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Jin WY, Zhao XJ, Chen H. Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms. Chin Med J (Engl) 2017; 129:2191-8. [PMID: 27625091 PMCID: PMC5022340 DOI: 10.4103/0366-6999.189908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD). Women, more frequently than men, are known to develop atypical angina symptoms. The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men. Methods: We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or proven CAD who successively underwent both MSCT and invasive CAG. CAD was defined as any coronary stenosis of ≥50% on conventional invasive CAG, which was used as the reference standard. The patients were divided into typical and atypical groups based on their symptoms of angina pectoris. The diagnostic accuracy of MSCT, including its sensitivity, specificity, negative predictive value, and positive predictive value (PPV), was calculated to determine the usefulness of MSCT in assessing stenoses. The diagnostic performance of MSCT was also assessed by constructing receiver operating characteristic (ROC) curves. Results: The PPV (91% vs. 97%, χ2 = 5.705, P < 0.05) and diagnostic accuracy (87% vs. 93%, χ2 = 5.093, P < 0.05) of MSCT in detecting CAD were lower in women than in men. Atypical presentation was an independent influencing factor on the diagnostic accuracy of MSCT in women (odds ratio = 4.94, 95% confidence intervals: 1.16–20.92, Walds = 4.69, P < 0.05). Compared with those in the atypical group, women with typical angina pectoris had higher PPV (98% vs. 74%, χ2 = 17.283. P < 0.001), diagnostic accuracy (93% vs. 72%, χ2 = 9.571, P < 0.001), and area under the ROC curve (0.91 vs. 0.64, Z = 2.690, P < 0.01) in MSCT diagnosis. Conclusions: Although MSCT is a reliable diagnostic modality for the exclusion of significant coronary artery stenoses in all patients, gender and atypical symptoms might have some influence on its diagnostic accuracy.
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Affiliation(s)
- Wen-Ying Jin
- Department of Cardiology, Peking University People's Hospital; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing 100044, China
| | - Xiu-Juan Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Hong Chen
- Department of Cardiology, Peking University People's Hospital; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing 100044, China
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Computed Tomograph Cardiovascular Imaging. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bayturan O, Uno K, Lavoie A, Nicholls SJ. Future requirement for arterial wall imaging modalities in the evaluation of novel anti-atherosclerotic therapies. Curr Med Res Opin 2010; 26:753-7. [PMID: 20092390 DOI: 10.1185/03007990903547582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND While arterial wall imaging has been used to characterize progression of atherosclerosis, there remain limitations to this approach. SCOPE A selective overview of emerging modalities to image the artery wall and highlight how they may be used to evaluate emerging anti-atherosclerotic agents. FINDINGS Ongoing developments appear to enable assessment of composition and molecular properties of plaque in addition to quantitation of burden. Non-invasiveness and correlation with clinical outcome remains a challenge. CONCLUSION New developments in imaging should enhance the ability to provide early characterization of the potential therapeutic efficacy of experimental agents.
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Lazoura O, Vlychou M, Vassiou K, Rountas C, Ioannis F. 128-detector-row computed tomography coronary angiography evaluating coronary artery disease: who avoids cardiac catheterization? Angiology 2009; 61:174-8. [PMID: 19625270 DOI: 10.1177/0003319709335513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the prevalence of significant coronary artery disease (CAD) and nondiagnostic studies in patients referred for clinically indicated coronary angiography performed by 128 multidetector computed tomography (MDCT). METHODS We examined patients referred for coronary computed tomography (CT) angiography for the presence of CAD. The analysis included 438 studies classified as normal, with nonsignificant CAD, with significant CAD, or nondiagnostic. RESULTS Of the 438 cases evaluated, 121 (27.6%) cases were reported as normal, 184 (42%) were classified as nonsignificant CAD, 92 (21%) as significant CAD, and 41 (9.3%) were inconclusive. Therefore, 69.7% of the study population most probably did not require conventional coronary angiography. CONCLUSION Among patients referred for computed tomography angiography (CTA) for appropriate indications, 69.6% had either normal coronary arteries or nonobstructive disease. Given the high negative predictive value of coronary CTA, these patients most likely would not require invasive coronary angiography. Selective cardiac CTA may substantially decrease unnecessary diagnostic cardiac catheterizations.
