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Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis. Eur Radiol 2016; 26:3781-3789. [PMID: 26863897 PMCID: PMC5052288 DOI: 10.1007/s00330-016-4229-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/18/2016] [Indexed: 02/08/2023]
Abstract
Objective To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization. Methods 160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8). Results 210 coronary segments were included (59 % positive). MLA of ≤1.8 mm2 was identified as the optimal cut-off (c = 0.97, p < 0.001; 95 % CI 0.94–0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm2 sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c = 0.92; p < 0.001; 95 % CI 0.88–95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95 % CI 0.84–93, c = 0.87; 95 % CI 0.82–92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c = 0.74 (95 % CI 0.67–81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84. Conclusions MLA ≤1.8 mm2 and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis. Key Points • Quantitative coronary CT-angiography is accurate for prediction of functional relevant stenosis. • Absolute lumen area and diameter rather than %stenosis predict functional relevance. • Lumen area <1.8 mm2and diameter <1.2 mm are the most accurate cut-offs. • Quantitative parameters are helpful for decision-making in terms of patient management.
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Kim JH, Heo SH, Nam HJ, Youn HC, Kim EJ, Lee JS, Kim YS, Kim HY, Koh SH, Chang DI. Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy. J Clin Neurol 2015; 11:364-71. [PMID: 26320844 PMCID: PMC4596101 DOI: 10.3988/jcn.2015.11.4.364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes. However, patient-level risks and predictors including coronary stenosis are rarely evaluated, especially in Asian patients. The aim of this study was to determine the relationship between the vascular risk factors underlying CEA, including coronary stenosis, and postoperative outcome. METHODS One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis. All patients underwent coronary computed tomography angiography before CEA. Data were analyzed to determine the vascular outcomes in patients with mild-to-moderate vs. severe coronary stenosis and high vs. standard operative risk, based on the criteria for high operative risk defined in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. The vascular outcome was defined as the occurrence of postoperative (≤30 days) stroke, myocardial infarction (MI), or death. RESULTS An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths. The vascular outcome differed significantly between the groups with mild-to-moderate and severe coronary stenosis (p=0.024), but not between the high- and standard-operative-risk groups (stratified according to operative risk as defined in the SAPPHIRE trial). Multivariable analysis adjusting for potent predictors revealed that severe coronary stenosis (odds ratio, 6.87; 95% confidence interval, 1.20-39.22) was a significant predictor of the early vascular outcome. CONCLUSIONS Severe coronary stenosis was identified herein as an independent predictor of an adverse early vascular outcome.
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Affiliation(s)
- Jung Hwa Kim
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Neurology, Seoul Bukbu Hospital, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea.
| | - Hyo Jung Nam
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyo Chul Youn
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Young Seo Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun Young Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Seong Ho Koh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Dae Il Chang
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea
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Umul M, Semerci B, Umul A, Ceylan N, Mammadov R, Turna B. Relationship between erectile dysfunction and silent coronary artery disease: detection with multidetector computed tomography coronary angiography. Urol Int 2013; 92:310-5. [PMID: 23920065 DOI: 10.1159/000351750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/22/2013] [Indexed: 11/19/2022]
Abstract
AIM Our aim was to determine the relationship between erectile dysfunction (ED) and silent coronary artery disease (CAD) by multidetector computed tomography (MDCT) coronary angiography. METHODS Thirty consecutive men with nonhormonal and nonpsychogenic ED and with no cardiac symptoms were evaluated. Medical history, physical examination and laboratory investigation were performed. The five-item brief form of the International Index of Erectile Function (IIEF-5) was performed for evaluation of ED. The Agatston score (AS) was determined from MDCT images under beta blockade to induce bradycardia. The MDCT coronary angiography findings were evaluated by two radiologists blinded to the clinical findings. Patients were classified into three categories (mild, moderate and severe ED) according to IIEF-5 scores and into five categories (very low, low, moderate, moderately high and high CAD risk) according to the AS. RESULTS Mean age was 58.3 ± 8.7 years (46-79). 6 patients had hypertriglyceridemia, 4 had hypercholesterolemia and 4 had hyperglycemia. All patients had normal early morning testosterone levels. Regarding IIEF-5 scores, none of them had mild ED, 14 had moderate ED and 16 had severe ED. Of the 14 patients with moderate ED, 21.4% had low and 28.5% had moderate CAD risk regarding AS. Of the 16 patients with severe ED, 25% had moderate, 31.2% had moderately high and 25% had high CAD risk regarding AS. Increasing age was a risk factor for high AS (p = 0.045). There was a significant correlation between AS and ED severity (p = 0.01). CONCLUSIONS ED and CAD often coexist. MDCT coronary angiography can detect coronary lesions and allow appropriate medical intervention.
