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Kadoya Y, Abtahi SS, Sritharan S, Omaygenc MO, Nehmeh A, Yam Y, Small GS, Chow BJW. The estimation of left ventricular function using prospective ECG-triggered coronary CT angiography. J Cardiovasc Comput Tomogr 2023; 17:429-435. [PMID: 37777389 DOI: 10.1016/j.jcct.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is vital for diagnosing coronary artery disease; however, prospective ECG-triggered acquisition, minimizing radiation exposure, limits left ventricular (LV) ejection fraction (EF) evaluation. We aimed to assess the feasibility and utility of LVEF100msec, a new index for estimating LV function using volumetric changes during 100 msec within systole. METHODS This retrospective study analyzed patients who underwent prospective ECG-triggered CCTA with systolic acquisition between January 2015 and June 2022. The LVEF100msec was calculated using the maximum and minimum LV volumes among the three phases (300, 350, and 400 msec post-QRS) and expressed as a percentage. Patients were classified into normal, mild-moderately reduced, or severely reduced LV function categories based on the reference test. The LVEF100msec was compared among groups, and the optimal cutoff value of LVEF100msec for predicting severe LV dysfunction was investigated. RESULTS The study included 271 patients (median age = 58 years, 52% male). LVEF was normal in 188 (69.4%), mild-moderately reduced in 57 (21.0%), and severely reduced in 26 (9.6%) patients. Median LVEF100msec value was 9.0 (6.7-12.6) for normal LV function, 4.7 (3.1-8.8) for mild-moderately reduced, and 2.9 (1.5-3.8) for severely reduced LV function. LVEF100msec values significantly differed among categories (p < 0.001). The optimal LVEF100msec cutoff for severe LV dysfunction was 4.3%, with an AUC of 0.924, sensitivity of 88%, and specificity of 89%. CONCLUSION The LVEF100msec may serve as a valuable indicator of severe LV dysfunction.
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Affiliation(s)
- Yoshito Kadoya
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Shahin Sean Abtahi
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Shankavi Sritharan
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Mehmet Onur Omaygenc
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Amal Nehmeh
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Yeung Yam
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Gary S Small
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Benjamin J W Chow
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada.
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Chaosuwannakit N, Makarawate P. Prevalence of intracardiac thrombi on cardiac computed tomography angiography: Outcome and impact on consequent management. Eur J Radiol Open 2021; 8:100330. [PMID: 33665232 PMCID: PMC7902280 DOI: 10.1016/j.ejro.2021.100330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Intracardiac thrombi are intermittently come across on cardiac computed tomography angiography (CCTA). This study aimed to examine the prevalence, outcome, and prognosis in patients with incidental found left-sided cardiac thrombi on CCTA. Material and Methods The Ethics Committee approved the present study of the Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. A retrospective review of CCTA was performed for incidental left-sided cardiac thrombi. Results A total of 1080 CCTAs were enrolled with the prevalence of incidental left-sided cardiac thrombi is 4.53%. Of the 49 patients with CCTA incidental left-sided cardiac thrombi, 16 had left atrial thrombi, and 33 had left ventricular thrombi. All thrombi were undetermined before the CCTA, and their identification subsequently generated anticoagulation treatment. In 10 patients, embolic complications happened, 4 of which were fatal. Patients with incidental detected left-sided intracardiac thrombi seen by CCTA had more embolic event than patients who did not discover left-sided intracardiac thrombi by CCTA (HR = 8.07; 95% CI 1.48-44.06; p = 0.016). Conclusions Incidental left-sided cardiac thrombi on CCTA guided to management adjustments and seemed to present substantial mortality and morbidity in the present study. Physicians who interpret CCTA should ensure a dedicated effort not to disregard these prospective pitfalls.
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Affiliation(s)
- Narumol Chaosuwannakit
- Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40000, Thailand
| | - Pattarapong Makarawate
- Cardiology Unit, Internal medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Coronary computed tomography angiography using 128-slice dual-source computed tomography in patients with severe calcification. Jpn J Radiol 2017; 35:432-439. [DOI: 10.1007/s11604-017-0650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
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Qi L, Tang LJ, Xu Y, Zhu XM, Zhang YD, Shi HB, Yu RB. The Diagnostic Performance of Coronary CT Angiography for the Assessment of Coronary Stenosis in Calcified Plaque. PLoS One 2016; 11:e0154852. [PMID: 27149622 PMCID: PMC4858195 DOI: 10.1371/journal.pone.0154852] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To prospectively evaluate the diagnostic performance of coronary CT angiography (CCTA) for the assessment of coronary stenosis in a calcified plaque, by using conventional coronary angiography (CAG) as a standard reference. Materials and Methods Eight hundred and ninety-four patients were known to have or have been suspicious of having coronary artery disease, underwent CCTA and conventional coronary angiography (CAG). All the images acquired were assessed. The calcified plaque in CCTA was classified into four types (I-IV) according to the ratio of calcified plaque volume to vessel circumference (RVTC). Overall diagnostic accuracy was made under receiver operating characteristic curve (AUC) analysis. CAG was used as the standard reference. Results A total of 12845 segments were evaluated in 894 patients, among which 4955 calcified plaques were detected on 3645(28.4%) segments by CCTA. The overall AUC, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.939, 97.8%, 90.1%, 71.2% and 99.4%, respectively. In type I-II calcification, CCTA had high diagnostic performance in AUC (type I: 0.983; type II: 0.976), sensitivity (96.7%; 98.1%), specificity (99.8%; 97.0%), PPV (95.7%; 90.1%), NPV (99.8%; 99.5%) and accuracy (99.6%; 97.3%). In type III-IV calcification, CCTA has high performance in sensitivity (type III: 97.6%; type IV: 97.9%) and NPV (98.3%; 98.7%), moderate performance in AUC (0.877; 0.829), while remarkable decrease in specificity (78.7%; 67.9%), PPV (71.0%; 56.2%) and accuracy (84.9%; 76.8%). Conclusion CCTA has highest accuracy in diagnosing the coronary artery stenosis of type I-II calcified plaques, but has a significant decrease in specificity, PPV and accuracy in type III-IV calcified plaque.
