Eur Radiol 2007; 17:2829-37. [PMID: 17639410 DOI: 10.1007/s00330-007-0685-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Revised: 04/06/2007] [Accepted: 05/08/2007] [Indexed: 10/23/2022]
Abstract
The lower the heart rate the better image quality in multislice computed tomography (MSCT) coronary angiography. We prospectively assessed the influence of heart rate on per-patient diagnostic accuracy and image quality of MSCT coronary angiography and compared adaptive multisegment and standard halfscan reconstruction. A consecutive cohort of 126 patients scheduled to undergo conventional coronary angiography was examined with 16-slice CT. For all heart rate groups, per-patient diagnostic accuracy was significantly higher for multisegment than halfscan reconstruction with values of 95 vs. 79% (p < 0.05, <65 bpm, 38 patients), 85 vs. 66% (p < 0.05, 65-74 bpm, 47 patients), and 78% vs. 41% (p < 0.001, >74 bpm, 41 patients). Differences in diagnostic accuracy between adjacent heart rate groups were only significant for halfscan reconstruction for the comparison between the 65-74 and >74 bpm group (p < 0.05). The vessel lengths free of motion artifacts were significantly longer with multisegment reconstruction in all heart rate groups and for all coronary arteries (p < 0.005). For noninvasive MSCT coronary angiography, both per-patient diagnostic accuracy and image quality decline with increasing heart rate, and multisegment reconstruction at high heart rates yields similar results as standard halfscan reconstruction at low heart rates.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, P.O. Box 10098, 10117, Berlin, Germany.
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Abstract
Owing to ongoing technical refinements and intense scientific and clinical evaluations, computed tomography (CT) of the heart has left the research realm and matured into a clinical application that is about to fulfill its promise to replace invasive cardiac catheterization in selected patient populations. CT coronary angiography is technically more challenging than other CT applications owing to the nature of its target, the continuously moving heart. Rapid technical developments in this field require constant adaptation of acquisition protocols. These challenges, however, are in no way insurmountable for users with knowledge of the general CT technique. The intent of this communication is to provide those interested in and involved with coronary CT angiography with a step-by-step "manual" describing the authors' approach to performing coronary CT angiography. Included are considerations regarding appropriate patient selection, patient medication, radiation protection, contrast enhancement, acquisition and reconstruction parameters, image display and analysis techniques, and the radiology report. The recommendations are based on the authors' experience, which spans the evolution of multi-detector row CT for cardiac applications, from its beginning to the advent of the most current generations of 64-section and dual-source CT technologies, which they believe herald the entrance of this examination into routine clinical practice.
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Affiliation(s)
- U Joseph Schoepf
- Department of Radiology, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425, USA.
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Practical tips and tricks in cardiovascular computed tomography: Patient preparation for optimization of cardiovascular CT data acquisition. J Cardiovasc Comput Tomogr 2007; 1:62-5. [DOI: 10.1016/j.jcct.2007.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 04/16/2007] [Indexed: 11/22/2022]
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Jabara R, Chronos N, Klein L, Eisenberg S, Allen R, Bradford S, Frohwein S. Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts. Am J Cardiol 2007; 99:1529-34. [PMID: 17531575 DOI: 10.1016/j.amjcard.2007.01.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 01/10/2007] [Accepted: 01/10/2007] [Indexed: 11/25/2022]
Abstract
This study prospectively evaluated the diagnostic accuracy of 64-slice computed tomographic angiography (CTA) in assessing the patency of coronary artery bypass grafts compared with invasive coronary angiography. In total 147 bypass grafts (100 venous grafts and 47 mammary artery grafts) were evaluated in 50 consecutive patients. Contrast-enhanced 64-slice CTA was performed and compared with invasive angiography. The computed tomographic angiographic scan protocol used 64- x 0.5-mm slice collimation and 0.33-second gantry rotation time during simultaneous electrocardiographic gating. Patients with a heart rate >65 beats/min received beta blockers. Overall 145 of 147 bypass grafts (98.6%) were detected by CTA; 2 nonvisualized grafts were occluded at the time of invasive angiography. Of the grafts visualized, 28 were totally occluded, 103 were patent, and 14 had significant stenoses that were confirmed by invasive angiography. Ninety-five percent (111 of 117) of patent grafts demonstrated good run-off distal to anastomoses but without an ability to accurately evaluate the presence of retrograde flow; 83% (97 of 117) of distal anastomoses were adequately evaluated, whereas the remaining 17% (20 of 117) were not well visualized due to vascular clips and/or calcification artifacts. Two grafts were not demonstrated by invasive angiography but were detected by CTA and found to be widely patent. In conclusion, multidetector 64-slice CTA is a valuable tool for direct visualization of coronary bypass grafts and assessment of their patency. Dysfunctional bypass grafts can be detected with high diagnostic accuracy.
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Affiliation(s)
- Refat Jabara
- Saint Joseph's Research Institute/Saint Joseph's Hospital of Atlanta, Georgia, USA.
