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Xiong QF, Fu XR, Ku LZ, Zhou D, Guo SP, Zhang WS. Diagnostic performance of coronary computed tomography angiography stenosis score for coronary stenosis. BMC Med Imaging 2024; 24:39. [PMID: 38336622 PMCID: PMC10854174 DOI: 10.1186/s12880-024-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Coronary computed tomography angiography stenosis score (CCTA-SS) is a proposed diagnosis score that considers the plaque characteristics, myocardial function, and the diameter reduction rate of the lesions. This study aimed to evaluate the diagnostic performance of the CCTA-SS in seeking coronary artery disease (CAD). METHODS The 228 patients with suspected CAD who underwent CCTA and invasive coronary angiography (ICA) procedures were under examination. The diagnostic performance was evaluated with the receiver operating curve (ROC) for CCTA-SS in detecting CAD (defined as a diameter reduction of ≥ 50%) and severe CAD (defined as a diameter reduction of ≥ 70%). RESULTS The area under ROC (AUC) of CCTA-SS was 0.909 (95% CI: 0.864-0.943), which was significantly higher than that of CCTA (AUC: 0.826; 95% CI: 0.771-0.873; P = 0.0352) in diagnosing of CAD with a threshold of 50%. The optimal cutoff point of CCTA-SS was 51% with a sensitivity of 90.66%, specificity of 95.65%, positive predictive value of 98.80%, negative predictive value of 72.13%, and accuracy of 91.67%, whereas the optimal cutoff point of CCTA was 55%, and the corresponding values were 87.36%, 93.48%, 98.15%, 65.15%, and 88.60%, respectively. With a threshold of 70%, the performance of CCTA-SS with an AUC of 0.927 (95% CI: 0.885-0.957) was significantly higher than that of CCTA with an AUC of 0.521 (95% CI: 0.454-0.587) (P < 0.0001). CONCLUSIONS CCTA-SS significantly improved the diagnostic accuracy of coronary stenosis, including CAD and severe CAD, compared with CCTA.
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Affiliation(s)
- Qing-Feng Xiong
- Hainan Enhance International Medical Center, Boao, China.
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China.
| | - Xiao-Rong Fu
- Wuchang Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Lei-Zhi Ku
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Di Zhou
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Sheng-Peng Guo
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
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Static CT myocardial perfusion imaging: image quality, artifacts including distribution and diagnostic performance compared to 82Rb PET. Eur J Hybrid Imaging 2022; 6:1. [PMID: 34981241 PMCID: PMC8724508 DOI: 10.1186/s41824-021-00118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rubidium-82 positron emission tomography (82Rb PET) MPI is considered a noninvasive reference standard for the assessment of myocardial perfusion in coronary artery disease (CAD) patients. Our main goal was to compare the diagnostic performance of static rest/ vasodilator stress CT myocardial perfusion imaging (CT-MPI) to stress/ rest 82Rb PET-MPI for the identification of myocardial ischemia.
Methods Forty-four patients with suspected or diagnosed CAD underwent both static CT-MPI and 82Rb PET-MPI at rest and during pharmacological stress. The extent and severity of perfusion defects on PET-MPI were assessed to obtain summed stress score, summed rest score, and summed difference score. The extent and severity of perfusion defects on CT-MPI was visually assessed using the same grading scale. CT-MPI was compared with PET-MPI as the gold standard on a per-territory and a per-patient basis.
Results On a per-patient basis, there was moderate agreement between CT-MPI and PET-MPI with a weighted 0.49 for detection of stress induced perfusion abnormalities. Using PET-MPI as a reference, static CT-MPI had 89% sensitivity (SS), 58% specificity (SP), 71% accuracy (AC), 88% negative predictive value (NPV), and 59% positive predictive value (PPV) to diagnose stress-rest perfusion deficits on a per-patient basis. On a per-territory analysis, CT-MPI had 73% SS, 65% SP, 67% AC, 90.8% NPV, and 34% PPV to diagnose perfusion deficits. Conclusions CT-MPI has high sensitivity and good overall accuracy for the diagnosis of functionally significant CAD using 82Rb PET-MPI as the reference standard. CT-MPI may play an important role in assessing the functional significance of CAD especially in combination with CCTA.