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Affiliation(s)
- Liang Qi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Li-Jun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao-Mei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- * E-mail: (HBS); (RBY)
| | - Rong-Bin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, PR China
- * E-mail: (HBS); (RBY)
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Selçuk T, Otçu H, Yüceler Z, Bilgili Ç, Bulakçı M, Savaş Y, Çelik Ö. Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality. Balkan Med J 2016; 33:283-93. [PMID: 27308072 DOI: 10.5152/balkanmedj.2016.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/01/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. AIMS In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. STUDY DESIGN Retrospective cross-sectional study. METHODS Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts- 4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. RESULTS Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. CONCLUSION CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates.
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Affiliation(s)
- Tuba Selçuk
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey; Department of Medical Imaging Techniques, İstanbul Gelişim University Vocational School of Health Services
| | - Hafize Otçu
- Department of Radiology, Halkalı Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zeyneb Yüceler
- Department of Radiology, Şereflikoçhisar Government Hospital, Ankara, Turkey
| | - Çiğdem Bilgili
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Mesut Bulakçı
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Yıldıray Savaş
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Halkalı Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Koplay M, Celik M, Avcı A, Erdogan H, Demir K, Sivri M, Nayman A. Comparison Between Prospectively Electrocardiogram-Gated High-Pitch Mode and Retrospectively Electrocardiogram-Gated Mode for Dual-Source CT Coronary Angiography. Pol J Radiol 2015; 80:561-8. [PMID: 26767072 PMCID: PMC4699622 DOI: 10.12659/pjr.895232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/04/2015] [Indexed: 01/01/2023] Open
Abstract
Background We aimed to report the image quality, relationship between heart rate and image quality, amount of contrast agent given to the patients and radiation doses in coronary CT angiography (CTA) obtained by using high-pitch prospectively ECG-gated “Flash Spiral” technique (method A) or retrospectively ECG-gated technique (method B) using 128×2-slice dual-source CT. Material/Methods A total of 110 patients who were evaluated with method A and method B technique with a 128×2-detector dual-source CT device were included in the study. Patients were divided into three groups based on their heart rates during the procedure, and a relationship between heart rate and image quality were evaluated. The relationship between heart rate, gender and radiation dose received by the patients was compared. Results A total of 1760 segments were evaluated in terms of image quality. Comparison of the relationship between heart rate and image quality revealed a significant difference between heart rate <60 beats/min group and >75 beats/min group whereas <60 beats/min and 60–75 beats/min groups did not differ significantly. The average effective dose for coronary CTA was calculated as 1.11 mSv (0.47–2.01 mSv) for method A and 8.22 mSv (2.19–12.88 mSv) for method B. Conclusions Method A provided high quality images with doses as low as <1 mSv in selected patients who have low heart rates with a high negative predictive value to rule out coronary artery disease. Although method B increases the amount of effective dose, it provides high diagnostic quality images for patients who have a high heart rate and arrhythmia which makes it is difficult to obtain images.
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Affiliation(s)
- Mustafa Koplay
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Mahmut Celik
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Ahmet Avcı
- Department of Cardiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Hasan Erdogan
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Kenan Demir
- Department of Cardiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Mesut Sivri
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Alaaddin Nayman
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
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Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenoses. Diagn Interv Imaging 2015; 97:461-9. [PMID: 26612669 DOI: 10.1016/j.diii.2015.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE "Flash Spiral" imaging is a new prospective ECG-triggered spiral scan mode that uses a very high-pitch for coronary computed tomography angiography (CTA). This enables complete image acquisition within one cardiac cycle with a very low radiation exposure. The aim of this study was to investigate the diagnostic accuracy, image quality, and effective radiation dose of prospectively ECG-triggered high-pitch spiral method (Flash spiral mode) of coronary CTA using dual-source technology for the evaluation of coronary artery stenoses. MATERIAL AND METHODS The study included 186 consecutive patients (115men, 71women; mean age: 53.37 years) who underwent coronary CTA. Coronary CTA was performed with a 128×2-slice dual-source CT (Somatom Definition Flash, Siemens, Germany) using a prospectively ECG-triggered high-pitch spiral mode. Patients were divided into three groups according to heart rate (≤65bpm, 66-75bpm, ≥76bpm) and body mass index (BMI) (20-24kg/m(2), 25-29kg/m(2), 30-34kg/m(2)) values. The correlation between heart rates, image quality and BMI values are investigated. A four-point scale (1=excellent, 4=poor/non-diagnostic) was used to rank the comparative image quality. Effective radiation doses were calculated. Also the correlation between radiation dose, sex and BMI values were investigated. In addition, diagnostic accuracy of CTA for detection of significant (≥50%) coronary artery stenoses was compared with invasive coronary angiography findings of 612vessel segments in 38patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were calculated. RESULTS A total of 2976coronary artery segments were present. Of all coronary artery segments, 2381 (80%) had an image quality score of 1, and 1.5% segments were rated as "poor/non-diagnostic". When the correlation between heart rate and image quality is investigated, there was a significant difference between ≤65bpm and ≥76bpm groups. However, there was no significant difference between ≤65bpm and 66-75bpm groups. The mean effective dose was found as 1.3mSv (min: 0.5, max: 2.4mSv). The correlation between effective radiation dose and BMI was moderate. However, the correlation between gender and radiation dose was significant. Sensitivity, specificity, negative predictive value and accuracy of coronary CTA on a per-vessel segment were 90.1%, 97.4%, 98.6%, and 96.5%, respectively. CONCLUSIONS Prospectively ECG-triggered high-pitch spiral mode coronary CTA provides high image quality and diagnostic accuracy, with very low radiation dose for evaluation and exclusion of coronary artery stenoses.