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Usefulness of multislice spiral computed tomography coronary angiography in patients with acute chest pain in the emergency department. J Cardiovasc Comput Tomogr 2007; 1:29-37. [PMID: 19083874 DOI: 10.1016/j.jcct.2007.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 04/25/2007] [Accepted: 04/30/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite reports that multislice spiral computed tomography (MSCT) has high sensitivity and specificity in preselected patient populations, the routine clinical feasibility and utility of MSCT coronary angiography in patients with acute chest pain in the emergency department remains uncertain. OBJECTIVES We sought to determine whether 16-slice MSCT coronary angiography can provide diagnostically useful images in patients with acute chest pain in the emergency department. METHODS Ninety-eight patients in the emergency department (41 men, 57 women; mean age +/- SD, 48.1 +/- 11.9 y) with acute chest pain underwent MSCT coronary angiography. Coronary calcium (Agatston) scoring was performed, followed by contrast-enhanced MSCT. Images were evaluated for mean image quality (MIQ) and for degree of stenosis. These data were correlated with body mass index (BMI; in kg/m(2)), heart rate, beat-to-beat variation, and calcium score to assess their influence on image quality. RESULTS The 28 patients (29%) with nondiagnostic MIQs had significantly higher BMIs (mean +/- SD, 32.9 +/- 9.1 vs 28.9 +/- 6.7; P < 0.05) and heart rates (mean +/- SD, 71.0 +/- 11.9 beats/min vs 65.6 +/- 9.9 beats/min; P < 0.05) than patients with diagnostic MIQs. Forty-five patients (46%) had at least 1 nondiagnostic coronary segment. These patients had significantly higher heart rates (mean +/- SD, 70.5 +/- 10.3 vs 64.1 +/- 13.7; P < 0.05) than patients with only diagnostic-quality scans. Image quality correlated inversely and strongly with BMI and heart rate. CONCLUSIONS Sixteen-slice MSCT coronary angiography cannot routinely provide diagnostically useful images in patients with acute chest pain in the emergency department.
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79
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Reimann AJ, Rinck D, Birinci-Aydogan A, Scheuering M, Burgstahler C, Schroeder S, Brodoefel H, Tsiflikas I, Herberts T, Flohr T, Claussen CD, Kopp AF, Heuschmid M. Dual-source computed tomography: advances of improved temporal resolution in coronary plaque imaging. Invest Radiol 2007; 42:196-203. [PMID: 17287650 DOI: 10.1097/01.rli.0000254409.79193.96] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to quantify image quality gains of a moving coronary plaque phantom using dual-source computed tomography (DSCT) providing 83 milliseconds temporal resolution in direct comparison to 64 slice single-source multidetector CT (MDCT) with a temporal resolution of 165 milliseconds. MATERIALS AND METHODS Three cardiac vessel phantoms with fixed 50% stenosis and changing plaque configurations were mounted on a moving device simulating cardiac motion. Scans were performed at a simulated heart frequency of 60 to 120 bpm. Image quality assessment was performed in different anatomic orientations inside a thoracic phantom. RESULTS A significant improvement of image quality using the DSCT could be found (P=0.0002). Relevant factors influencing image quality aside from frequency (P=0.0002) are plaque composition (P<0.0001), as well as orientation (P<0.0001). CONCLUSION Scanning with 83 milliseconds temporal resolution improved image quality of coronary plaque at higher heart frequencies.
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Affiliation(s)
- Anja J Reimann
- Department of Diagnostic Radiology, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
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Hur J, Kim TH, Kim SJ, Ryu YH, Kim HJ. Assessment of the right ventricular function and mass using cardiac multi-detector computed tomography in patients with chronic obstructive pulmonary disease. Korean J Radiol 2007; 8:15-21. [PMID: 17277559 PMCID: PMC2626700 DOI: 10.3348/kjr.2007.8.1.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective We wanted to assess the relationship between measurements of the right ventricular (RV) function and mass, with using cardiac multi-detector computed tomography (MDCT) and the severity of chronic obstructive pulmonary disease (COPD) as determined by the pulmonary function test (PFT). Materials and Methods Measurements of PFT and cardiac MDCT were obtained in 33 COPD patients. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the patients were divided into three groups according to the severity of the disease: stage I (mild, n = 4), stage II (moderate, n = 15) and stage III (severe, n = 14). The RV function and the wall mass were obtained by cardiac MDCT. The results were compared among the groups using the Student-Newman-Keuls method. Pearson's correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and the wall mass results with the PFT results. P-values less than 0.05 were considered statistically significant. Results The RVEF and mass were 47±3% and 41±2 g in stage I, 46±6% and 46±5 g in stage II, and 35±5% and 55±6 g in stage III, respectively. The RVEF was significantly lower in stage III than in stage I and II (p < 0.01). The RV mass was significantly different among the three stages, according to the disease severity of COPD (p < 0.05). The correlation was excellent between the MDCT results and forced expiratory volume in 1 sec (r = 0.797 for RVEF and r = -0.769 for RV mass) and forced expiratory volume in 1 sec to the forced vital capacity (r = 0.745 for RVEF and r = -0.718 for RV mass). Conclusion Our study shows that the mean RV wall mass as measured by cardiac MDCT correlates well with the COPD disease severity as determined by PFT.