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Singh A, Mor-Avi V, Patel AR. The role of computed tomography myocardial perfusion imaging in clinical practice. J Cardiovasc Comput Tomogr 2020; 14:185-194. [DOI: 10.1016/j.jcct.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 01/17/2023]
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Forte E, Punzo B, Gentile F, Salvatore M, Cavaliere C, Cademartiri F. Normal patterns of left ventricle rest myocardial perfusion assessed by third-generation cardiac computed tomography. Clin Physiol Funct Imaging 2019; 40:30-36. [PMID: 31578827 DOI: 10.1111/cpf.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate diastolic and systolic patterns of segmental and transmural rest perfusion of the left ventricle (LV) in normal subjects (NS) undergoing third-generation dual-source cardiac computed tomography (CCT). METHODS Forty consecutive NS, with normal coronary arteries and cardiac chambers both anatomically and functionally on the basis of CCT, were retrospectively enrolled in the study. Relative normalized myocardial attenuation density (rnMAD) and transmural perfusion ratio (TPR) were calculated in diastole and systole for each segment and layer of the LV and then pooled into territories. RESULTS Statistical analysis showed that sub-endocardial rnMAD was significantly higher than intra-myocardial and sub-epicardial for all myocardial territories both in systolic and diastolic phases (P<0·001). Basal and mid-ventricular rnMAD were higher than apical for all myocardial layers (P<0·001). Septum displayed higher rnMAD in intra-myocardium and sub-epicardium (179 ± 61 and 170 ± 59 in diastole and 172 ± 60 and 166 ± 58 in systole, respectively) than the anterior, lateral and inferior wall (P<0·001). Diastolic and systolic TPR were significantly different for the anterior and lateral wall (P<0·001), while septal TPR (1·06 ± 0·06 in diastole and 1·05 ± 0·06 in systole, respectively) was the lowest as compared to other territories' TPR. Finally, basal, mid-ventricular and apical TPR showed a significant linear trend with basal lower than mid-ventricular and apical values. CONCLUSION Inter-territory and inter-layer myocardial perfusion differences can be accurately assessed with CCT in NS. This assessment is the basic step to further evaluate abnormal rest perfusion patterns in ischaemic and non-ischaemic diseases.
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The Potential Role of Combined Highly Sensitive Troponin and Coronary Computed Tomography Angiography in the Evaluation of Patients with Suspected Acute Coronary Syndrome in the Emergency Department. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ferencik M, Hoffmann U, Bamberg F, Januzzi JL. Highly sensitive troponin and coronary computed tomography angiography in the evaluation of suspected acute coronary syndrome in the emergency department. Eur Heart J 2016; 37:2397-405. [PMID: 26843275 PMCID: PMC6279199 DOI: 10.1093/eurheartj/ehw005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/16/2015] [Accepted: 01/05/2016] [Indexed: 02/02/2023] Open
Abstract
The evaluation of patients presenting to the emergency department with suspected acute coronary syndrome (ACS) remains a clinical challenge. The traditional assessment includes clinical risk assessment based on cardiovascular risk factors with serial electrocardiograms and cardiac troponin measurements, often followed by advanced cardiac testing as inpatient or outpatient (i.e. stress testing, imaging). Despite this costly and lengthy work-up, there is a non-negligible rate of missed ACS with an increased risk of death. There is a clinical need for diagnostic strategies that will lead to rapid and reliable triage of patients with suspected ACS. We provide an overview of the evidence for the role of highly sensitive troponin (hsTn) in the rapid and efficient evaluation of suspected ACS. Results of recent research studies have led to the introduction of hsTn with rapid rule-in and rule-out protocols into the guidelines. Highly sensitive troponin increases the sensitivity for the detection of myocardial infarction and decreases time to diagnosis; however, it may decrease the specificity, especially when used as a dichotomous variable, rather than continuous variable as recommended by guidelines; this may increase clinician uncertainty. We summarize the evidence for the use of coronary computed tomography angiography (CTA) as the rapid diagnostic tool in this population when used with conventional troponin assays. Coronary CTA significantly decreases time to diagnosis and discharge in patients with suspected ACS, while being safe. However, it may lead to increase in invasive procedures and includes radiation exposure. Finally, we outline the opportunities for the combined use of hsTn and coronary CTA that may result in increased efficiency, decreased need for imaging, lower cost, and decreased radiation dose.
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Affiliation(s)
- Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, 3180 SW Sam Jackson Park Road, Mail Code UHN62, Portland, OR 97239, USA Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Fabian Bamberg
- Department of Radiology, University of Tuebingen, Tuebingen, Germany
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW Computed tomography (CT) coronary angiography is a well-validated non-invasive technique for accurate and expedient diagnosis of coronary artery disease (CAD). However, a limitation of coronary CT angiography (CCTA) is its limited capability to identify physiologically significant stenoses, which may eventuate the need for further functional testing. Stress CT myocardial perfusion imaging (CT-MPI) is an emerging technique that has the ability to identify flow-limiting stenoses. RECENT FINDINGS The combination of CCTA coronary and CT-MPI has transformed the modality from a tool to assess anatomy and morphology to a modality capable of simultaneous assessment of coronary stenoses and their physiologic significance. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CT-MPI in comparison to a number of reference standard modalities for CAD diagnosis, including single-photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve testing. SUMMARY While there is still a need for consensus regarding acquisition techniques as well as analysis and interpretation of CT-MPI, with further validation, it is likely to become a powerful adjunctive tool to CCTA in the management of patients with suspected coronary disease.