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Zhang JL, Liu BL, Zhao YM, Liang HW, Wang GK, Wan Y, Huang YH, Shen BZ. Combining Coronary with Carotid and Cerebrovascular Angiography Using Prospective ECG Gating and Iterative Reconstruction with 256-slice CT. Echocardiography 2014; 32:1291-8. [PMID: 25371093 DOI: 10.1111/echo.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin-Ling Zhang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Bai-Lu Liu
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Yan-Ming Zhao
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Hong-Wei Liang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Guo-Kun Wang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Yong Wan
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Ya-Hua Huang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Bao-Zhong Shen
- Department of Radiology; The Fourth Affiliated Hospital of Harbin Medical University; Key Laboratory of Molecular Imaging in College of Heilongjiang Province; Harbin China
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Jiang B, Wang J, Lv X, Cai W. Dual-source CT versus single-source 64-section CT angiography for coronary artery disease: A meta-analysis. Clin Radiol 2014; 69:861-9. [PMID: 24854029 DOI: 10.1016/j.crad.2014.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 01/14/2023]
Abstract
AIM To perform a meta-analysis to compare the diagnostic performance of single-source 64-section computed tomography (CT) versus dual-source CT angiography for diagnosis of coronary artery disease (CAD). MATERIALS AND METHODS The Cochrane Library, MEDLINE, and EMBASE were searched for relevant original papers. Inclusion criteria were (1) significant CAD defined as ≥50% reduction in luminal diameter by invasive coronary angiography as reference standard; (2) single-source 64-section CT or dual-source CT was used; (3) results were reported in absolute numbers of true-positive, false-positive, true-negative, and false-negative results or sufficiently detailed data for deriving these numbers were presented. A random-effects model was used for the meta-analysis. RESULTS Fifty-one papers including 3966 patients who underwent single-source 64-section CT and 2047 patients who underwent dual-source CT at a per-patient level were pooled. The diagnostic values of single-source 64-section CT versus dual-source CT were 97% versus 97% for sensitivity (p = 0.386), 78% versus 86% for specificity (p < 0.001), 90% versus 85% for positive predictive value (PPV; p < 0.001), 93% versus 97% for negative predictive value (NPV; p = 0.001), 6.8 versus 6.5 for positive likelihood ratio (p = 0.018), 0.04 versus 0.04 for negative likelihood ratio (p = 0.625), and 191.59 versus 207.37 for diagnostic odds ratio (p = 0.043), respectively. CONCLUSION Dual-source CT and single-source 64-section CT have similar negative likelihood ratios and, therefore, there was no significant difference in their utility to rule out CAD in intermediate-risk patients. However, compared to single-source 64-section CT, dual-source CT has significantly higher specificity, so that CT-based decisions for subsequent coronary catheter angiography are more accurate.
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Affiliation(s)
- B Jiang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - J Wang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China.
| | - X Lv
- Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - W Cai
- Department of Cardiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
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Multicenter Evaluation Of Coronary Dual-Source CT angiography in patients with intermediate Risk of Coronary Artery Stenoses (MEDIC): study design and rationale. J Cardiovasc Comput Tomogr 2014; 8:183-8. [PMID: 24939066 DOI: 10.1016/j.jcct.2014.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The diagnostic performance of multidetector row CT to detect coronary artery stenosis has been evaluated in numerous single-center studies, with only limited data from large cohorts with low-to-intermediate likelihood of coronary disease and in multicenter trials. The Multicenter Evaluation of Coronary Dual-Source CT Angiography in Patients with Intermediate Risk of Coronary Artery Stenoses (MEDIC) trial determines the accuracy of dual-source CT (DSCT) to identify persons with at least 1 coronary artery stenosis among patients with low-to-intermediate pretest likelihood of disease. METHODS The MEDIC trial was designed as a prospective, multicenter, international trial to evaluate the diagnostic performance of DSCT for the detection of coronary artery stenosis compared with invasive coronary angiography. The study includes 8 sites in Germany, India, Mexico, the United States, and Denmark. The study population comprises patients referred for a diagnostic coronary angiogram because of suspected coronary artery disease with an intermediate pretest likelihood as determined by sex, age, and symptoms. All evaluations are performed by blinded core laboratory readers. RESULTS The primary outcome of the MEDIC trial is the accuracy of DSCT to identify the presence of coronary artery stenoses with a luminal diameter narrowing of 50% or more on a per-vessel basis. Secondary outcome parameters include per-patient and per-segment diagnostic accuracy for 50% stenoses and accuracy to identify stenoses of 70% or more. Furthermore, secondary outcome parameters include the influence of heart rate, Agatston score, body weight, body mass index, image quality, and diagnostic confidence on the accuracy to detect coronary artery stenoses >50% on a per-vessel basis. CONCLUSION The results of the MEDIC trial will assess the clinical utility of coronary CT angiography in the evaluation of patients with intermediate pretest likelihood of coronary artery disease.