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Affiliation(s)
- Jin Hur
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul 135-270, Korea
| | - Tae Hoon Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul 135-270, Korea
| | - Sang Jin Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul 135-270, Korea
| | - Young Hoon Ryu
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul 135-270, Korea
| | - Hyung Jung Kim
- Department of Pulmonology, Yonsei University College of Medicine, Research Institute of Medical Science, Seoul 135-270, Korea
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81
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Johnson TRC, Nikolaou K, Fink C, Becker A, Knez A, Rist C, Reiser MF, Becker CR. Dual-source-CT in der Diagnostik des Thoraxschmerzes. Radiologe 2007; 47:301-9. [PMID: 17285271 DOI: 10.1007/s00117-007-1480-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND With the depiction of pulmonary arteries, coronary arteries, and the aorta, CT angiography of the chest offers a comprehensive diagnostic work-up of unclear chest pain. The aim of this study was to assess the diagnostic accuracy of dual-source CT in this patient group. MATERIALS AND METHODS A total of 47 patients suffering from unclear chest pain were examined with a Siemens Somatom Definition. Volume and flow of contrast media (Ultravist, Schering) were adapted to the body weight. The examinations were evaluated with regard to image quality and contrast opacification and to the diagnostic accuracy with reference to the final clinical diagnosis. RESULTS Adequate contrast opacification was achieved in all examinations. The depiction of the coronary arteries was diagnostic in all cases. The cause of chest pain could be identified in 41 cases. Among the diagnoses were coronary and myocardial pathologies, valvular disease, aortic aneurysms and dissections, pulmonary embolism, and pneumonic consolidation. CONCLUSION DSCT angiography of the chest offers a very good image quality even at high heart rates so that a high diagnostic accuracy is achieved in patients with acute chest pain.
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Affiliation(s)
- Thorsten R C Johnson
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Rist C, Johnson TR, Becker A, Leber AW, Huber A, Busch S, Becker CR, Reiser MF, Nikolaou K. Dual-source-Computertomographie des Herzens. Radiologe 2007; 47:287-90, 292-4. [PMID: 17285272 DOI: 10.1007/s00117-007-1479-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a newly developed dual-source computed tomography system (DSCT) the relation of heart rate and image quality and the possible advantages of the system's superior temporal resolution in the evaluation of left ventricular parameters as compared to results of cardiac magnetic resonance imaging (MRI) were assessed. Coronary CT angiography was performed using a DSCT (Somatom Defintion, Siemens Medical Solutions, Forchheim, Germany) in 21 patients (mean age 62+/-8; 15 male, 6 female). Image quality of the coronary arteries, the heart valves, and the left ventricular myocardium was assessed using a three-point grading scale. Ten of these patients also underwent cardiac MRI for the assessment of left ventricular function, using a SSFP (steady-state free precession) sequence. Left ventricular ejection fractions (LV-EF), the end-systolic volumes (ESV), and the end-diastolic volumes (EDV) were measured employing MRI and DSCT datasets. The image quality ratings for the coronary arteries at the optimal reconstruction interval were diagnostic even in patients with high heart rates (1.42+/-0.49). Analysis of global LV function using DSCT quantified from CTA datasets showed a good correlation with results of cardiac MRI [EF: r=0.75 (p=0.01); ESV: r=0.72 (p=0.19); EDV: r=0.71 (p=0.02)]. The dual-source CT system offers robust image quality of the coronary arteries, independent of the heart rate, and provides combined diagnostic imaging of coronary arteries, the heart valves, the myocardium, and the global left ventricular function.
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Affiliation(s)
- Carsten Rist
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, München, Deutschland.
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Burgstahler C, Reimann A, Beck T, Kuettner A, Baumann D, Heuschmid M, Brodoefel H, Claussen CD, Kopp AF, Schroeder S. Influence of a Lipid-Lowering Therapy on Calcified and Noncalcified Coronary Plaques Monitored by Multislice Detector Computed Tomography. Invest Radiol 2007; 42:189-95. [PMID: 17287649 DOI: 10.1097/01.rli.0000254408.96355.85] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Multislice detector computed tomography (MSCT) is an accurate noninvasive modality to detect and classify different stages of atherosclerosis. The aim of the New Age II Study was to detect coronary lesions in men without established coronary artery disease (CAD) but with a distinct cardiovascular risk profile. We also sought to assess the effect after 1 year of a lipid-lowering therapy (LLT) using 20 mg of atorvastatin. METHODS Forty-sixe male patients (mean, 61 +/- 10 years) with an elevated risk for CAD (PROCAM score >3 quintile) without LLT were included. Native and contrast-enhanced scans were performed in all patients. A total of 27 of 46 patients received a follow-up scan (after 488 +/- 138 days). Coronary plaque burden (CPB) was assessed volumetrically. RESULTS The prevalence of CAD was 83% (38/46 patients), and 11% (5/46) without coronary calcifications still had noncalcified plaques. Total cholesterol and low-density lipoprotein cholesterol levels decreased significantly under LLT (225 +/- 41 mg/dL vs. 162 +/- 37 mg/dL, P < 0.0001 and 148 +/- 7 mg/dL vs. 88 +/- 5 mg/dL, P < 0.001, respectively). On follow-up, calcium score and CPB remained unchanged (Agatston score: 261 +/- 301 vs. 282 +/- 360; CPB: 0.149 +/- 0.108 vs. 0.128 +/- 0.075 mL, P > 0.05), whereas mean plaque volume of noncalcified plaques decreased significantly from 0.042 +/- 0.029 mL versus 0.030 +/- 0.014 mL (P < 0.05, mean reduction 0.012 +/- 0.017 mL or 24 +/- 13%). CONCLUSIONS Statin therapy led to a significant reduction of noncalcified plaque burden that was not reflected in calcium scoring or total plaque burden. This finding might explain the risk reduction after the initiation of statin therapy. Using multislice detector computed tomography, physicians have the potential to monitor medical treatment in patients with coronary atherosclerosis.