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Noninvasive physiologic assessment of coronary stenoses using cardiac CT. BIOMED RESEARCH INTERNATIONAL 2015; 2015:435737. [PMID: 25685790 PMCID: PMC4320886 DOI: 10.1155/2015/435737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022]
Abstract
Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive "one-stop-shop" diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.
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Carmona-Rubio AE, Lee AM, Puchner S, Ghoshhajra B, Sharma UC. A review of adherence to the guidelines for coronary CT angiography quantitative stenosis grading thresholds in published research. Postgrad Med 2014; 127:194-201. [PMID: 25540988 DOI: 10.1080/00325481.2015.995065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The degree of coronary stenosis of potential hemodynamic significance is central to the interpretation of coronary computed tomography angiography (CCTA), but has been variably defined in the literature. Societal guidelines have attempted to address this issue via recommended thresholds. OBJECTIVES We surveyed the various thresholds for defining significant coronary stenosis reported in research published since the introduction of the Society for Cardiovascular Computed Tomography guidelines regarding the interpretation and reporting of CCTA. METHODS We systematically reviewed the results of bibliographic searches of all original research articles on CCTA, focusing on studies reporting > 25 subjects, to assess the definitions of severity of coronary lesions as found on CCTA. To enable comparisons, we stratified the methods of reporting lesion severity into ≥ 50%, 50% to 69%, and "others" (including infrequent reporting methods). RESULTS Fifty-nine11 published studies were identified and met inclusion criteria. Eighteen studies reported the severity of coronary stenosis using a definition of 50% to 69% as moderate stenosis; 35 studies defined ≥ 50% coronary stenosis as "stenosis," "significant stenosis," or "obstructive lesion" without distinguishing a threshold for moderate versus severe stenosis. Six studies utilized other thresholds, such as 20% to 75%, 40% to 69%, 40% to 70%, 40% to 79%, and 50% to 75% to define moderate coronary stenosis. CONCLUSIONS Fifty-three of 59 studies were graded in accordance with the recommended threshold of ≥ 50% defining potentially significant stenosis, with 18 studies reporting precisely in accordance with the guidelines-recommended thresholds of ≥ 50% narrowing as defining moderate stenosis and ≥ 70% narrowing as defining severe stenosis. Six studies were reported using alternative thresholds for significant stenosis. However, a majority of research studies published since 2009 do not follow the societal guidelines for stenosis grading, since these studies do not clearly describe the degree of coronary stenosis.
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Affiliation(s)
- Andres E Carmona-Rubio
- Department of Medicine, University at Buffalo, State University of New York, School of Medicine , Buffalo, NY
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Dave DM, Ferencic M, Hoffmann U, Udelson JE. Imaging techniques for the assessment of suspected acute coronary syndromes in the emergency department. Curr Probl Cardiol 2014; 39:191-247. [PMID: 24952880 DOI: 10.1016/j.cpcardiol.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Computed Tomography Assessment of Hemodynamic Significance of Coronary Artery Disease. J Thorac Imaging 2014; 29:163-72. [DOI: 10.1097/rti.0000000000000073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel AR, Bhave NM, Mor-Avi V. Myocardial perfusion imaging with cardiac computed tomography: state of the art. J Cardiovasc Transl Res 2013; 6:695-707. [PMID: 23963959 DOI: 10.1007/s12265-013-9499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
Cardiac computed tomography (CCT) has become an important tool for the anatomic assessment of patients with suspected coronary disease. Its diagnostic accuracy for detecting the presence of underlying coronary artery disease and ability to risk stratify patients are well documented. However, the role of CCT for the physiologic assessment of myocardial perfusion during resting and stress conditions is only now emerging. With the addition of myocardial perfusion imaging to coronary imaging, CCT has the potential to assess both coronary anatomy and its functional significance with a single non-invasive test. In this review, we discuss the current state of CCT myocardial perfusion imaging for the detection of myocardial ischemia and myocardial infarction and examine its complementary role to CCT coronary imaging.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, Section of Cardiology, Cardiac Imaging Center, University of Chicago, Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, IL, 60637, USA,
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