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Affiliation(s)
- Mehmet Umul
- Department of Urology, Süleyman Demirel University School of Medicine, Isparta, Turkey
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Marano R, Savino G, Merlino B, Verrillo G, Silvestri V, Tricarico F, Meduri A, Natale L, Bonomo L. MDCT coronary angiography -- postprocessing, reading, and reporting: last but not least. Acta Radiol 2013; 54:249-58. [PMID: 23446750 DOI: 10.1258/ar.2012.120205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Significant literature on MDCT coronary angiography (MDCT-CA) has emerged in the last decade concerning patient's selection, technical aspects of different generations of CT equipment, ECG gating, contrast material and beta-blockade administration, acquisition parameters, and radiation dose. However, the literature regarding postprocessing, reading, and reporting is not so extensive. This review highlights the main elements of MDCT-CA data analysis, thereby allowing the radiologist to take full advantage of this technology and enable a structured report to be generated, promoting best practice with high-quality results.
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Affiliation(s)
- Riccardo Marano
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Giancarlo Savino
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Biagio Merlino
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Gemma Verrillo
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Valentina Silvestri
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Francesco Tricarico
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Agostino Meduri
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Luigi Natale
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University - “A. Gemelli” University Hospital, Rome, Italy
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Sheth T, Butler C, Chow B, Chan MTV, Mitha A, Nagele P, Tandon V, Stewart L, Graham M, Choi GYS, Kisten T, Woodard PK, Crean A, Abdul Aziz YF, Karthikeyan G, Chow CK, Szczeklik W, Markobrada M, Mastracci T, Devereaux PJ. The coronary CT angiography vision protocol: a prospective observational imaging cohort study in patients undergoing non-cardiac surgery. BMJ Open 2012; 2:bmjopen-2012-001474. [PMID: 22855630 PMCID: PMC3449273 DOI: 10.1136/bmjopen-2012-001474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION At present, physicians have a limited ability to predict major cardiovascular complications after non-cardiac surgery and little is known about the anatomy of coronary arteries associated with perioperative myocardial infarction. We have initiated the Coronary CT Angiography (CTA) VISION Study to (1) establish the predictive value of coronary CTA for perioperative myocardial infarction and death and (2) describe the coronary anatomy of patients that have a perioperative myocardial infarction. METHODS AND ANALYSIS The Coronary CTA VISION Study is prospective observational study. Preoperative coronary CTA will be performed in 1000-1500 patients with a history of vascular disease or at least three cardiovascular risk factors who are undergoing major elective non-cardiac surgery. Serial troponin will be measured 6-12 h after surgery and daily for the first 3 days after surgery. Major vascular outcomes at 30 days and 1 year after surgery will be independently adjudicated. ETHICS AND DISSEMINATION Coronary CTA results in a measurable radiation exposure that is similar to a nuclear perfusion scan (10-12 mSV). Treating physicians will be blinded to the CTA results until 30 days after surgery in order to provide the most unbiased assessment of its prognostic capabilities. The only exception will be the presence of a left main stenosis >50%. This approach is supported by best available current evidence that, excluding left main disease, prophylatic revascularisation prior to non-cardiac surgery does not improve outcomes. An external safety and monitoring committee is overseeing the study and will review outcome data at regular intervals. Publications describing the results of the study will be submitted to major peer-reviewed journals and presented at international medical conferences.
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Affiliation(s)
- Tej Sheth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Craig Butler
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin Chow
- Department of Medicine (Cardiology) and Radiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - M T V Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ayesha Mitha
- Departments of Radiology, Inokusi Hospital, Durban, South Africa
| | - Peter Nagele
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University, St. Louis, Washington, USA
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lori Stewart
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - G Y S Choi
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - T Kisten
- Department of Anesthesia, Inokusi Hospital, Durban, South Africa
| | - P K Woodard
- Division of Radiology, Washington University, St. Louis, Washington, USA
| | - Andrew Crean
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Y F Abdul Aziz
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia
| | - G Karthikeyan
- Division of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - C K Chow
- Department of Cardiology, Westmead Hospital & The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - W Szczeklik
- Department of Cardiology, Westmead Hospital & The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - M Markobrada
- Departments of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - T. Mastracci
- Division of General Internal Medicine, University of Western Ontario, London, Ontario, Canada
| | - P J Devereaux
- Endovascular and Vascular Surgery Department, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Quantification of coronary stenosis by dual source computed tomography in patients: A comparative study with intravascular ultrasound and invasive angiography. Eur J Radiol 2012; 81:83-8. [DOI: 10.1016/j.ejrad.2010.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 11/19/2010] [Accepted: 12/02/2010] [Indexed: 11/20/2022]
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Anders K, Ropers U, Kuettner A, Wechsel M, Daniel WG, Uder M, Achenbach S. Individually adapted, interactive multiplanar reformations vs. semi-automated coronary segmentation and curved planar reformations for stenosis detection in coronary computed tomography angiography. Eur J Radiol 2011; 80:89-95. [DOI: 10.1016/j.ejrad.2010.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/08/2010] [Indexed: 11/29/2022]