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Affiliation(s)
- Christof Burgstahler
- Department of Internal Medicine, Division of Cardiology, Eberhard-Karls-University, Tuebingen, Germany
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Burgstahler C, Beck T, Reimann A, Kuettner A, Kopp AF, Heuschmid M, Claussen CD, Schroeder S. Diagnostic accuracy of multislice computed tomography for the detection of coronary artery disease in diabetic patients. J Diabetes Complications 2007; 21:69-74. [PMID: 17331854 DOI: 10.1016/j.jdiacomp.2005.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 11/29/2005] [Accepted: 12/29/2005] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diabetes mellitus is an important risk factor for coronary artery disease. Cardiac multislice computed tomography (MSCT) permits visualization of the coronary arteries with good sensitivity and specificity. However, at present, there are no data whether MSCT allows an accurate assessment of coronary arteries of diabetic patients, in comparison to nondiabetic patients. Thus, we compared the catheter-controlled MSCT results from diabetic and nondiabetic patients in a cohort of 116 patients with regard to sensitivity, specificity, positive predictive value, and negative predictive value, as well as image quality. METHODS AND MATERIALS Twenty-two diabetic patients (age, 64.6+/-8.5 years; number of risk factors, 3.4+/-1.1) and 94 nondiabetic patients (age, 64.2+/-9.2 years; number of risk factors, 2.4+/-1.0) were examined by MSCT (Sensation 16 Speed 4 D, Siemens, Forchheim, Germany; gantry rotation time, 375 ms) and invasive coronary angiography. MSCT results were compared, blinded to the results of the coronary angiography with regard to the presence or absence of a significant stenosis (>50%) in a modified American Heart Association 13-segment model. Image quality was assessed on a qualitative scale between 1 (very good) and 5 (invisible) for each segment. RESULTS Sensitivity, specificity, positive predictive value, and negative predictive value were statistically not different in diabetic and nondiabetic patients (0.85/0.98/0.92/0.96 vs. 0.84/0.97/0.91/0.95). One diabetic and three nondiabetic patients had to be excluded from analysis. Diabetic patients had relevantly more risk factors (P < .05), but calcium scoring was not different in both groups (Agatston score 1090+/-1278 vs. 798+/-1033). The image quality in both cohorts was comparable. CONCLUSIONS MSCT allows the assessment of the coronary arteries noninvasively in diabetic patients with a good sensitivity and specificity, and diabetes does not have an impact on the number of evaluable segments. Thus, MSCT is a noninvasive tool in the care of these patients.
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Affiliation(s)
- Christof Burgstahler
- Division of Cardiology, Department of Internal Medicine, Eberhard-Karls-University Tuebingen, 72076 Tuebingen, Germany
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Hazirolan T, Turkbey B, Karcaaltincaba M, Akata D, Sahiner L, Aytemir K, Oto MA, Arslan U, Balkanci F, Besim A. Impact of scanning direction on heart rate at certain levels of heart in electrocardiogram-gated 16-multidetector computed tomography angiography of coronary artery bypass grafts. J Comput Assist Tomogr 2007; 31:5-8. [PMID: 17259826 DOI: 10.1097/01.rct.0000232476.14786.58] [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: 11/26/2022]
Abstract
OBJECTIVE To assess impact of scanning direction on heart rates at certain levels of heart in electrocardiogram-gated 16-multidetector computed tomography (MDCT) detection of coronary artery bypass grafts and native coronary arteries. METHODS Ninety patients with 219 grafts were studied by 16-MDCT. Forty-five patients were scanned craniocaudally. The remaining 45 patients were scanned caudocranially. Heart rates at each level were noted and compared between the 2 groups. RESULTS The difference between mean heart rates of craniocaudal and caudocranial groups was found to be statistically significant at midcardiac, internal mammary artery origin, and cardiac base levels (P < 0.05). For the remaining levels, there was no statistically significant difference in mean heart rates. CONCLUSIONS Performing electrocardiogram-gated 16-MDCT angiography for the evaluation of coronary arteries and bypass grafts in caudocranial direction provides lower heart rate at midcardiac and cardiac base levels of the heart, which are more prone to motion artifacts.
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Affiliation(s)
- Tuncay Hazirolan
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
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86
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Gaemperli O, Schepis T, Koepfli P, Valenta I, Soyka J, Leschka S, Desbiolles L, Husmann L, Alkadhi H, Kaufmann PA. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2007; 34:1162-71. [PMID: 17219136 DOI: 10.1007/s00259-006-0307-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 10/18/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using (99m)Tc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD). METHODS MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses > or =50% and > or =75% were compared with the MPI findings. RESULTS In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses > or =50% in 57 of 376 coronary arteries (15.2%) and stenoses > or =75% in 32 (8.5%) coronary arteries. Using a cut-off at > or =75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively. CONCLUSION Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia.
