1
|
Addae-Mensah K, Revels J, Febbo J. Pitfalls and pearls in the imaging of cardiac ischemia. Semin Ultrasound CT MR 2022; 43:184-193. [PMID: 35688530 DOI: 10.1053/j.sult.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease is the most common cause of cardiac ischemia and a leading cause of death globally. There are multiple imaging modalities which can assess cardiac ischemia, in particular coronary CT calcium score, coronary CT angiography, and cardiac MRI. Each of these modalities offers insight into the overall patient picture. However, coronary CT and cardiac MRI are not free from limitations. This article will review the roles of CT and MRI in cardiac imaging, mimics, technical limitations, and potential pitfalls that may be encountered.
Collapse
Affiliation(s)
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, Albuquerque, NM..
| |
Collapse
|
2
|
Pregowski J, Kepka C, Kruk M, Mintz GS, Kalinczuk L, Ciszewski M, Kochanowski L, Wolny R, Chmielak Z, Jastrzębski J, Klopotowski M, Zalewska J, Demkow M, Karcz M, Witkowski A. The clinical significance and management of patients with incomplete coronary angiography and the value of additional computed tomography coronary angiography. Int J Cardiovasc Imaging 2014; 30:825-32. [DOI: 10.1007/s10554-014-0397-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 03/04/2014] [Indexed: 01/08/2023]
|
3
|
Pregowski J, Kepka C, Kalinczuk L, Kruk M, Mintz GS, Ciszewski A, Chmielak Z, Ciszewski M, Wolny R, Szubielski M, Tyczynski P, Witkowski A. Comparison of Intravascular Ultrasound, Quantitative Coronary Angiography, and Dual-Source 64-Slice Computed Tomography in the Preprocedural Assessment of Significant Saphenous Vein Graft Lesions. Am J Cardiol 2011; 107:1453-9. [DOI: 10.1016/j.amjcard.2011.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 01/12/2011] [Accepted: 01/12/2011] [Indexed: 11/30/2022]
|
4
|
Romagnoli A, Patrei A, Mancini A, Arganini C, Vanni S, Sperandio M, Simonetti G. Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries. Radiol Med 2010; 115:1167-78. [PMID: 20852959 DOI: 10.1007/s11547-010-0580-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 02/09/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Our aim was to evaluate the accuracy, sensitivity and specificity of 64-slice multidetector computed tomography (MDCT) in the assessment of occlusions and stenoses of arterial and venous bypass grafts and disease progression in the native vessels distal to the graft, and to compare the results with those of conventional coronary angiography. MATERIALS AND METHODS We enrolled 78 individuals (45 men, 33 women; mean age 59) and evaluated 213 bypass grafts using a 64-slice MDCT scanner. All patients underwent conventional coronary angiography with a mean time interval between the two examinations of 2 days. RESULTS One patient was excluded due to arrhythmia during the examination. The 212 bypass grafts in the remaining 77 patients (98.7%) consisted of 115 (54%) venous grafts and 97 (46%) arterial grafts. In the 115 venous grafts, MDCT showed a sensitivity, specificity and accuracy of 100% in evaluating occluded grafts and a sensitivity of 94.4%, specificity of 98.4% and accuracy of 96.9% in evaluating significant stenoses. In evaluating occluded arterial grafts, sensitivity was 83.3%, specificity 100% and accuracy 98.9%, whereas in evaluating stenoses of arterial grafts, sensitivity was 100%, specificity 97.7% and accuracy 98%. CONCLUSIONS Sensitivity, specificity and accuracy in evaluating native coronary vessels distal to the graft allow for a complete assessment of the surgical and native circulation. The examination appears therefore to be exhaustive in ruling out or confirming the presence of diseased vessels in the postoperative follow-up.