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Arbab-Zadeh A, Hoe J. Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography methods, caveats, and implications. JACC Cardiovasc Imaging 2011; 4:191-202. [PMID: 21329905 DOI: 10.1016/j.jcmg.2010.10.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 10/06/2010] [Accepted: 10/12/2010] [Indexed: 12/14/2022]
Abstract
Multidetector computed tomography (MDCT) is a rapidly evolving technology for performing noninvasive coronary angiography. Despite good sensitivity and specificity for detecting significant coronary artery disease in patients, disagreement on individual coronary arterial stenosis severity is common between MDCT and the current gold standard, conventional angiography. The reasons for such disagreement are numerous, but are at least partly inherent to MDCT's modest spatial and temporal resolution at present. Less well acknowledged, however, is the fact that MDCT and conventional angiography are fundamentally different technologies, rendering good agreement on the degree of lumen narrowing rather unrealistic, given both of their respective limitations. Discrepant stenosis assessment by MDCT and conventional angiography receives remarkable attention, whereas its significance for patient outcome is less certain. On the other hand, the ability to noninvasively assess coronary arterial plaque characteristics and composition in addition to lumen obstruction shows strong promise for improved risk assessment and may at last enable us to move beyond mere coronary stenosis assessment for the management of patients with coronary artery disease.
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Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
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10
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CT comparison of visual and computerised quantification of coronary stenosis according to plaque composition. Eur Radiol 2010; 21:712-21. [DOI: 10.1007/s00330-010-1970-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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Meerkin D, Marom H, Cohen-Biton O, Einav S. Three-dimensional vessel analyses provide more accurate length estimations than the gold standard QCA. J Interv Cardiol 2010; 23:152-9. [PMID: 20236215 DOI: 10.1111/j.1540-8183.2010.00533.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare lesion dimensions as determined by a three-dimensional quantitative coronary angiographic (QCA) system to that of a validated two-dimensional QCA system. BACKGROUND In an era of drug-eluting stents, device sizing has become an important clinical application of online QCA. The CardiOp-B system integrates two standard angiographic projections to provide a three-dimensional reconstruction of the arterial segment of interest. METHODS Phase 1 - 47 stenoses from consecutive coronary angiograms were assessed in two projections with both systems providing two data sets for the CMS-Medis system and a single data set for CardiOp-B. Phase 2--a perspex phantom with a known lesion length, was analyzed at increasing degrees of foreshortening with acceptance criteria set at 5% from the absolute value. RESULTS Phase 1 demonstrated an adequate correlation between the CardiOp-B and Medis systems when minimal luminal diameter was measured in the optimal view (1.32 +/- 0.47 mm vs 1.42 +/- 0.49 mm respectively; r = 0.82). A stronger correlation was noted when length was measured (25.27 +/- 10.76 mm and 21.32 +/- 8.08 mm, respectively; r = 0.95); however CardiOp-B provided a consistently longer length (P < 0.0001). On phantom length measurements the mean accuracy result for the CardiOp-B system was -1.3%. This compared favorably with the two-dimensional system where all measures performed at greater than 20 degrees of for shortening were beyond the 5% criteria from the known length. CONCLUSIONS Three-dimensional QCA provides accurate and precise vessel diameter assessments. Length assessments are consistently longer than two-dimensional measures and are significantly less affected by foreshortened projections.
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Affiliation(s)
- David Meerkin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Aldrovandi A, Cademartiri F, Menozzi A, Ugo F, Lina D, Maffei E, Palumbo A, Fusaro M, Crisi G, Ardissino D. Evaluation of coronary atherosclerosis by multislice computed tomography in patients with acute myocardial infarction and without significant coronary artery stenosis: a comparative study with quantitative coronary angiography. Circ Cardiovasc Imaging 2009; 1:205-11. [PMID: 19808544 DOI: 10.1161/circimaging.108.786962] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is known that 9% to 31% of women and 4% to 14% of men with acute myocardial infarction have normal coronary arteries or nonsignificant coronary disease at angiography. These patients represent a diagnostic and therapeutic challenge. Multislice computed tomography (CT) can noninvasively identify the presence of coronary plaques even in the absence of significant coronary artery stenosis. This study evaluated the role of 64-slice CT, in comparison with coronary angiography, in detecting and characterizing coronary atherosclerosis in patients with acute myocardial infarction without significant coronary artery stenosis. METHODS AND RESULTS Thirty consecutive patients with acute myocardial infarction but without significant coronary stenosis at coronary angiography underwent 64-slice CT. All coronary segments were quantitatively analyzed by means of coronary angiography (CA-QCA) and 64-slice CT (CT-QCA). Forty-seven (10.4%) of the 450 coronary segments were not evaluable by CT. The mean proximal reference diameters at CT-QCA and CA-QCA were, respectively, 2.88+/-0.75 mm and 2.65+/-0.9 mm; the overall correlation between CT-QCA and CA-QCA for quantification of reference diameter was r(s)=0.77; P<0.001. The mean percent stenosis was 14.4+/-8.0% at CT-QCA and 4.0+/-11.0% at CA-QCA and the correlation was r(s)=0.11; P=0.03. Overall CT-QCA showed the presence of 50 plaques, of which only 11 were detected by CA-QCA. CT-QCA identified 25 plaques in infarct-related coronary arteries. Positive remodeling was present in 38 of the 50 plaques (76%), with a higher prevalence in the coronary plaques not visualized by CA-QCA (82.1% versus 54.5%). CONCLUSIONS CT-QCA correlates well with CA-QCA in terms of coronary reference diameter analysis, but not stenosis quantification. Multislice CT can detect coronary atherosclerotic plaques in segments of nonstenotic coronary arteries that are underestimated by CA and may have an incremental diagnostic value for the diagnosis of acute myocardial infarction in patients without significant coronary stenosis at CA.