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Affiliation(s)
- Oliver Gaemperli
- Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich NUK C 40, Raemistrasse 100, 8091 Zurich, Switzerland
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Bordeleau E, Lamonde A, Prenovault J, Belblidia A, Coté G, Lespérance J, Soulez G, Chartrand-Lefebvre C. Accuracy and rate of coronary artery segment visualization with CT angiography for the non-invasive detection of coronary artery stenoses. Int J Cardiovasc Imaging 2007; 23:771-80. [PMID: 17216125 DOI: 10.1007/s10554-006-9198-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 11/17/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate CT coronary angiography (CTA) when compared with catheter coronary angiography (CCA), for the detection of coronary artery stenoses and rate of optimal coronary artery segment visualization. METHOD Retrospective, two-center study enrolling 26 patients who underwent CCA and ECG-gated 16-detector CTA (slice thickness 0.6 mm; rotation 500 ms). RESULTS AND CONCLUSION 283 segments were available for postprocessing. Sensitivity, specificity, and positive predictive value were, respectively, 80, 100, and 100%, for detecting more than 50% luminal stenoses, when optimally visualized segments were considered, in comparison to CCA. Negative predictive value was excellent (98%). Rate of non-optimally visualized coronary segments was 26%. Most clinical benefits of coronary CT angiography should probably be obtained when it is performed to exclude significant stenoses on selected populations of patients with a low pre-test probability of severe coronary artery disease, and under optimal conditions of controlled heart rate and minimal presence of calcium.
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Affiliation(s)
- Edith Bordeleau
- Cardiopulmonary Section, Radiology department, University of Montreal Medical Center (CHUM), Saint-Luc Hospital, 1058 Saint-Denis street, H2X 3J4, Montreal, QC, Canada
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88
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Computed Tomographic Cardiovascular Imaging. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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89
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Wu YW, Tadamura E, Yamamuro M, Kanao S, Nakayama K, Togashi K. Evaluation of three-dimensional navigator-gated whole heart MR coronary angiography: The importance of systolic imaging in subjects with high heart rates. Eur J Radiol 2007; 61:91-6. [PMID: 16987631 DOI: 10.1016/j.ejrad.2006.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 08/04/2006] [Accepted: 08/04/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the influence of heart rate (HR) on magnetic resonance coronary angiography (MRCA) image quality in diastolic and systolic phases. MATERIALS AND METHODS Twenty-seven healthy volunteers (9 men; 33+/-9 years, HR 53-110 bpm), were evaluated with the electrocardiography and three-dimensional navigator-gating MRCA in a 1.5-T MR scanner (Avanto, Siemens) in diastolic and systolic phases (steady-state free precession; TR/TE/flip angle=3.2 ms/1.6 ms/90 degrees). The timing of scanning was individually adapted to the cardiac rest periods obtained in the prescanning, by visually identifying when the movement of right coronary artery was minimized during diastole and systole. Images of two phases were side-by-side compared on a four-point scale (from 1=poor to 4=excellent visibility; score of 3 or 4 as diagnostic). RESULTS Of 13 subjects with HR < or =65 bpm (low HR group, mean 59.8+/-4.9 bpm, range 53-65), the image quality scores were significantly better than that with higher heart rates (73.9+/-9.0 bpm, range 68-110) in diastolic MRCA. The image quality was significantly improved during systole in high HR group. Overall, 91.3% of low HR group had MRCA image of diagnostic quality acquired at diastole, while 88.3% of high HR group had diagnostic images at systole by segmental analysis (p=NS). CONCLUSIONS MRCA at systole offered superior quality in patients with high heart rates.
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Affiliation(s)
- Yen-Wen Wu
- Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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90
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Nagatani Y, Takahashi M, Takazakura R, Nitta N, Murata K, Ushio N, Matsuo S, Yamamoto T, Horie M. Multidetector-Row Computed Tomography Coronary Angiography Optimization of Image Reconstruction Phase According to the Heart Rate. Circ J 2007; 71:112-21. [PMID: 17186988 DOI: 10.1253/circj.71.112] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To optimize the image reconstruction phase of multidetector-row computed tomography (MDCT) coronary angiography according to the heart rate is crucial. METHODS AND RESULTS Scan data were reconstructed for 10 different phases in 58 sequential patients who underwent 8-row cardiac MDCT. The obtained images were scored and compared in terms of motion artifacts and visibility of the vessels, and moreover, ECG record-based evaluations were added for clarification of the temporal relationships among these 10 phases. In the cases with lower heart rates (<65 beats/min), the best quality images were obtained when the end of the image reconstruction phase was positioned at the peak of the P wave. In some cases with higher heart rates (>65 beats/min), they were obtained in the late systolic period. CONCLUSION As the heart rate increased, the optimal image reconstruction phase changed from mid diastole to late systole. However, it is recommended to try to decrease the heart rate of patients before data acquisition.
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Affiliation(s)
- Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan.