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Affiliation(s)
- Olga Lazoura
- Department of Radiology, Medical School of Thessaly, Greece.
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Gopal A, Nasir K, Ahmadi N, Gul K, Tiano J, Flores M, Young E, Witteman AM, Holland TC, Flores F, Mao SS, Budoff MJ. Cardiac computed tomographic angiography in an outpatient setting: An analysis of clinical outcomes over a 40-month period. J Cardiovasc Comput Tomogr 2009; 3:90-5. [DOI: 10.1016/j.jcct.2009.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 01/12/2009] [Accepted: 01/26/2009] [Indexed: 01/07/2023]
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Gopal A, Budoff MJ. A new method to reduce radiation exposure during multi-row detector cardiac computed tomographic angiography. Int J Cardiol 2009; 132:435-6. [DOI: 10.1016/j.ijcard.2007.08.072] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Accepted: 08/04/2007] [Indexed: 11/30/2022]
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Overview of cardiac computed tomography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2008. [DOI: 10.1007/s12410-008-0013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Ostrom MP, Gopal A, Ahmadi N, Nasir K, Yang E, Kakadiaris I, Flores F, Mao SS, Budoff MJ. Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol 2008; 52:1335-43. [PMID: 18929245 DOI: 10.1016/j.jacc.2008.07.027] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/11/2008] [Accepted: 07/14/2008] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. BACKGROUND Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. METHODS In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 +/- 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (> or =50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC). RESULTS During a mean follow-up of 78 +/- 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD. CONCLUSIONS The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.
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Affiliation(s)
- Matthew P Ostrom
- Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
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Budoff MJ, Gopal A, Gul KM, Mao SS, Fischer H, Oudiz RJ. Prevalence of obstructive coronary artery disease in an outpatient cardiac CT angiography environment. Int J Cardiol 2008; 129:32-6. [PMID: 17651836 DOI: 10.1016/j.ijcard.2007.06.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Revised: 02/21/2007] [Accepted: 06/15/2007] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the prevalence of significant obstructive disease and non-diagnostic studies using coronary computed tomographic angiography (CTA) in an outpatient environment, to establish if CTA could help avoid unnecessary diagnostic cardiac catheterizations. METHODS We evaluated all cases consecutively performed in our outpatient CTA laboratory seen over one year with an indication that could warrant a cardiac catheterization to establish the presence or absence of coronary artery disease (CAD). Excluded were patients without established indications for cardiac catheterization and those with known CAD (i.e.- prior myocardial infarction, revascularization). Four hundred and ninety-three (493) CTA case studies were included for the analysis. Patients were classified as normal (no luminal irregularities seen), non-obstructive coronary disease (<50% stenosis), significant obstructive coronary disease (>50% stenosis), or a non-diagnostic study. We assumed that all patients assigned to the obstructive CAD group and the non-diagnostic study group would require a cardiac catheterization. In the remaining two groups, a cardiac catheterization would not be necessary for diagnosis or treatment. RESULTS Of the 493 index cases evaluated, 157 (32%) cases were reported to be normal, 204 patients were classified as having non-obstructive disease (41%), 93 patients were defined to have obstructive CAD (19%), and 39 cases were inconclusive (8%). Thus, in 27% of the study population, a conventional coronary angiography would be indicated to clarify the diagnosis or provide definitive disease severity for subsequent revascularization. CONCLUSION Among ambulatory patients referred for CT angiography with symptoms or positive (or equivocal) cardiac stress tests, 73% of patients were found to have either normal coronary arteries or non-obstructive disease. Given the high negative predictive power of cardiac CTA (93-99%), these patients most likely would not require subsequent invasive coronary angiography. A strategy of selective cardiac catheterization may substantially decrease unnecessary diagnostic cardiac catheterizations and reduce health care expenses.