Collapse
Affiliation(s)
- A Romagnoli
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Università di Tor Vergata, Viale Oxford 81, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
5
|
Lee R, Lim J, Kaw G, Wan G, Ng K, Ho KT. Comprehensive noninvasive evaluation of bypass grafts and native coronary arteries in patients after coronary bypass surgery: accuracy of 64-slice multidetector computed tomography compared to invasive coronary angiography. J Cardiovasc Med (Hagerstown) 2010; 11:81-90. [PMID: 19851118 DOI: 10.2459/jcm.0b013e32832f3e2e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
|
7
|
Pernès JM, Sirol M, Chabbert V, Christiaens L, Alison D, Hamon M, Caussin C. Les indications actuelles du scanner cardiaque. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2009. [DOI: 10.1016/s1878-6480(09)70351-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Is There an Indication for Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Coronary Artery Bypass Grafts? J Comput Assist Tomogr 2009; 33:317-27. [DOI: 10.1097/rct.0b013e3181807a5e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
CT angiography after coronary artery bypass graft surgery. CURRENT CARDIOVASCULAR IMAGING REPORTS 2008. [DOI: 10.1007/s12410-008-0019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Bettencourt N, Chiribiri A, Nagel E. MSCT evaluation of patients with prior coronary bypass surgery: what we have and what we lack. Int J Cardiovasc Imaging 2008; 25:171-3. [PMID: 18975134 DOI: 10.1007/s10554-008-9378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 10/01/2008] [Indexed: 11/25/2022]
|
11
|
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]
|
12
|
Non-invasive coronary angiography: the clinical value of multi-slice computed tomography in the assessment of patients with prior coronary bypass surgery. Evaluating grafts and native vessels. Int J Cardiovasc Imaging 2008; 25:161-70. [PMID: 18759133 DOI: 10.1007/s10554-008-9361-x] [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] [Received: 05/13/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contrast enhanced multi-slice computed tomography (MSCT) is the leading modality in non-invasive coronary angiography (CTA) today. We investigated MSCT based assessment of coronary artery bypass grafts (CABG) by analyzing assets and drawbacks of CTA in order to define demands on latest technology. METHODS In a clinical setting 39 CABG patients (69.2 +/- 1.4 years; male n = 36) underwent CTA (collimation 16 x 0.75 mm, contrast medium 100 ml; 320 mAs, 120 KV). Ninety-seven CABG (61 venous, 36 arterial grafts) were evaluated. A subgroup of 18 patients underwent additional invasive coronary angiography (CA). RESULTS CTA for CABG assessment resulted in an overall sensitivity (sens.) of 100%, specificity (spec.) of 92.4% and positive and negative predictive values (PPV, NPV) of 60% and 100%, respectively. CABG anastomoses showed slightly inferior diagnostic accuracy than other CABG segments. Limitations in imaging quality caused 21% unevaluable segments of the CABG anastomoses. Evaluation of native vessel segments proximal and distal to the anastomoses resulted in a sens, spec, PPV and NPV of 57.5, 94.6, 92 and 67.3%, respectively. With 28.5% unevaluable segments, the native vessel segments showed serious limitations in imaging quality. Radiation exposure was 9.88 +/- 3.20 mSv (9.69 +/- 3.25 mSv male; 12.08 +/- 1.35 mSv female). CONCLUSION 16-slice MSCT based CABG assessment offers sufficient diagnostic accuracy. However, focussing on the bypass anastomoses and the native revascularized coronary arteries, clinical value is limited.
Collapse
|
13
|
|
14
|
Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, Hundley WG, Manning WJ, Printz BF, Stuber M, Woodard PK. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation 2008; 118:586-606. [PMID: 18586979 DOI: 10.1161/circulationaha.108.189695] [Citation(s) in RCA: 351] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
15
|
Hamon M, Lepage O, Malagutti P, Riddell JW, Morello R, Agostini D, Hamon M. Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery Bypass Graft Assessment: Meta-Analysis. Radiology 2008; 247:679-86. [PMID: 18403629 DOI: 10.1148/radiol.2473071132] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michèle Hamon
- Departments of Radiology, University Hospital of Caen, Avenue Côte de Nacre 14033 Caen, Normandy, France.
| | | | | | | | | | | | | |
Collapse
|
16
|
Ohlmann S, Nowak R, Daliri A, Michulla R, Froelich JJ. [Refined staging in Hilar bronchial neoplasms with ECG-gated multislice-CT---case report]. ACTA ACUST UNITED AC 2008; 56:185-90. [PMID: 19294876 DOI: 10.1016/j.rontge.2007.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Equivocal initial CT-based staging in 2 patients with hilar bronchial neoplasms was reassessed with retrospective ECG-gated Multislice-CT and optimized examination parameters prior to definition of treatment. An initially suspected irresectable T4 tumor with mediastinal infiltration was downstaged to T2 in one case, while tumor infiltration into the left atrium could be confirmed in the other case. In doubtful conditions, ECG-gated multislice CT with optimized examination parameters may be helpful for refined staging in patients with hilar bronchial neoplasms, thus possibly influencing treatment strategies.
