Developments in coronary CT angiography

Morphology of Coronary Ostia in Domestic Shorthair Cat

Diagnosis and treatment of heart diseases due to changes in the coronary vascularization need a detailed knowledge on the morphology and possible variations of the aortic valves and coronary ostia. This study was performed to clarify details on morphology of these structures in domestic cats. The tricuspid aortic valve was examined in 65 domestic shorthair cats. The location of coronary ostia was determined either inferior to (26 and 20%, left and right coronary ostium - LCO and RCO), at (65 and 66%) or superior to the intercommissural line (9 and 14%). In 13 cats (20%), accessory ostia were found either for left, right or both coronary arteries (LCA and RCA). Their position varied between specimens. They were located beyond the main ostium, at its edge, or inside just below the edge. In one cat, no main trunk of the LCA was found. In one cat, two accessory ostia next to the RCO were observed. Coronary ostia in cats show anatomical variants and morphological anomalies. This study provides basic data useful for, for example, angiography performed for diagnosis of cardiac diseases and as a basis for surgical interventions.

Does clinical pretest probability influence image quality and diagnostic accuracy in dual-source coronary CT angiography?

RATIONALE AND OBJECTIVES

To prospectively evaluate the influence of the clinical pretest probability assessed by the Morise score onto image quality and diagnostic accuracy in coronary dual-source computed tomography angiography (DSCTA).

MATERIALS AND METHODS

In 61 patients, DSCTA and invasive coronary angiography were performed. Subjective image quality and accuracy for stenosis detection (>50%) of DSCTA with invasive coronary angiography as gold standard were evaluated. The influence of pretest probability onto image quality and accuracy was assessed by logistic regression and chi-square testing. Correlations of image quality and accuracy with the Morise score were determined using linear regression.

RESULTS

Thirty-eight patients were categorized into the high, 21 into the intermediate, and 2 into the low probability group. Accuracies for the detection of significant stenoses were 0.94, 0.97, and 1.00, respectively. Logistic regressions and chi-square tests showed statistically significant correlations between Morise score and image quality (P < .0001 and P < .001) and accuracy (P = .0049 and P = .027). Linear regression revealed a cutoff Morise score for a good image quality of 16 and a cutoff for a barely diagnostic image quality beyond the upper Morise scale.

CONCLUSION

Pretest probability is a weak predictor of image quality and diagnostic accuracy in coronary DSCTA. A sufficient image quality for diagnostic images can be reached with all pretest probabilities. Therefore, coronary DSCTA might be suitable also for patients with a high pretest probability.