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Affiliation(s)
- Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.
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Budoff MJ, Rasouli ML, Shavelle DM, Gopal A, Gul KM, Mao SS, Liu SH, McKay CR. Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI)-a comparison in detecting significant coronary artery disease. Acad Radiol 2007; 14:252-7. [PMID: 17307657 DOI: 10.1016/j.acra.2006.11.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 11/15/2006] [Accepted: 11/16/2006] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Endowed with sufficient diagnostic accuracy, electron beam computed tomography angiography (CTA) is being increasingly used to evaluate coronary arteries. However, data on direct comparisons with nuclear myocardial perfusion studies are limited. In this study, we sought to compare the accuracies of CTA and myocardial perfusion imaging (MPI) for identifying symptomatic patients with hemodynamically significant obstructive coronary artery disease (CAD). MATERIALS AND METHODS In a single-center study, symptomatic outpatients who were scheduled for cardiac catheterization were prospectively enrolled. Only patients with exertional angina or dyspnea were included. After fulfilling the inclusion criteria, 30 patients were enrolled in the study (mean age 54 +/- 9 years and 70% males). Patients underwent MPI, CTA including coronary artery calcification (CAC) measure, and invasive coronary angiography for evaluation of obstructive coronary artery disease. Significant CAD was defined as >50% left main artery stenosis or >70% stenosis of any other epicardial vessel by invasive angiography. The sensitivities, specificities and predictive values of MPI, CAC, and CTA were analyzed per patient RESULTS CTA demonstrated significant higher sensitivity than MPI (95% vs. 81%, P < .05). CTA demonstrated significantly higher specificity than both MPI (89% versus 78%, P = .04) and CAC (56%, P = .002). CTA also performed better in a per-vessel analysis (sensitivity 94%, specificity 96%) than both nuclear and CAC. There were no significant differences between the sensitivities and specificities of MPI and CAC. CONCLUSION CTA accurately detects obstructive CAD in symptomatic patients and may be more accurate than MPI or CAC assessment. Larger studies in a more diverse population are needed.
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Affiliation(s)
- Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 W. Carson Street, RB2, Torrance, CA 90502, USA.
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Budoff MJ, Ahmed V, Gul KM, Mao SS, Gopal A. Coronary anomalies by cardiac computed tomographic angiography. Clin Cardiol 2007; 29:489-93. [PMID: 17133845 PMCID: PMC6654267 DOI: 10.1002/clc.4960291104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early identification of an anomalous coronary anatomy is quite relevant because of the increased incidence of sudden cardiac death or related symptoms of myocardial ischemia in the patients. Invasive coronary angiography (ICA) is not only invasive, but expensive, and cannot always adequately provide the required information about the abnormal coronary anatomy. Cardiac computed tomographic angiography (CTA) is a robust noninvasive imaging modality that has several clinical applications and is now being used increasingly in practices across the nation. It not only provides high-resolution anatomical information of the coronary artery tree but also helps define other aspects of the cardiovascular anatomy, be it normal or abnormal. HYPOTHESIS This study sought to determine the clinical role played by CTA in the evaluation of different types of coronary arterial anomalies by reviewing CTA studies since 1997. METHODS We reviewed 6,089 case studies of contrast CTA conducted at our institution. There were 53 coronary anomalies in 39 patients (0.64%). RESULTS Computed tomographic angiography correctly identified the course of coronary arteries in all cases. CONCLUSION The results of this study support the use of CTA as a safe and effective noninvasive imaging modality for defining coronary arterial anomalies in an appropriate clinical setting, providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive angiography.
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Affiliation(s)
- Matthew J Budoff
- Division of Cardiology, Department of Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California 90502, USA.