Collapse
Affiliation(s)
- Susanne Ohlmann
- Klinik für Radiologie und Nuklearmedizin, Klinikum Bad Hersfeld, Seilerweg 29, D-36251 Bad Hersfeld
| | | | | | | | | |
Collapse
|
17
|
Achenbach S. Cardiac CT: State of the art for the detection of coronary arterial stenosis. J Cardiovasc Comput Tomogr 2007; 1:3-20. [DOI: 10.1016/j.jcct.2007.04.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
|
18
|
Crusco F, Antoniella A, Papa V, Menzano R, Giovagnoni A. Evidence based medicine: role of multidetector CT in the follow-up of patients receiving coronary artery bypass graft. Radiol Med 2007; 112:509-25. [PMID: 17563851 DOI: 10.1007/s11547-007-0158-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 08/07/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to define the role of multidetector computed tomography (MDCT) in the follow-up assessment of patients undergoing coronary artery bypass grafting (CABG) using an evidence-based medicine (EBM) approach. MATERIALS AND METHODS We performed a literature search of the most reputable studies published in the period 1990-2005 on the clinical follow-up of patients after myocardial revascularisation by CABG. Relevant studies were ranked according to levels of evidence using EBM criteria. A similar search was also conducted on the Internet to identify and review the guidelines posted by the major international scientific societies. RESULTS A total of 29 papers meeting the basic reliability requirements of EBM were identified. The reported sensitivity and specificity for electrocardiogram (ECG) testing, stress echocardiography and radionuclide myocardial perfusion imaging were 45% and 82%, 86% and 90%, and 68% and 84%, respectively. All 16 CT studies (one retrospective, the remaining prospective) were validation studies comparing MDCT with conventional coronary angiography. The total number of patients and graft segments studied were 705 and 1,974, respectively. The total number of assessable graft segments were 62%-100%, with a sensitivity and specificity of 75%-100% and 76.9%-100%, respectively. CONCLUSIONS The applications of MDCT in the follow-up assessment of patients after CABG are derived from indirect evidence only. The efficacy of the method should be evaluated in randomised clinical trials comparing MDCT not only with conventional coronary angiography but also with other noninvasive stress imaging methods. On the basis of the clinical evidence reported in the literature, the indications for the use of MDCT are still limited. In our view, the completion of such randomised trials combined with the development of new-generation scanners is required to correctly define the role of MDCT in the follow-up assessment of patients who have undergone CABG.
Collapse
Affiliation(s)
- F Crusco
- Dipartimento Diagnostica per Immagini, AUSL 3 Umbria, Via Antica Vena n. 18, I-06087 Ospedale Foligno, Perugia, Italy.
| | | | | | | | | |
Collapse
|
19
|
Funabashi N, Mizuno N, Yoshida K, Tsunoo T, Mori S, Tanada S, Endo M, Komuro I. Superiority of synchrony of 256-slice cone beam computed tomography for acquiring pulsating objects. Comparison with conventional multislice computed tomography. Int J Cardiol 2007; 118:400-5. [PMID: 17052785 DOI: 10.1016/j.ijcard.2006.07.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 07/09/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE A prototype 256-slice cone beam computed tomography (CT) provides complete volumetric data within a single gantry rotation (1 s/rotation) with 0.5 mm slice-thickness. MATERIALS AND METHODS Calcified phantoms (200-400 HU) were attached to the balloon of a pulsating phantom and moved at a rate of 5-90/min. Acquisition was performed during one to-and-fro motion at each pulsation rate without electrocardiogram (ECG)-gating. Each period was divided into 10 phases, and compared to conventional multislice CT scanning without ECG-gating. RESULTS At 5-20/min, the configuration of calcified phantoms continued to the through-plane without gaps. At 60/min, duplicated calcified phantoms at end-systole and end-diastole were observed without motion. At 90/min, motion could be observed without gaps but was more blurred, and total calcified volume, Agatston scores, mean and max CT values of three phantoms were almost equal compared with those at static state. However, at 60/min, total calcified volume, scores, mean and max CT values of three phantoms were decreased to 64%, 37%, 80% and 56%, respectively, compared with those at static state. In multislice CT, even at lower rates, there were gaps in the through-plane. At 60/min, total calcified volume, scores, mean and max CT values of three phantoms were decreased to only 8%, 3%, 79% and 53%, respectively, compared with static state. CONCLUSION This new prototype's unique character (synchrony) enables the acquisition of pulsating objects. These can be acquired without gaps in the through-plane even in the absence of ECG-gating. However, its present temporal resolution only permits accurate quantitative evaluation of calcium up to 20/min.