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91
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Johnson TRC, Nikolaou K, Wintersperger BJ, Knez A, Boekstegers P, Reiser MF, Becker CR. ECG-Gated 64-MDCT Angiography in the Differential Diagnosis of Acute Chest Pain. AJR Am J Roentgenol 2007; 188:76-82. [PMID: 17179348 DOI: 10.2214/ajr.05.1153] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The most important differential diagnoses of acute chest pain include myocardial infarction, aortic dissection, and pulmonary embolism. The purpose of this study was to evaluate the diagnostic value of an ECG-gated 64-MDCT angiography protocol for simultaneous assessment of the pulmonary arteries, coronary arteries, and aorta within a single breath-hold. SUBJECTS AND METHODS In 55 patients with acute chest pain, ECG-gated CT angiography was performed with a CT system in which 64 slices per gantry rotation were acquired. Density measurement and visual assessment of motion artifacts were performed to evaluate image quality. CT findings were correlated with results of laboratory tests and clinical follow-up. For 20 patients, two independent blinded reviewers compared findings on CT angiography with those on X-ray coronary angiography. RESULTS Adequate contrast enhancement of the pulmonary vessels, coronary arteries, and aorta was achieved in all cases. Regarding image quality of the coronary arteries, there was minor blurring in seven patients, and in one examination the images did not provide enough information for diagnosis. The average image quality rating was 1.2 on a scale in which 1 indicated no artifacts; 2, minor motion artifacts; and 3, image insufficient for diagnosis. The cause of chest pain was correctly identified with MDCT in 37 patients. The diagnoses included pulmonary embolism (n = 10), coronary stenosis (n = 9), and aortic dissection (n = 1). In four patients, additional diagnoses were found with other examinations. CONCLUSION With current techniques, ECG-gated CT angiography of the entire chest has very good image quality. The protocol proved helpful in the differential diagnosis of acute chest pain.
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Affiliation(s)
- Thorsten R C Johnson
- Department of Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistrasse 15, 81377 Munich, Germany.
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92
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Abstract
Multislice computer tomography has undergone substantial technological progress during the past years. Current 64-slice scanners with gantry rotation speeds of as little as 330 ms, and particularly the recently introduced dual source CT equipped with two X-ray tubes, provide a temporal and spatial resolution that is sufficient to allow reliable imaging of cardiac morphology and coronary arteries. Especially the ability to noninvasively visualize the coronary arteries, including the assessment and quantification of calcifications, as well as the detection of luminal obstruction and atherosclerotic plaque, constitutes an attractive addition to currently available diagnostic tools for the work-up of patients with known or suspected coronary artery disease. Besides the evaluation of coronary artery calcium and atherosclerotic plaques, this review focuses on the contrast-enhanced CT visualization of the coronary vessels, including native coronary arteries, bypass grafts, and coronary stonts. Thereby detailed information concerning the scan protocol, clinical data, possible indications, and limitations using up-to-date 64-slice technology is provided. Finally, the overview includes design and initial image examples of dual source CT technology as the newest development in the field.
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Affiliation(s)
- Dieter Ropers
- Department of Internal Medicine 2, Cardiology and Angiology, University of Erlangen-Nurenberg, Ulmenweg, Erlangen, Germany.
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93
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Chabbert V, Carrie D, Bennaceur M, Maupas E, Lauwers V, Mhem M, Lhermusier T, Elbaz M, Joffre F, Rousseau H, Puel J. Evaluation of in-stent restenosis in proximal coronary arteries with multidetector computed tomography (MDCT). Eur Radiol 2006; 17:1452-63. [PMID: 17115159 DOI: 10.1007/s00330-006-0510-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 09/20/2006] [Accepted: 10/12/2006] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to assess the ability of 16-slice computed tomography (CT) to detect in-stent restenosis of proximal coronary arteries. From November 2002 to April 2004, 134 consecutive patients with proximal stents (3.25 +/- 0.47 mm) were prospectively studied. Multidetector CT (MDCT) was performed 24 h (baseline) and 6 months after angioplasty and analysed by two radiologists blinded to the results of the coronary angiography. Sensitivity, specificity, positive and negative predictive values for in-stent restenosis were compared with conventional quantitative coronary angiography (QCA). Stenosis with a diameter >or=50% was considered diagnostic of in-stent restenosis. The CT analysis was performed in 131 and 114 patients at baseline and 6 months, respectively. The in-stent lumen was evaluable in 111 (121 stents) and 99 patients (108 stents) at baseline and 6 months, respectively. The prevalence of in-stent restenosis was 22.5%. Restenoses were correctly identified in 91.7 and 87.5% by the two radiologists. The sensitivity, specificity, positive and negative predictive values for the assessment of significant in-stent restenosis were 92, 67, 43, 97% and 87, 66, 41, 95% for the radiologists, respectively. MDCT is a potential non-invasive technique for the screening of in-stent restenosis of proximal coronary arteries that needs further improvements.
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Affiliation(s)
- V Chabbert
- Department of Radiology, CHU Rangueil, 1 avenue Jean-Poulhes TSA 50032, 31059 Toulouse Cedex 9, France.