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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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13
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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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Chau A, Gopal A, Mao S, Tseng PH, Fischer H, Budoff MJ. Comparison of Three Generations of Electron Beam Tomography on Image Noise and Reproducibility, a Phantom Study. Invest Radiol 2006; 41:522-6. [PMID: 16763471 DOI: 10.1097/01.rli.0000209664.29849.b7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The detection of coronary artery calcification (CAC) using the electron beam tomography (EBT) scanner provides a noninvasive indicator for coronary artery disease (CAD). Physicians interested in preventative medicine also are using this modality to track atherosclerosis over time. Two new iterations of the EBT scanner have been introduced. We sought to evaluate the image quality of each machine to examine whether patients scanned on a previous model would have similar image quality and results to those scanned on the newest scanner. METHODS This study used the C-150 XP, C300, and the e-Speed EBT scanners in high-resolution volume mode. A cork chest phantom was constructed for use as a human chest. A mixture of calcium phosphate, cornstarch and glue was placed inside the wells to simulate coronary calcium. The foci masses were 3, 5, 7, 10, 15, 20, 40, 60, 80, 100, and 200 mg (calcium mass), which provided the 55 foci of different masses and densities to simulate coronary calcium in the chest phantom. Each phantom was scanned multiple times, using both 1.5- and 3-mm slice thickness and table collimation settings with each scanner. RESULTS There were no statistical differences found between the 1.5-mm and 3.0-mm slice thickness calcium foci scores (Agatston & volumetric) for all 3 EBT scanners. The C-150 XP scanner had a variability of 6.01% between 1.5-mm and 3.0-mm slice thickness. Analysis by t test revealed that the mean noise value of C-150 XP was significantly higher than the C300, e-Speed (50 milliseconds), and e-Speed (100 milliseconds) with P values of 0.001, 0.025, and 0.001, respectively. Comparison of 1.5-mm versus 3.0-mm slice thickness noise value showed a significant difference only for the C-150 XP scanner (P < 0.05). CONCLUSIONS The use of the 3 EBT scanners in longitudinal studies of patients coronary calcium score is feasible to obtain similar calcium score values. The C-150 XP has the greatest noise effect in comparison to the C300 and e-Speed scanners. Improved image noise should improve reproducibility of the calcium measurement with these newer devices.
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Affiliation(s)
- Alex Chau
- Department of Medicine, Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, CA 90502, USA
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Budoff MJ, Shinbane JS, Child J, Carson S, Chau A, Liu SH, Mao S. Multiphase contrast medium injection for optimization of computed tomographic coronary angiography. Acad Radiol 2006; 13:159-65. [PMID: 16428050 DOI: 10.1016/j.acra.2005.09.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2005] [Revised: 09/13/2005] [Accepted: 09/21/2005] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVES Electron beam angiography is a minimally invasive imaging technique. Adequate vascular opacification throughout the study remains a critical issue for image quality. We hypothesized that vascular image opacification and uniformity of vascular enhancement between slices can be improved using multiphase contrast medium injection protocols. MATERIALS AND METHODS We enrolled 244 consecutive patients who were randomized to three different injection protocols: single-phase contrast medium injection (Group 1), dual-phase contrast medium injection with each phase at a different injection rate (Group 2), and a three-phase injection with two phases of contrast medium injection followed by a saline injection phase (Group 3). Parameters measured were aortic opacification based on Hounsfield units and uniformity of aortic enhancement at predetermined slices (locations from top [level 1] to base [level 60]). RESULTS In Group 1, contrast opacification differed across seven predetermined locations (scan levels: 1st versus 60th, P < .05), demonstrating significant nonuniformity. In Group 2, there was more uniform vascular enhancement, with no significant differences between the first 50 slices (P > .05). In Group 3, there was greater uniformity of vascular enhancement and higher mean Hounsfield units value across all 60 images, from the aortic root to the base of the heart (P < .05). CONCLUSIONS The three-phase injection protocol improved vascular opacification at the base of the heart, as well as uniformity of arterial enhancement throughout the study.
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Affiliation(s)
- Matthew Jay Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA.