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Affiliation(s)
- Annachiara Aldrovandi
- Division of Cardiology, Department of Heart and Lung, Azienda Ospedaliero-Universitaria di Parma, Italy.
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Knollmann FD, Wieltsch A, Peters S, Mahlke A, Niederberger S, Kertesz T. Flat panel volume computed tomography of the coronary arteries. Acad Radiol 2009; 16:1251-62. [PMID: 19608434 DOI: 10.1016/j.acra.2009.05.015] [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] [Received: 01/01/2009] [Revised: 05/17/2009] [Accepted: 05/18/2009] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Multidetector-row computed tomography (MDCT) has evolved into a sensitive diagnostic tool for the noninvasive detection of coronary artery stenosis, but remains limited by spatial resolution. Flat panel volume computed tomography (fpVCT) offers a higher spatial resolution. In a postmortem investigation of autopsy specimens, the accuracies of fpVCT for measuring the severity of coronary artery stenosis and the size of atherosclerotic plaque components were determined. METHODS AND MATERIALS In 25 autopsy cases, hearts were isolated, the left anterior descending coronary arteries filled with contrast agent, and depicted with a prototype fpVCT unit with a slice thickness of 0.25 mm. Transections of the left anterior descending coronary arteries were reconstructed and compared with histopathologic sections using light microscopy. RESULTS FpVCT measurements of luminal stenosis (r = 0.81), total plaque area (r = 0.88), calcified plaque area (r = 0.92), noncalcified plaque area (r = 0.83), and lipid core size (r = 0.67; P < .02) correlated well with histopathology (P < .0001). The limits of agreement for measuring any plaque component were three times smaller than those reported for MDCT. CONCLUSIONS Postmortem coronary fpVCT provides an accurate and reproducible method for the quantitative assessment of both luminal stenosis and atherosclerotic plaque size. Because of its high spatial resolution, the method should be sufficiently accurate to reliably detect the lipid pools of vulnerable plaques.
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Affiliation(s)
- Friedrich D Knollmann
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
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Achenbach S. Stress computed tomography myocardial perfusion: steps, questions, and layers. J Am Coll Cardiol 2009; 54:1085-7. [PMID: 19744617 DOI: 10.1016/j.jacc.2009.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/05/2009] [Indexed: 12/01/2022]
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Dewey M, Zimmermann E, Deissenrieder F, Laule M, Dübel HP, Schlattmann P, Knebel F, Rutsch W, Hamm B. Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 2009; 120:867-75. [PMID: 19704093 DOI: 10.1161/circulationaha.109.859280] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Noninvasive coronary angiography with the use of multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value; however, the radiation exposure associated with this technique is rather high. We evaluated coronary angiography using whole-heart 320-row CT, which avoids exposure-intensive overscanning and overranging. METHODS AND RESULTS A total of 30 consecutive patients with suspected coronary artery disease referred for clinically indicated conventional coronary angiography (CCA) were included in this prospective intention-to-diagnose study. CT was performed with the use of up to 320 simultaneous detector rows before same-day CCA, which, together with quantitative analysis, served as the reference standard. The per-patient sensitivity and specificity for CT compared with CCA were 100% (95% confidence interval [CI], 72 to 100) and 94% (95% CI, 73 to 100), respectively. Per-vessel versus per-segment sensitivity and specificity were 89% (95% CI, 62 to 98) and 96% (95% CI, 90 to 99) versus 78% (95% CI, 56 to 91) and 98% (95% CI, 96 to 99), respectively. Interobserver agreement between the 2 readers was significantly better for CCA (97% of 121 coronary arteries) than for CT (90%; P=0.04). Percent diameter stenosis determined with the use of CT showed good correlation with CCA (P<0.001, R=0.81) without significant underestimation or overestimation (-3.1+/-24.4%; P=0.08). Intraindividual comparison of CT with CCA revealed a significantly smaller effective radiation dose (median, 4.2 versus 8.5 mSv; P<0.05) and amount of contrast agent required (median, 80 versus 111 mL; P<0.001) for 320-row CT. The majority of patients (87%) indicated that they would prefer CT over CCA for future diagnostic imaging (P<0.001). CONCLUSIONS CT with the use of emerging technology has the potential to significantly reduce the radiation dose and amount of contrast agent required compared with CCA while maintaining high diagnostic accuracy.