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94
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Frydrychowicz A, Pache G, Saueressig U, Föll D, Kotter E, Langer M, Bley TA. Comparison of Reconstruction Intervals in Routine ECG-Pulsed 64-Row-MSCT Coronary Angiography in Frequency Controlled Patients. Cardiovasc Intervent Radiol 2006; 30:79-84. [PMID: 17086457 DOI: 10.1007/s00270-006-0010-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE In light of the increasing use and acceptance of multislice computed tomography (MSCT) coronary angiography it was the purpose of this study to compare reconstruction intervals used in a routine ECG-pulsed MSCT coronary artery angiography setting with frequency controlled patients. METHODS Examinations were performed on a Siemens Somatom Sensation 64 scanner with a total of 110 ml of contrast agent and ECG pulsing (interval from 40% to 70%) after oral application of a beta-blocker if the heart rate was higher than 65 bpm. All human subjects were referred for the evaluation of suspected coronary artery disease. Coronary artery segments were evaluated by two experienced radiologists in a consensus reading. A ranking of diagnostic image quality (from 1 (no evaluation possible) to 5 (excellent image quality)) was statistically evaluated by Wilcoxon Signed Rank Test. RESULTS In 45 patients (30 male, 15 female, age 63.8 +/- 12.1 years) we detected a significant advantage of the 60% reconstruction interval over 40%, 50%, and 70% (for each p < 0.05). In cases of sudden arrhythmia or movement during the scan, additional reconstruction intervals within the ECG-pulsed reconstruction intervals remained necessary for diagnosis. CONCLUSION In a routine diagnostic setting with frequency controlled patients and ECG pulsing the 60% reconstruction interval can be considered superior for the initial diagnosis in 64-row multislice computed tomography coronary angiography. However, further information can be derived from various reconstruction intervals such as 40% and 70%.
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Affiliation(s)
- Alex Frydrychowicz
- Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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95
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Achenbach S. Computed tomography coronary angiography. J Am Coll Cardiol 2006; 48:1919-28. [PMID: 17112978 DOI: 10.1016/j.jacc.2006.08.012] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 06/02/2006] [Accepted: 06/06/2006] [Indexed: 11/20/2022]
Abstract
Recent developments in computed tomography technology have made imaging of the coronary arteries possible. All the same, the rapid motion and small dimensions of the coronary vessels make coronary computed tomography angiography (coronary CTA) challenging. With the last generations of 16- and 64-slice computed tomography and adequate patient preparation (which includes lowering of the heart rate), rates of sensitivity ranging from 83% to 99% and specificity between 93% and 98% have been reported for the detection of coronary artery stenoses in comparison with invasive coronary angiography. The high negative predictive value (95% to 100%) found in these studies suggests that coronary CTA may be a useful diagnostic technique to rule out the presence of coronary stenoses in selected patients, especially those with a rather low pretest likelihood of disease. Imaging of coronary artery bypass grafts is reliable, but clinical applications can be hampered by difficulties in assessing the native coronary arteries in patients after undergoing bypass because of their often-severe calcification. The detection of in-stent restenosis is made difficult by artifacts caused by metal, especially in smaller stents. Finally, initial reports that coronary CTA allows the detection and, to a certain extent, also the characterization and quantification of noncalcified coronary arteriosclerotic plaque are interesting, but they currently do not provide sufficient data to support clinical applications in the context of risk stratification.
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Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany.
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96
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Sirineni GKR, Kalra MKS, Pottala KM, Syed MA, Tigges S, Cann AD. Visualization Techniques in Computed Tomographic Coronary Angiography. Curr Probl Diagn Radiol 2006; 35:245-57. [PMID: 17084239 DOI: 10.1067/j.cpradiol.2006.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac computed tomography (CT) scans can produce enormous datasets (>3,000 images), making traditional axial image interpretation un-workable. Previously existing and new techniques including multiplanar reformats, volume rendering, maximum intensity projections, curved multiplanar reformats, and "4D" (time-resolved) methods have all been used to increase diagnostic accuracy and reduce interpretation times. The methods and applications of these techniques to cardiac anatomy will be reviewed and discussed with an eye toward practical film interpretation.
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Affiliation(s)
- Gopi Kiran Reddy Sirineni
- Department of Radiology, Emory University School of Medicine, Emory University Hospital, Atlanta, GA 30060, USA
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97
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Leschka S, Wildermuth S, Boehm T, Desbiolles L, Husmann L, Plass A, Koepfli P, Schepis T, Marincek B, Kaufmann PA, Alkadhi H. Noninvasive Coronary Angiography with 64-Section CT: Effect of Average Heart Rate and Heart Rate Variability on Image Quality. Radiology 2006; 241:378-85. [PMID: 16966483 DOI: 10.1148/radiol.2412051384] [Citation(s) in RCA: 234] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate prospectively the effect of average heart rate and heart rate variability on image quality at 64-section computed tomographic (CT) coronary angiography. MATERIALS AND METHODS The study protocol had local ethics committee approval; written informed consent was obtained. There were 125 patients (45 women, 80 men; mean age, 59.9 years +/- 12.9 [standard deviation]; 79 receiving beta-blockers) who underwent 64-section CT coronary angiography with retrospective electrocardiographic gating. Data sets were reconstructed in 5% steps from 20% to 80% of R-R interval. Heart rate variability was calculated as 1 standard deviation from mean rate during scanning. Two observers rated image quality of each coronary segment at least 1.5-mm diameter (1 = no motion artifacts, 5 = not evaluative). Repeated analysis of variance measurements were performed to evaluate quantitative parameters. Pearson correlation analysis was performed to compare image quality in each patient with average heart rate and heart rate variability. RESULTS Average heart rate was 63.3 beats per minute +/- 13.1, with variability of 3.2 beats per minute +/- 2.1. Diagnostic image quality (score < or = 3) was attained in 1821 of 1836 segments at the best reconstruction interval. There was no correlation between mean heart rate and image quality for all segments of the right coronary and left anterior descending arteries, but there was a significant correlation for left circumflex artery (r = 0.33, P < .05). Heart rate variability was correlated with image quality overall (r = 0.75, P < .001) and for each coronary artery. Heart rate was less variable and image quality was better (P < .05) in patients receiving beta-blockers. Best image quality was obtained in diastole with heart rate less than 80 beats per minute and in systole with faster heart rate. CONCLUSION Coronary angiography with 64-section CT provides diagnostic image quality within a wide range of heart rates. Reducing average heart rate and heart rate variability is beneficial for reducing artifacts.