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Gerber TC, Breen JF, Kuzo RS, Kantor B, Williamson EE, Safford RE, Morin RL. Computed Tomographic Angiography of the Coronary Arteries: Techniques and Applications. Semin Ultrasound CT MR 2006; 27:42-55. [PMID: 16562571 DOI: 10.1053/j.sult.2005.11.005] [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] [Indexed: 12/24/2022]
Abstract
Computed tomographic coronary angiography (CT-CA) is a direct but minimally invasive method of visualizing coronary arteries. Multidetector-row computed tomography (MDCT) is currently the CT modality most commonly used for coronary artery imaging. MDCT has been successfully used to detect stenoses in coronary arteries and coronary artery bypass grafts and to assess congenital coronary anomalies. Patients should not undergo CT-CA with MDCT if they have an irregular heart rhythm, a heart rate greater than 70 beats/min, and contraindications to pharmacologic agents for heart rate control, or if they have severe coronary artery disease or are likely to require revascularization.
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Affiliation(s)
- Thomas C Gerber
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA.
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Enzweiler CNH, Höhn S, Taupitz M, Lembcke AE, Wiese TH, Hamm B, Kivelitz DE. Contrast enhancement in electron beam tomography of the heart: comparison of a monomeric and a dimeric iodinated contrast agent in 59 patients. Acad Radiol 2006; 13:95-103. [PMID: 16399037 DOI: 10.1016/j.acra.2005.09.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 09/21/2005] [Accepted: 09/21/2005] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of the study is to determine whether intravascular time-density course and visualization of the coronary arteries differ with use of a hyperosmolar monomeric versus an iso-osmolar dimeric contrast agent in electron beam tomography (EBT) of the heart. MATERIALS AND METHODS Fifty-nine patients underwent EBT of the coronary arteries using the monomeric ioversol or the dimeric iodixanol at the same concentration of 320 mg I/mL. Contrast volume was determined relative to body surface area and injected over 40 seconds. Intravascular time-density curves were created for quantitative analysis. For qualitative assessment, visualization of coronary arteries on axial scans and three-dimensional reconstructions was scored. Patients were matched for contrast flow, transit time, and mean pulse rate for statistical analysis. RESULTS Ioversol produced a significantly greater increase in intravascular density for up to 30 seconds after injection (P < .01) compared with iodixanol. No difference between the two contrast media was seen in the qualitative assessment. CONCLUSION Monomeric and dimeric contrast media differ in their time-density curves at coronary EBT, a reason for which is not apparent. Qualitative evaluation of coronary arteries is not affected by this difference.
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Affiliation(s)
- Christian N H Enzweiler
- Institut für Radiologie, Universitätsmedizin Berlin, Charité Campus Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany.
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Mao S, Shinbane JS, Oudiz RJ, Flores F, Chau A, Liu S, Wang S, Gao Y, Budoff MJ. Detection of small vessels with electron beam computed tomographic angiography using 1.5 and 3 mm collimator protocols. Int J Cardiovasc Imaging 2005; 22:275-82. [PMID: 16041563 DOI: 10.1007/s10554-005-9002-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 05/26/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the effect of scanner collimation on the ability to detect small cardiac vessels using electron beam CT coronary angiography (EBA). MATERIALS AND METHODS EBA scans from 40 patients who underwent study on two separate occasions with 3 mm (initial scan) and 1.5 mm (follow-up scan) collimation protocols were analyzed. Vessels of <2 mm in diameter were identified. RESULTS The 1.5 mm collimation allowed 3-D visualization of 129 vessels<2 mm in diameter, while 3 mm collimation only allowed visualization of 89 vessels (p<0.001). The right coronary artery branches and distal LAD segments though were not displayed satisfactorily in almost half of the 3-D studies with either protocol. CONCLUSIONS There was significant improvement in detection of small cardiac vessels with a 1.5 mm collimation EBA protocol compared to a 3 mm protocol. Both protocols though were insufficient for reliable visualization of the right coronary artery branches and distal LAD segments.
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Affiliation(s)
- Songshou Mao
- Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, CA 90502, USA
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