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Affiliation(s)
- Marc Dewey
- Charité, Medical School, Departments of Radiology, Humboldt Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
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Gouya H, Varenne O, Trinquart L, Touzé E, Vignaux O, Spaulding C, Mas JL, Sablayrolles JL. Coronary Artery Stenosis in High-risk Patients: 64–Section CT and Coronary Angiography—Prospective Study and Analysis of Discordance. Radiology 2009; 252:377-85. [DOI: 10.1148/radiol.2522081271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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HUSMANN L, GAEMPERLI O, VALENTA I, SCHEPIS T, SCHEFFEL H, STOLZMANN P, LESCHKA S, DESBIOLLES L, MARINCEK B, ALKADHI H, KAUFMANN PA. Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT. Br J Radiol 2009; 82:649-53. [DOI: 10.1259/bjr/40319502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Accuracy of Noninvasive Coronary Stenosis Quantification of Different Commercially Available Dedicated Software Packages. J Comput Assist Tomogr 2009; 33:505-12. [DOI: 10.1097/rct.0b013e3181888363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kristensen TS, Engstrøm T, Kelbæk H, von der Recke P, Nielsen MB, Kofoed KF. Correlation between coronary computed tomographic angiography and fractional flow reserve. Int J Cardiol 2009; 144:200-5. [PMID: 19427706 DOI: 10.1016/j.ijcard.2009.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 03/31/2009] [Accepted: 04/11/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established technique to determine the hemodynamic severity of a coronary artery lesion. The aim of this study was to compare CCTA with FFR. METHODS In 56 coronary artery stenoses (42 patients) we performed CCTA, quantitative coronary angiography and FFR. CCTA measurements included diameter stenosis (DS, %), area stenosis (AS, %), minimal lumen diameter (MLD, mm), minimal lumen area (MLA, mm(2)), lesion length (LL, mm), plaque volume (mm(3)) and burden (%). RESULTS FFR averaged 0.81±0.14, and 10 lesions had an abnormal FFR (<0.75). We found significant correlations between FFR and DS (r=-0.67, p<0.001), AS (r=-0.68, p<0.001), MLD (r=0.58, p<0.001), MLA (r=0.53, p<0.001), LL (r=-0.36, p=0.02), plaque volume (r=-0.36, p=0.02) and plaque burden (r=-0.59, p<0.001). By multivariate regression analysis AS and LL were the strongest determinants of an abnormal FFR. The optimal cut-off value for AS was >73% (sensitivity 90%, specificity 80%, negative predictive value 97%, and positive predictive value 50%) and for LL >10 mm (sensitivity 60% and specificity 49%). CONCLUSION This study demonstrates that quantitative CCTA is correlated to FFR. Using our CCTA criteria of abnormality, significant coronary artery stenoses can be ruled out with a high negative predictive value.