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Ricardo C Cury
- Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- Marcelo F Di Carli
- Division of Nuclear Medicine/PET, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | | |
Collapse
|
22
|
Schussler JM, Smith ER. Sixty-four–slice computed tomographic coronary angiography: will the “triple rule out” change chest pain evaluation in the ED? Am J Emerg Med 2007; 25:367-75. [PMID: 17349915 DOI: 10.1016/j.ajem.2006.08.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 08/04/2006] [Accepted: 08/04/2006] [Indexed: 11/27/2022] Open
Abstract
Sixty-four-slice computed tomographic (CT) coronary angiography is a new technique for the noninvasive visualization of the coronary arteries. It enables noninvasive detection of coronary plaque and determination of severity without instrumentation of the heart. Although not yet commonly used in the emergency department setting, it stands poised to dramatically change the way that patients with chest pain are evaluated. In addition to evaluation of the coronary arteries, CT angiography has long been used to evaluate patients for other dangerous causes of chest pain such as aortic dissection and pulmonary embolus. Although these new scanners excel at all of these diagnostic modalities, the true excitement is in the possibility of combining several different protocols into one, allowing for multiple causes of chest pain to be "ruled out" simultaneously. This article describes the current state of the art of cardiac CT, current state of research, and current areas of controversy.
Collapse
Affiliation(s)
- Jeffrey M Schussler
- Division of Cardiovascular Disease, Department of Internal Medicine, Baylor University Medical Center/Jack and Jane Hamilton Heart Hospital, Dallas, TX 75226, USA.
| | | |
Collapse
|
23
|
Jones CM, Athanasiou T, Dunne N, Kirby J, Aziz O, Haq A, Rao C, Constantinides V, Purkayastha S, Darzi A. Multi-Detector Computed Tomography in Coronary Artery Bypass Graft Assessment: A Meta-Analysis. Ann Thorac Surg 2007; 83:341-8. [PMID: 17184705 DOI: 10.1016/j.athoracsur.2006.08.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Revised: 08/03/2006] [Accepted: 08/08/2006] [Indexed: 11/25/2022]
Abstract
Multi-detector computed tomography (MDCT) has become an alternative to coronary angiography in diagnosis of graft occlusion and stenosis after coronary artery bypass. A literature search was performed for studies comparing angiography to 8-slice, 16-slice, and 64-slice MDCT in the assessment of coronary grafts. In assessing occlusion, 14 studies produced pooled sensitivity of 97.6%, specificity of 98.5%, diagnostic odds ratio of 934.2, area under the curve of 0.996, and Q* of 0.977. Ninety-six percent of all grafts were visualized for occlusion assessment. Beta blockers, symptomatic status, and postoperative period did not significantly affect diagnostic performance. Stenosis assessment produced sensitivity of 88.7% and specificity of 97.4%. Eighty-eight percent of patent grafts could be assessed for stenosis. The diagnostic accuracy of MDCT approaches angiography for diagnosing graft occlusion and stenosis in patients with venous and arterial coronary bypass grafts. Our findings show that cardiac surgeons will need to interpret MDCT images of both native and grafted vessels soon in preparation for primary or re-do coronary bypass grafting procedures.