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Affiliation(s)
- Sebastian Leschka
- Institute of Diagnostic Radiology, the Clinic for Cardiovascular Surgery, and the Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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98
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Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JAC, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006; 114:1761-91. [PMID: 17015792 DOI: 10.1161/circulationaha.106.178458] [Citation(s) in RCA: 998] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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99
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Mühlenbruch G, Seyfarth T, Soo CS, Pregalathan N, Mahnken AH. Diagnostic value of 64-slice multi-detector row cardiac CTA in symptomatic patients. Eur Radiol 2006; 17:603-9. [PMID: 17008986 DOI: 10.1007/s00330-006-0429-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 07/25/2006] [Accepted: 08/01/2006] [Indexed: 10/24/2022]
Abstract
Cardiac multi-detector-row computed tomography (MDCT) angiography has shown high levels of sensitivity and especially negative predictive value regarding the diagnosis of coronary artery disease (CAD). This study was designed to determine the value of a 64-slice-MDCT scanner in comparison to invasive coronary angiography for the detection of CAD in a population of symptomatic patients. Fifty-one patients with suspected CAD underwent conventional coronary angiography and ECG-gated cardiac 64-slice-MDCT angiography with a rotation time of 330 ms, a collimation of 64x0.6 mm and a slice thickness of 0.75 mm. Blinded patient- and segment-based analysis was performed for the detection of stenoses >or=70% of the vessel lumen. 95% of all coronary segments were assessable by MDCT angiography. Patient-based (segment-based) analysis revealed a sensitivity of 97.8% (86.7%), specificity of 50% (95.2%), positive predictive value of 93.6% (75.2%) and negative predictive value of 75% (97.7%). Inter-rater agreement revealed a kappa-value of 0.558 (0.722). In this symptomatic patient group a 64-slice-MDCT scanner shows good agreement on a segment-based analysis but only moderate agreement on a patient-based analysis. The diagnostic accuracy of 64-slice-MDCT coronary angiography is negatively influenced by the high pre-test probability of this symptomatic patient collective.
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Affiliation(s)
- Georg Mühlenbruch
- Department of Diagnostic Radiology, University Hospital (RWTH) Aachen, Pauwelsstrasse 30, 52057, Aachen, Germany.
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100
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Hoffmann U, Pena AJ, Cury RC, Abbara S, Ferencik M, Moselewski F, Siebert U, Brady TJ, Nagurney JT. Cardiac CT in emergency department patients with acute chest pain. Radiographics 2006; 26:963-78; discussion 979-80. [PMID: 16844926 DOI: 10.1148/rg.264055709] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Current strategies for the triage of patients who have chest pain but normal initial cardiac enzyme levels and nondiagnostic electrocardiograms do not permit efficient risk stratification. The potentially fatal consequences and high malpractice costs of missed acute coronary syndromes lead every year to the unnecessary hospital admission of about 2.8 million patients who present with acute chest pain in emergency departments in the United States. Most of these patients are at very low risk for an acute coronary syndrome. However, the standard clinical work-up does not provide information about the presence and extent of coronary artery disease. In most patients (80%-94%) with an acute coronary syndrome, a significant coronary artery stenosis can be detected with selective coronary angiography. High levels of diagnostic accuracy also have been established for the detection of significant coronary artery stenosis with the use of 16- and 64-section multidetector computed tomography (CT) in patients with stable angina. Preliminary data indicate that multidetector CT also can help quantify and characterize coronary atherosclerotic plaque and that the CT findings are in good agreement with those at intravascular ultrasonography. Although multidetector CT provides accurate information about the presence of coronary artery disease, large blinded observational studies are warranted to identify CT characteristics with high accuracy for diagnosis of acute coronary syndromes. Such information would enable the conduct of randomized controlled trials to determine whether the detection of coronary stenosis and plaque with multidetector CT improves triage and reduces the costs or increases the cost-effectiveness of management of acute chest pain.
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Affiliation(s)
- Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, 165 Charles River Plaza, Suite 400, Boston, MA 02114, USA.
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