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Fei X, Du X, Bai M, Li Y, Li P, Wei L, Li K. An Objective Evaluation Method Designed for Pulsating Cardiac Phantom with 64-row MDCT. J Med Syst 2009; 34:349-55. [DOI: 10.1007/s10916-008-9247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Bastarrika G, Schoepf UJ. Evolving CT Applications in Ischemic Heart Disease. Semin Thorac Cardiovasc Surg 2008; 20:380-92. [DOI: 10.1053/j.semtcvs.2008.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2008] [Indexed: 11/11/2022]
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23
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Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: A systematic review. Int J Cardiol 2008; 130:386-404. [DOI: 10.1016/j.ijcard.2008.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 05/21/2008] [Accepted: 06/28/2008] [Indexed: 11/22/2022]
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The Malaysian consensus statement on utilisation of cardiac CT. Biomed Imaging Interv J 2008; 4:e41. [PMID: 21611020 PMCID: PMC3097749 DOI: 10.2349/biij.4.4.e41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 08/22/2008] [Indexed: 01/07/2023] Open
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Primak AN, Dong Y, Dzyubak OP, Jorgensen SM, McCollough CH, Ritman EL. A technical solution to avoid partial scan artifacts in cardiac MDCT. Med Phys 2008; 34:4726-37. [PMID: 18196800 DOI: 10.1118/1.2805476] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Quantitative evaluation of cardiac image data obtained using multidetector row computed tomography (CT) is compromised by partial scan reconstructions, which improve the temporal resolution but significantly increase image-to-image CT number variations for a fixed region of interest compared to full reconstruction images. The feasibility of a new approach to solve this problem is assessed. An anthropomorphic cardiac phantom and an anesthetized pig were scanned on a dual-source CT scanner using both full and partial scan acquisition modes under different conditions. Additional scans were conducted with the electrocardiogram (ECG) signal being in synchrony with the gantry rotation. In the animal study, a simple x-ray detector was used to generate a signal once per gantry rotation. This signal was then used to pace the pig's heart. Phantom studies demonstrated that partial scan artifacts are strongly dependent on the rotational symmetry of angular projections, which is determined by the object shape and composition and its position with respect to the isocenter. The degree of partial scan artifacts also depends on the location of the region of interest with respect to highly attenuating materials (bones, iodine, etc.) within the object. Single-source partial scan images (165 ms temporal resolution) were significantly less affected by partial scan artifacts compared to dual-source partial scan images (82 ms temporal resolution). When the ECG signal was in synchrony with the gantry rotation, the same cardiac phase always corresponded to the same positions of the x-ray tube(s) and, hence, the same scattering and beam hardening geometry. As a result, the range of image-to-image CT number variations for partial scan reconstruction images acquired in synchronized mode was decreased to that achieved using full reconstruction image data. The success of the new approach, which synchronizes the ECG signal with the position of the x-ray tube(s), was demonstrated both in the phantom and animal experiments.
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Affiliation(s)
- A N Primak
- CT Clinical Innovation Center, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Chang SA, Choi SI, Choi EK, Kim HK, Jung JW, Chun EJ, Kim KS, Cho YS, Chung WY, Youn TJ, Chae IH, Choi DJ, Chang HJ. Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. Am Heart J 2008; 156:375-83. [PMID: 18657674 DOI: 10.1016/j.ahj.2008.03.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 03/18/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established. METHODS We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS. RESULTS The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up. CONCLUSION Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.
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Affiliation(s)
- Sung-A Chang
- Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Dodd JD, Rieber J, Pomerantsev E, Chaithiraphan V, Achenbach S, Moreiras JM, Abbara S, Hoffmann U, Brady TJ, Cury RC. Quantification of Nonculprit Coronary Lesions: Comparison of Cardiac 64-MDCT and Invasive Coronary Angiography. AJR Am J Roentgenol 2008; 191:432-438. [DOI: 10.2214/ajr.07.3315] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jonathan D. Dodd
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Johannes Rieber
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Eugene Pomerantsev
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Vithaya Chaithiraphan
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stephan Achenbach
- Department of Medicine 2, University Hospital Erlangen, Erlangen, Germany
| | - Javier M. Moreiras
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Suhny Abbara
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Thomas J. Brady
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ricardo C. Cury
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman DS. Moving Beyond Binary Grading of Coronary Arterial Stenoses on Coronary Computed Tomographic Angiography. JACC Cardiovasc Imaging 2008; 1:460-71. [DOI: 10.1016/j.jcmg.2008.05.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 05/06/2008] [Accepted: 05/15/2008] [Indexed: 01/24/2023]
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Quantification of Coronary Artery Stenoses by Computed Tomography. JACC Cardiovasc Imaging 2008; 1:472-4. [DOI: 10.1016/j.jcmg.2008.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 05/16/2008] [Indexed: 11/23/2022]
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Accuracy of quantitative coronary angiography with computed tomography and its dependency on plaque composition. Int J Cardiovasc Imaging 2008; 24:895-904. [DOI: 10.1007/s10554-008-9327-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 06/04/2008] [Indexed: 11/30/2022]
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Schnapauff D, Zimmermann E, Dewey M. Technical and Clinical Aspects of Coronary Computed Tomography Angiography. Semin Ultrasound CT MR 2008; 29:167-75. [DOI: 10.1053/j.sult.2008.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Francone M, Carbone I, Napoli A, Algeri E, Grazhdani H, Lezoche R, Mirabelli F, Gaudio C, Calabrese FA, Catalano C, Passariello R. Imaging of myocardial infarction using a 64-slice MDCT scanner: correlation between infarcted region and status of territory-dependent coronary artery. Radiol Med 2007; 112:1100-16. [PMID: 18080098 DOI: 10.1007/s11547-007-0209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 04/26/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was performed to evaluate the ability of 64-slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territory-dependent coronary vessel status was examined. MATERIALS AND METHODS We retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. RESULTS After clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5+/-19 HU vs. 56.1+/-23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI. CONCLUSIONS The presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.