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Li M, Zhang GM, Zhao JS, Jiang ZW, Peng ZH, Jin ZT, Sun G. Diagnostic performance of dual-source CT coronary angiography with and without heart rate control: systematic review and meta-analysis. Clin Radiol 2013; 69:163-71. [PMID: 24268513 DOI: 10.1016/j.crad.2013.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography with and without the application of a β-blocker. MATERIALS AND METHODS An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize diagnostic test data. RESULTS The pooled sensitivity at the patient level was 0.98 [95% confidence intervals (CI): 0.97-0.99], and specificity 0.88 (95% CI: 0.84-0.91). The results showed that without heart rate control, the sensitivity and specificity at the patient level did not decrease (p = 0.27 and 0.56, respectively). At the artery level, no significant differences in sensitivity and specificity for studies with and without heart rate control were detected (p = 0.04 and 0.05, respectively). At the segment level, the specificity decreased without heart rate control (p = 0.03), whereas the sensitivity was not influenced (p = 0.63). The median radiation exposure was 2.6 mSv, with 1.6 mSv and 8 mSv for heart rate-controlled studies and uncontrolled studies, respectively. CONCLUSIONS DSCT coronary angiography without heart rate control has a similar excellent diagnostic performance at the patient level as that of heart rate control groups. However, controlling for heart rate to decrease radiation and to provide effective information for selecting the therapeutic strategy and risk stratification is recommended.
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Affiliation(s)
- M Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - G-M Zhang
- Department of Medical Cardiology, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - J-S Zhao
- Department of Radiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong Province, China
| | - Z-W Jiang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Z-H Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Z-T Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - G Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
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Srichai MB, Chandarana H, Donnino R, Lim IIP, Leidecker C, Babb J, Jacobs JE. Diagnostic accuracy of cardiac computed tomography angiography for myocardial infarction. World J Radiol 2013; 5:295-303. [PMID: 24003355 PMCID: PMC3758497 DOI: 10.4329/wjr.v5.i8.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/13/2013] [Accepted: 07/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate diagnostic accuracy of high, low and mixed voltage dual energy computed tomography (DECT) for detection of prior myocardial infarction (MI).
METHODS: Twenty-four consecutive patients (88% male, mean age 65 ± 11 years old) with clinically documented prior MI (> 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI. Computed tomography (CT) examinations were performed using a dual source CT system (64-slice Definition or 128-slice Definition FLASH, Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions. Using the 17-segment model, regional systolic function was analyzed using first pass CT as normal or abnormal (hypokinetic, akinetic, dyskinetic). Regions with abnormal systolic function were identified as infarct segments. Late phase DE scans were reconstructed into: 140 kVp, 100 kVp, mixed (120 kVp) images and iodine-only datasets. Using the same 17-segment model, each dataset was evaluated for possible (grade 2) or definite (grade 3) late phase myocardial enhancement abnormalities. Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.
RESULTS: All patients reported prior history of documented myocardial infarction, with most occurring more than 5 years prior (n = 18; 75% of cohort). Fifty-five of 408 (13%) segments demonstrated abnormal wall motion and were classified as infarct. The remaining 353 segments were classified as non-infarcted segments. A total of 1692 segments were analyzed for late phase enhancement abnormalities, with 91 (5.5%) segments not interpretable due to artifact. Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated. Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy (87%; 95%CI: 80%-90%), sensitivity (86%-93%; 95%CI: 54%-78%) and specificity (90%; 95%CI: 86%-93%) compared to the other reconstructions. For sensitivity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.0005), 100 kVp vs mixed (P < 0.0001), and 100 kVp vs iodine only (P < 0.005) using combined grade 2 and grade 3 perfusion abnormalities. For specificity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.005), and 100 kVp vs mixed (P < 0.01) using combined grades 2 and 3 perfusion abnormalities.
CONCLUSION: Low voltage acquisition CT, 100 kVp in this study, demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.