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Affiliation(s)
- M Francone
- Dipartimento di Scienze Radiologiche, Università degli Studi di Roma La Sapienza, Viale Regina Elena 324, Rome, Italy.
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Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol 2007; 18:576-83. [PMID: 17934740 DOI: 10.1007/s00330-007-0773-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/28/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE CT has undergone generational change that has led to true volume imaging. Interpretation of volume images requires interaction between the radiologist and the volume data sets. The aim of this review is to examine postprocessing options and the evidence in the literature for changing the process of reporting to digital volume reporting. CONCLUSION Diagnostic confidence and the accuracy of interpretation of volume CT images have increased with improvements in postprocessing techniques.
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Affiliation(s)
- Frank John Parrish
- Department of Radiology, MIA Victoria, 1355 High St., Malvern, Victoria 3144, Australia.
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Cury RC, Nieman K, Shapiro MD, Nasir K, Cury RC, Brady TJ. Comprehensive cardiac CT study: evaluation of coronary arteries, left ventricular function, and myocardial perfusion--is it possible? J Nucl Cardiol 2007; 14:229-43. [PMID: 17386386 DOI: 10.1016/j.nuclcard.2007.01.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With advances in multidetector computed tomography (MDCT) technology, the new generation of 64-slice MDCT scanners with submillimeter collimation and a faster gantry rotation allows imaging of the entire heart in a single breath-hold with excellent temporal and spatial resolution. This potentially permits a comprehensive assessment of coronary anatomy, left ventricular function, and myocardial perfusion. As will be seen in this review of the current literature regarding 16- and 64-slice MDCT, there is great promise for a comprehensive cardiac computed tomography (CT) study. The available data support the notion that CT coronary angiography may be an alternative to invasive coronary angiography in symptomatic patients with a low to intermediate likelihood of having coronary artery disease. By use of the same data acquired for CT coronary angiography, evaluation of global and regional left ventricular function and myocardial perfusion can be added to the MDCT evaluation without additional exposure to contrast medium or radiation and may provide a more conclusive cardiac workup in these patients. The potential applications and limitations of coronary stenosis detection, global and regional left ventricular function, and myocardial perfusion assessment by MDCT will be reviewed. The full potential of cardiac MDCT is just beginning to be realized.
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Affiliation(s)
- Ricardo C Cury
- Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
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Dewey M, Rutsch W, Schnapauff D, Teige F, Hamm B. Coronary Artery Stenosis Quantification Using Multislice Computed Tomography. Invest Radiol 2007; 42:78-84. [PMID: 17220725 DOI: 10.1097/01.rli.0000251569.01317.60] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Reliable noninvasive detection of stenoses with multislice computed tomography (MSCT) is feasible. This study's aim was to analyze the agreement, correlation, and reliability of MSCT with conventional coronary angiography as the reference standard for quantification of coronary artery stenoses. MATERIALS AND METHODS A total of 118 significant (at least 50%) coronary artery stenoses with a reference vessel diameter of at least 1.5 mm in 62 patients were analyzed by MSCT using 16 detector rows (Aquilion, Toshiba, Otawara, Japan), multisegment reconstruction, and voxel sizes of 0.35x0.35x0.5 mm. The degree of stenosis on MSCT and quantitative coronary angiography (QCA) was measured by correlating the difference between the reference vessel diameter (average of 2 measurements directly proximal and distal to the stenosis) and the stenotic vessel diameter to the reference vessel diameter. RESULTS Correlation between the percent diameter stenosis determined by MSCT (78.2+/-13.6%) and QCA (76.0+/-14.8%) was significant (P<0.001) but only moderately so (R=0.51). Bland-Altman analysis revealed no systematic under- or overestimation with MSCT but large limits of agreements (+/-27.6%). Also the limits of agreement for interobserver agreement (reliability) of MSCT data were considerably large (+/-24.8%). Among the 27 coronary artery stenoses with a reference diameter of at least 3.5 mm, there was improved correlation (R=0.80) and the limits of agreement between MSCT and QCA were significantly smaller (+/-17.3%, P<0.008). The agreement between MSCT and QCA was not significantly different for stenoses with no calcification or only calcium spots (+/-28.2%) as compared with those with moderate-or-severe calcifications (+/-27.3%; P=0.8). MSCT allowed correct classification of coronary stenoses into low-grade (below 75%) and high-grade stenoses (at least 75%), in 62% (73 of 118). CONCLUSIONS The accuracy and reliability of coronary artery stenosis quantification with MSCT using isotropic voxel sizes and multisegment reconstruction is still too low to recommend routine clinical application because of rather low agreement, correlation, and reliability. Despite these limitations, the current results demonstrate the potential of MSCT for reliable and accurate quantification of coronary artery stenoses in the near future provided that further improvements in spatial and temporal resolution will be achieved.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Berlin, Germany.
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Hoe JWM, Toh KH. A practical guide to reading CT coronary angiograms--how to avoid mistakes when assessing for coronary stenoses. Int J Cardiovasc Imaging 2006; 23:617-33. [PMID: 17186138 DOI: 10.1007/s10554-006-9173-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 09/29/2006] [Indexed: 01/02/2023]
Abstract
There are now many physicians, both radiologists and cardiologists who are reporting CT coronary angiography (CTCA) scans who may not be aware that there are many pitfalls present. For the inexperienced reader a significant stenosis in a coronary artery can be easily missed or a moderate stenosis overcalled as significant. Artifacts can also be misinterpreted as representing a significant lesion. It is important that the studies are correctly interpreted, especially as the reported high negative predictive value of CTCA scans is a major strength of this imaging technique. The learning curve of reading these scans is steep and access to conventional coronary catheterisation results is essential for feedback and to improve the readers results. We have developed some rules to aid beginners avoid some of the pitfalls that can occur as these studies are not as easy to read as they may appear initially.
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Affiliation(s)
- John W M Hoe
- Medi-Rad Associates Ltd, CT Centre, Mt Elizabeth Hospital, 3 Mt Elizabeth, Singapore 288185, Singapore.
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Primak AN, McCollough CH, Bruesewitz MR, Zhang J, Fletcher JG. Relationship between noise, dose, and pitch in cardiac multi-detector row CT. Radiographics 2006; 26:1785-94. [PMID: 17102050 DOI: 10.1148/rg.266065063] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In spiral computed tomography (CT), dose is always inversely proportional to pitch. However, the relationship between noise and pitch (and hence noise and dose) depends on the scanner type (single vs multi-detector row) and reconstruction mode (cardiac vs noncardiac). In single detector row spiral CT, noise is independent of pitch. Conversely, in noncardiac multi-detector row CT, noise depends on pitch because the spiral interpolation algorithm makes use of redundant data from different detector rows to decrease noise for pitch values less than 1 (and increase noise for pitch values > 1). However, in cardiac spiral CT, redundant data cannot be used because such data averaging would degrade the temporal resolution. Therefore, the behavior of noise versus pitch returns to the single detector row paradigm, with noise being independent of pitch. Consequently, since faster rotation times require lower pitch values in cardiac multi-detector row CT, dose is increased without a commensurate decrease in noise. Thus, the use of faster rotation times will improve temporal resolution, not alter noise, and increase dose. For a particular application, the higher dose resulting from faster rotation speeds should be justified by the clinical benefits of the improved temporal resolution.
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Affiliation(s)
- Andrew N Primak
- CT Clinical Innovation Center, Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Sirineni GKR, Kalra MK, Pottala K, Waldrop S, Syed M, Tigges S. Effect of Contrast Concentration, Tube Potential and Reconstruction Kernels on MDCT Evaluation of Coronary Stents: an in Vitro Study. Int J Cardiovasc Imaging 2006; 23:253-63. [PMID: 16821123 DOI: 10.1007/s10554-006-9107-6] [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] [Received: 01/25/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION To evaluate effect of different kVp, reconstruction kernels and contrast concentrations on stent luminal diameter measurements and luminal contrast attenuation values. METHODS Two metallic coronary stents (2.75 mm and 3.0 mm) were deployed in silicone tubes and tubes were filled with diluted iodinated contrast (1:20 dilution of Iohexol 350 mg% to achieve an attenuation value of 550 HU at 120 kVp). The tubes were scanned at 80, 100, 120 and 140 kVp. Each scan acquisition was reconstructed using B10f, B25f, B31f, B36f, B41f, B46f, B60f, and B80f kernels. Scans were repeated using 1:35 contrast dilution (350 HU at 120 kVp). Luminal diameter was measured at mid stent level for each stent, in datasets acquired at different kVp, contrast concentrations, and reconstruction kernels. Luminal attenuation values (HU) were measured at the mid stent level and at a distance of 1 cm from the stent entrance within the tube lumen. RESULTS kVp did not have a significant effect on the visualization of stent luminal diameter (P > 0.277). The change in kernel significantly affected the difference in luminal HU values at stent and non-stent levels (P < 0.001), with B46f showing the least difference in HU values. The lower contrast concentration (350 HU) showed substantially less artifactual stent stenosis compared to high contrast concentration (550 HU) (P < 0.001). There was excellent inter-observer agreement for stent luminal diameters and attenuation value measurements (r (2)=0.971, P < 0.001). CONCLUSIONS For lower spatial resolution kernels, 120 kVp or 140 kVp provides better estimate of stent lumen. Reconstruction kernels and contrast concentration (HU) have significant effect on visualization of in-stent luminal diameter and artifactual stenosis. In clinical practice, B46f kernel and lower contrast enhancement value ( approximately 350 HU) may be optimal for evaluating the stent lumen.
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