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Influence of observer experience and training on proficiency in coronary CT angiography interpretation. Eur J Radiol 2013; 82:1240-7. [DOI: 10.1016/j.ejrad.2013.02.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 01/25/2023]
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64-slice multidetector-row computed tomography in the diagnosis of coronary artery disease: interobserver agreement among radiologists with varied levels of experience on a per-patient and per-segment basis. J Thorac Imaging 2012; 27:29-35. [PMID: 21102356 DOI: 10.1097/rti.0b013e3181f82805] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the interobserver variability of 4 radiologists with different levels of experience in the evaluation of 64-slice coronary computed tomographic angiography (cCTA). MATERIALS AND METHODS Two board-certified radiologists with 10 and 8 years of experience in reading cCTA and 2 radiology residents, 1 with 3 years of experience in reading cCTA and 1 with experience in reading general computed tomographic scans but without dedicated cCTA training, participated in the study. All the observers independently analyzed 50 cCTA studies for signs of coronary artery disease (stenosis of 0%, ≤49%, 50% to 74%, 75% to 99%, or 100%). Diagnostic accuracy of the 4 readers for stenosis detection on cCTA was compared with that of conventional angiography on a per-segment and per-patient basis. No patients, vessels, or segments were excluded from analysis. RESULTS On a per-segment basis, correlation between cCTA and invasive coronary angiography was good for readers with more than 10 (r=0.75), more than 8 (r=0.75), and more than 3 (r=0.73) years of cCTA experience. The correlation coefficient was poor (r=0.39) for the untrained reader. Sensitivity was not significantly (P=0.56) different between observers with more than 8 and more than 10 years of experience but was significantly (P>0.05) lower for the reader with less than 3 years experience and for the untrained reader. However, we found no significant difference in overall diagnostic accuracy on a per-patient (P=0.86) and on a per-segment level (P=0.72) among the 4 readers. CONCLUSION The level of experience significantly influences the sensitivity of coronary artery stenosis detection at cCTA, and thus highlights the need for dedicated training in cCTA interpretation.
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Takakuwa KM, Keith SW, Estepa AT, Shofer FS. A meta-analysis of 64-section coronary CT angiography findings for predicting 30-day major adverse cardiac events in patients presenting with symptoms suggestive of acute coronary syndrome. Acad Radiol 2011; 18:1522-8. [PMID: 22055795 DOI: 10.1016/j.acra.2011.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 08/15/2011] [Accepted: 09/11/2011] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the accuracy of 64-section coronary computed tomography angiography (CCTA) in predicting 30 day major adverse cardiac events (MACE) for patients presenting with symptoms concerning for acute coronary syndrome (ACS). MATERIALS AND METHODS Electronic databases between January 1, 2005, and May, 1, 2011, and reference lists from relevant published research articles were searched. We included studies on adult patients who presented with active symptoms suggestive of ACS, had immediate 64-section CCTA performed and were assessed for MACE at a minimum of 30 days past their initial presentation. Studies had to report or provide sufficient detail to determine sensitivity, specificity, positive predictive value, and negative predictive value in relation to MACE using a 50% diameter stenosis as cutoff criterion for coronary artery disease. RESULTS Nine studies were included for a total of 1559 patients studied (42.3% women, mean age 51.9 ± 10.6). Patients ranged from low to intermediate risk for ACS. All had initial inconclusive electrocardiograms and negative cardiac biomarker results. A total of 14.8% of patients had a positive CCTA result. The pooled sensitivity was 93.3% (95% CI 88.3%-96.6%), specificity was 89.9% (95% CI 88.3%-91.3%), positive predictive value was 48.1% (95% CI 42.5%-53.8%), and negative predictive value was 99.3% (95% CI 98.7%-99.6%). CONCLUSION Sixty-four section CCTA had a 99.3% negative predictive value in excluding MACE for 30 days after initial symptom presentation in 85.2% of our study population. Although the value of 64-section CCTA is best for identifying patients who can safely be discharged home, it is less useful for patients who have positive results.
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Affiliation(s)
- Kevin M Takakuwa
- Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19107, USA.
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Salavati A, Radmanesh F, Heidari K, Dwamena BA, Kelly AM, Cronin P. Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2011; 6:78-90. [PMID: 22226727 DOI: 10.1016/j.jcct.2011.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/22/2011] [Accepted: 10/20/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Development of an accurate test for noninvasive assessment of coronary arteries has been highly desirable. OBJECTIVES We performed a systematic review of diagnostic accuracy of the dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD). METHODS Eight medical databases were searched for articles published from January 2005 through March 2011. Studies compared DSCT coronary angiography (DSCT-CA) and invasive coronary angiography, as the reference standard, in consecutive patients with suspected or known CAD, and relevant data were extracted by 2 independent reviewers. Summary diagnostic accuracies were calculated, and the effect of covariates on the diagnostic performance was evaluated by meta-regression. RESULTS Twenty-five studies were included. In per-patient analysis (n = 2303), pooled sensitivity was 99% [95% confidence interval (CI), 97%-99%] with specificity of 89% (95% CI, 84%-92%). The summary positive (+LR) and negative (-LR) likelihood ratios were 8.6 (95% CI, 6.4-11.6) and 0.02 (95% CI, 0.01-0.03), respectively. In per-segment analysis (n = 32,615), pooled sensitivity was 94% (95% CI, 92%-96%) with specificity of 97% (95% CI, 96%--98%). Summary +LR and -LR were 30.2 (95% CI, 22.1-43.5) and 0.06 (95% CI, 0.04-0.08), respectively. CONCLUSIONS DSCT-CA seems to be robust to elevate heart rates while maintaining a high level of diagnostic performance.
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Affiliation(s)
- Ali Salavati
- Department of Nuclear Medicine, Center for PET/CT, Zentralklinik Bad Berka, Bad Berka 99437, Germany.
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Weustink AC, de Feyter PJ. The role of multi-slice computed tomography in stable angina management: a current perspective. Neth Heart J 2011; 19:336-43. [PMID: 21792743 PMCID: PMC3144326 DOI: 10.1007/s12471-011-0096-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Contrast-enhanced CT coronary angiography (CTCA) has evolved as a reliable alternative imaging modality technique and may be the preferred initial diagnostic test in patients with stable angina with intermediate pre-test probability of CAD. However, because CTCA is moderately predictive for indicating the functional significance of a lesion, the combination of anatomic and functional imaging will become increasingly important. The technology will continue to improve with better spatial and temporal resolution at low radiation exposure, and CTCA may eventually replace invasive coronary angiography. The establishment of the precise role of CTCA in the diagnosis and management of patients with stable angina requires high-quality randomised study designs with clinical outcomes as a primary outcome.
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Affiliation(s)
- A C Weustink
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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May MS, Deak P, Kuettner A, Lell MM, Wuest W, Scharf M, Keller AK, Häberle L, Achenbach S, Seltmann M, Uder M, Kalender WA. Radiation dose considerations by intra-individual Monte Carlo simulations in dual source spiral coronary computed tomography angiography with electrocardiogram-triggered tube current modulation and adaptive pitch. Eur Radiol 2011; 22:569-78. [PMID: 21984448 DOI: 10.1007/s00330-011-2300-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate radiation dose levels in patients undergoing spiral coronary computed tomography angiography (CTA) on a dual-source system in clinical routine. METHODS Coronary CTA was performed for 56 patients with electrocardiogram-triggered tube current modulation (TCM) and heart-rate (HR) dependent pitch adaptation. Individual Monte Carlo (MC) simulations were performed for dose assessment. Retrospective simulations with constant tube current (CTC) served as reference. Lung tissue was segmented and used for organ and effective dose (ED) calculation. RESULTS Estimates for mean relative ED was 7.1 ± 2.1 mSv/100 mAs for TCM and 12.5 ± 5.3 mSv/100 mAs for CTC (P < 0.001). Relative dose reduction at low HR (≤60 bpm) was highest (49 ± 5%) compared to intermediate (60-70 bpm, 33 ± 12%) and high HR (>70 bpm, 29 ± 12%). However lowest ED is achieved at high HR (5.2 ± 1.5 mSv/100 mAs), compared with intermediate (6.7 ± 1.6 mSv/100 mAs) and low (8.3 ± 2.1 mSv/100 mAs) HR when automated pitch adaptation is applied. CONCLUSIONS Radiation dose savings up to 52% are achievable by TCM at low and regular HR. However lowest ED is attained at high HR by pitch adaptation despite inferior radiation dose reduction by TCM. KEY POINTS • Monte Carlo simulations allow for individual radiation dose calculations. • ECG-triggered tube current modulation (TCM) can effectively reduce radiation dose. • Slow and regular heart rates allow for highest dose reductions by TCM. • Adaptive pitch accounts for lowest radiation dose at high heart rates. • Women receive higher effective dose than men undergoing spiral coronary CT-angiography.
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Affiliation(s)
- Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
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Kerl JM, Deseive S, Tandi C, Kaiser C, Kettner M, Korkusuz H, Lehmann R, Herzog C, Schoepf UJ, Vogl TJ, Bauer RW. Dual energy CT for the assessment of reperfused chronic infarction - a feasibility study in a porcine model. Acta Radiol 2011; 52:834-9. [PMID: 21873508 DOI: 10.1258/ar.2011.100315] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Detection of myocardial infarction has been the focus of considerable research over the past few decades. Recently developed dual source computed tomography (DSCT) scanners with dual energy mode have been used to detect myocardial infarction, but the studies on this topic are few. PURPOSE To evaluate the feasibility and performance of dual energy CT (DECT) during arterial phase in coronary CT angiography for the detection of chronic infarction compared with late enhancement MRI (LE-MRI) and histopathology in a porcine model of reperfused myocardial infarction. MATERIAL AND METHODS Myocardial infarctions were induced by 30 min occlusion of the proximal left anterior descending coronary artery in eight minipigs. DECT, post-contrast LE-MRI and histopathology were performed 60 days after infarct induction. The CT scan was performed in dual energy mode using a dedicated protocol. Myocardial iodine distribution was superimposed as color maps on grey scale multiplanar reformats of the heart. Two radiologists in consensus interpreted all imaging studies for presence of gadolinium uptake at LE-MRI reduced iodine content at DECT and hypoenhanced areas in the initial 100 kV coronary CT angiography images that were acquired during the DECT-acquisition. Results were compared with histopathology. RESULTS Based on evaluable segments, DECT showed a sensitivity and specificity of 0.72 and 0.88; LE-MRI showed a sensitivity and specificity of 0.78 and 0.92; and the 100 kV data-set of the DECT scan showed a sensitivity and specificity of 0.60 and 0.93, respectively, for the detection of histological proved ischemia. CONCLUSION DECT during arterial phase coronary CT angiography, which is ordinarily used for coronary artery evaluation, is feasible for the detection of a chronic reperfused myocardial infarction.
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Affiliation(s)
- J Matthias Kerl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Simon Deseive
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Christa Tandi
- Department of Animal Research, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Christina Kaiser
- Department of Forensic Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Mattias Kettner
- Department of Forensic Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Huedayi Korkusuz
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ralf Lehmann
- Department of Cardiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Christopher Herzog
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - U Joseph Schoepf
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Accuracy of dual-source CT to identify significant coronary artery disease in patients with uncontrolled hypertension presenting with chest pain: comparison with coronary angiography. Int J Cardiovasc Imaging 2011; 28:1173-80. [DOI: 10.1007/s10554-011-9907-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 06/03/2011] [Indexed: 01/31/2023]
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21
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Reimann AJ, Tsiflikas I, Pecha S, Blumenstock G, Teufel M, Drosch T, Heuschmid M, Schröder S, Claussen CD, Burgstahler C. Prognostic value of significant and non-significant coronary artery stenosis detection using MDCT for major adverse cardiac events. Int J Cardiol 2011; 149:126-8. [DOI: 10.1016/j.ijcard.2011.01.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 01/29/2011] [Indexed: 10/18/2022]
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Moon JH, Park EA, Lee W, Yin YH, Chung JW, Park JH, Lee HY, Kang HJ, Kim HS. The diagnostic accuracy, image quality and radiation dose of 64-slice dual-source CT in daily practice: a single institution's experience. Korean J Radiol 2011; 12:308-18. [PMID: 21603290 PMCID: PMC3088848 DOI: 10.3348/kjr.2011.12.3.308] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 01/10/2011] [Indexed: 02/02/2023] Open
Abstract
Objective We wanted to evaluate the image quality, diagnostic accuracy and radiation exposure of 64-slice dual-source CT (DSCT) coronary angiography according to the heart rate in symptomatic patients during daily clinical practice. Materials and Methods We performed a retrospective search for the DSCT coronary angiography reports of 729 consecutive symptomatic patients. For the 131 patients who underwent invasive coronary angiography, the image quality, the diagnostic performance (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] for detecting significant stenosis ≥ 50% diameter) and the radiation exposure were evaluated. These values were compared between the groups with differing heart rates (HR): mean HR < 65 or ≥ 65 and HR variability (HRV) < 15 or ≥ 15. Results Among the 729 patients, the CT reports showed no stenosis or insignificant coronary artery stenosis in 72%, significant stenosis in 26% and non-diagnostic in 2%. For the 131 patients who underwent invasive coronary angiography, 95% of the patients and 97% of the segments were evaluable, and the overall per-patient/per-segment sensitivity, the perpatient/per-segment specificity, the per-patient/per-segment PPV and the per-patient/per-segment NPV were 100%/90%, 71%/98%, 95%/88% and 100%/97%, respectively. The image quality was better in the HR < 65 group than in the HR ≥ 65 group (p = 0.001), but there was no difference in diagnostic performance between the two groups. The mean effective radiation doses were lower in the HR < 65 or HRV < 15 group (p < 0.0001): 5.5 versus 6.7 mSv for the mean HR groups and 5.3 versus 9.3 mSv for the HRV groups. Conclusion Dual-source CT coronary angiography is a highly accurate modality in the clinical setting. Better image quality and a significant radiation reduction are being rendered in the lower HR group.
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Affiliation(s)
- Joon Ho Moon
- Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
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Abstract
Technical development has substantially improved diagnostic performance of coronary computed tomography angiography (CCTA). A large number of studies have addressed proof of concept, feasibility, and clinical robustness of this noninvasive diagnostic technique, and most have consistently described the ability of CCTA to reliably rule out significant coronary artery stenosis. Clinical evidence supports the significant role of CCTA in an increasing number of scenarios, including the detection of coronary disease in symptomatic patients who are at intermediate risk and evaluation of coronary revascularization procedures. After initial feasibility testing, the scientific evaluation of CCTA now points toward analyzing prognosis, outcome, and cost-effectiveness of this noninvasive diagnostic tool. In this article, appropriate clinical indications, diagnostic performance, current clinical applications, prognostic value, and cost-effectiveness of CCTA are reviewed.
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Drosch T, Brodoefel H, Reimann A, Thomas C, Tsiflikas I, Heuschmid M, Schroeder S, Burgstahler C. Prevalence and clinical characteristics of symptomatic patients with obstructive coronary artery disease in the absence of coronary calcifications. Acad Radiol 2010; 17:1254-8. [PMID: 20591696 DOI: 10.1016/j.acra.2010.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES The quantification of coronary calcification has established itself as a valid risk marker to predict cardiovascular events. However, data derived from cardiac multi-detector row computed tomography could demonstrate that the exclusion of coronary calcification is not synonymous with the exclusion of coronary artery disease (CAD). The aims of this retrospective analysis were to determine the prevalence of significant CAD in a symptomatic cohort with indications for invasive angiography but without coronary calcification (Agatston score 0) as assessed by multislice computed tomography and to investigate whether there were any differences in terms of risk factors between patients with and without significant CAD. MATERIALS AND METHODS Five hundred multislice computed tomographic scans (in 371 men and 129 women) were included in the analysis. Agatston scores were determined on native scans. All patients underwent coronary angiography to detect or rule out obstructive CAD. Patients with negative calcium scoring were selected and divided into two subgroups: those without obstructive CAD and those with obstructive CAD (luminal stenoses > 50%). These subgroups were characterized in terms of clinical characteristics (age and sex) and cardiovascular risk factors (diabetes mellitus, hypertension, hyperlipoproteinemia, familial predisposition, smoking, and overweight). RESULTS Sixty-one of 500 patients (12.2%) had negative calcium scores (Agatston score 0). Sixteen of these patients (26.3%, or 3.2% of the total population) had obstructive CAD according to invasive angiography. Patients with obstructive CAD were significantly older (mean age, 64 ± 9 vs 55 ± 10 years; P = .003) and were more frequently diabetic (25% vs 4%, P = .0389) than patients without obstructive CAD. There were no significant differences with regard to the other risk factors. CONCLUSIONS In this high-risk population, the absence of coronary calcification was not sufficient to rule out CAD. Among patients without coronary calcification, the presence of significant CAD was associated with increased age and the presence of diabetes mellitus.
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Affiliation(s)
- Tanja Drosch
- Medizinische Klinik und Poliklinik III, Medizinische Universitätsklinik Tübingen, D-72076 Tübingen, Germany
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Diagnostic accuracy of first generation dual-source computed tomography in the assessment of coronary artery disease: a meta-analysis from 24 studies. Int J Cardiovasc Imaging 2010; 27:755-71. [DOI: 10.1007/s10554-010-9690-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 08/14/2010] [Indexed: 12/22/2022]
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26
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Donati OF, Stolzmann P, Desbiolles L, Leschka S, Kozerke S, Plass A, Wyss C, Falk V, Marincek B, Alkadhi H, Scheffel H. Coronary artery disease: which degree of coronary artery stenosis is indicative of ischemia? Eur J Radiol 2010; 80:120-6. [PMID: 20708362 DOI: 10.1016/j.ejrad.2010.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/12/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To prospectively determine the best cut-off value of stenosis degree for low-dose computed tomography coronary angiography (CTCA) to predict the hemodynamic significance of coronary artery stenoses compared to catheter angiography (CA) using a cardiac magnetic resonance based approach as standard of reference. MATERIALS AND METHODS Fifty-two patients (mean age, 64±10 years) scheduled for CA underwent cardiac magnetic resonance (CMR) at 1.5-T and dual-source CTCA using prospective ECG-triggering the same day. Diagnostic performance of CTCA and CA to detect myocardial ischemia was evaluated with CMR as the standard of reference. The diagnostic performance and best cut-off values to predict the hemodynamic significance of coronary were determined from receiver operating characteristics analysis (ROC). RESULTS CA revealed >50% stenoses in 131/832 segments (15.7%) in 78/156 (50.0%) coronary arteries in 32/52 (62%) patients. CTCA revealed >50% stenoses in 148/807 (18.3%) segments, corresponding to 83/156 (53.2%) coronary arteries in 34/52 (65.4%) patients. CMR revealed ischemia in 118/832 (14.2%) myocardial segments corresponding to the territories of 60/156 (38.5%) coronary arteries in 29/52 (56%) patients. ROC analysis showed equal diagnostic performance for low-dose CTCA and CA with areas under the curve (AUC) of 0.82 and 0.83 (P=0.64). The optimal cut-off value was determined at stenosis of >60% for the prediction of hemodynamically significant coronary stenosis by CTCA. Using this cut-off value, sensitivity, specificity, NPV and PPV to predict hemodynamic significance by CTCA were 100%, 83%, 100%, and 88% on a per-patient basis and 88%, 73%, 83% and 81% on a per-artery analysis, respectively. CONCLUSION By considering coronary stenosis >60%, diagnostic performance for predicting the hemodynamic significance of coronary stenosis by CTCA is optimal and equals that of CA.
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Affiliation(s)
- Olivio F Donati
- Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland
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Rocha-Filho JA, Blankstein R, Shturman LD, Bezerra HG, Okada DR, Rogers IS, Ghoshhajra B, Hoffmann U, Feuchtner G, Mamuya WS, Brady TJ, Cury RC. Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiology 2010; 254:410-9. [PMID: 20093513 DOI: 10.1148/radiol.09091014] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE First, to assess the feasibility of a protocol involving stress-induced perfusion evaluated at computed tomography (CT) combined with cardiac CT angiography in a single examination and second, to assess the incremental value of perfusion imaging over cardiac CT angiography in a dual-source technique for the detection of obstructive coronary artery disease (CAD) in a high-risk population. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. The study was HIPAA compliant. Thirty-five patients at high risk for CAD were prospectively enrolled for evaluation of the feasibility of CT perfusion imaging. All patients underwent retrospectively electrocardiographically gated (helical) adenosine stress CT perfusion imaging followed by prospectively electrocardiographically gated (axial) rest myocardial CT perfusion imaging. Analysis was performed in three steps: (a)Coronary arterial stenoses were scored for severity and reader confidence at cardiac CT angiography, (b)myocardial perfusion defects were identified and scored for severity and reversibility at CT perfusion imaging, and (c)coronary stenosis severity was reclassified according to perfusion findings at combined cardiac CT angiography and CT perfusion imaging. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac CT angiography before and after CT perfusion analysis were calculated. RESULTS With use of a reference standard of greater than 50% stenosis at invasive angiography, all parameters of diagnostic accuracy increased after CT perfusion analysis: Sensitivity increased from 83% to 91%; specificity, from 71% to 91%; PPV, from 66% to 86%; and NPV, from 87% to 93%. The area under the receiver operating characteristic curve increased significantly, from 0.77 to 0.90 (P < .005). CONCLUSION A combination protocol involving adenosine perfusion CT imaging and cardiac CT angiography in a dual-source technique is feasible, and CT perfusion adds incremental value to cardiac CT angiography in the detection of significant CAD.
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Affiliation(s)
- Jose A Rocha-Filho
- Department of Radiology, Massachusetts General Hospital, Boston, Mass., USA
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