Collapse
|
24
|
Ropers D, Pohle FK, Kuettner A, Pflederer T, Anders K, Daniel WG, Bautz W, Baum U, Achenbach S. Diagnostic Accuracy of Noninvasive Coronary Angiography in Patients After Bypass Surgery Using 64-Slice Spiral Computed Tomography With 330-ms Gantry Rotation. Circulation 2006; 114:2334-41; quiz 2334. [PMID: 17088461 DOI: 10.1161/circulationaha.106.631051] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multidetector computed tomographic angiography (MDCT) has been shown to allow detection of coronary artery bypass graft (CABG) occlusions and stenoses. However, the assessment of native coronary arteries in addition to CABG has thus far not been sufficiently validated. METHODS AND RESULTS Fifty patients with a total of 138 CABG (34 mammary grafts, 3 radial grafts, 101 venous grafts) were investigated by MDCT (0.6-mm collimation, 32 detector rows, 2 focal points, 330-ms rotation) 9 to 252 months (mean, 106 months) after surgery. CABG and all native coronary arteries with a diameter of > 1.5 mm were evaluated for the presence of significant stenoses (> or = 50% diameter reduction). Results were compared with quantitative coronary angiography. By MDCT, all CABG were evaluable and were correctly classified as occluded (n=38) or patent (n=100). Sensitivity for stenosis detection in patent grafts was 100% (16/16) with a specificity of 94% (79/84). For the per-segment evaluation of native coronary arteries and distal runoff vessels, sensitivity in evaluable segments (91%) was 86% (87/101) with a specificity of 76% (354/465). If evaluation was restricted to nongrafted arteries and distal runoff vessels, sensitivity was 86% (38/44) with a specificity of 90% (302/334). On a per-patient basis, classifying patients with at least 1 detected stenosis in a CABG, a distal runoff vessel, or a nongrafted artery or with at least 1 unevaluable segment as "positive," MDCT yielded a sensitivity of 97% (35/36) and specificity of 86% (12/14). CONCLUSIONS We found that 64-slice MDCT permits the evaluation of bypass grafts and the assessment of the native coronary arteries for the presence of stenosis.
Collapse
Affiliation(s)
- Dieter Ropers
- Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Achenbach S. Computed tomography coronary angiography. J Am Coll Cardiol 2006; 48:1919-28. [PMID: 17112978 DOI: 10.1016/j.jacc.2006.08.012] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 06/02/2006] [Accepted: 06/06/2006] [Indexed: 11/20/2022]
Abstract
Recent developments in computed tomography technology have made imaging of the coronary arteries possible. All the same, the rapid motion and small dimensions of the coronary vessels make coronary computed tomography angiography (coronary CTA) challenging. With the last generations of 16- and 64-slice computed tomography and adequate patient preparation (which includes lowering of the heart rate), rates of sensitivity ranging from 83% to 99% and specificity between 93% and 98% have been reported for the detection of coronary artery stenoses in comparison with invasive coronary angiography. The high negative predictive value (95% to 100%) found in these studies suggests that coronary CTA may be a useful diagnostic technique to rule out the presence of coronary stenoses in selected patients, especially those with a rather low pretest likelihood of disease. Imaging of coronary artery bypass grafts is reliable, but clinical applications can be hampered by difficulties in assessing the native coronary arteries in patients after undergoing bypass because of their often-severe calcification. The detection of in-stent restenosis is made difficult by artifacts caused by metal, especially in smaller stents. Finally, initial reports that coronary CTA allows the detection and, to a certain extent, also the characterization and quantification of noncalcified coronary arteriosclerotic plaque are interesting, but they currently do not provide sufficient data to support clinical applications in the context of risk stratification.
Collapse
Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany.
| |
Collapse
|
26
|
Abstract
Non-invasive methods for detection of coronary atherosclerosis have been limited to indirect markers, such as myocardial perfusion or wall motion during exercise or pharmacological stress. However, advances in multislice computed tomography (MSCT) not allow sufficient spatial resolution for direct non-invasive imaging of the coronary arteries. This review focuses on imaging techniques and clinical applications of MSCT in human studies. Published studies of the diagnostic accuracy of MSCT in native coronary arteries and bypass grafts indicate excellent sensitivity and specificity for detection of 50% diameter stenosis. MSCT is particularly good for evaluating the origin and course of anomalous coronary arteries. MSCT offers the ability to visualise both the lumen and wall of artery, as well as to quantify coronary classification. Further technical developments promise to render MSCT the ideal non-invasive tool for direct visualisation of the coronary arteries.
Collapse
Affiliation(s)
- Jeffrey M Schussler
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
| | | |
Collapse
|
27
|
Beck T, Burgstahler C, Reimann A, Kuettner A, Heuschmid M, Kopp AF, Schroeder S. Technology Insight: possible applications of multislice computed tomography in clinical cardiology. ACTA ACUST UNITED AC 2005; 2:361-8. [PMID: 16265562 DOI: 10.1038/ncpcardio0240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2005] [Accepted: 04/21/2005] [Indexed: 11/09/2022]
Abstract
With the introduction of four-slice scanners in 1999, multislice CT (MSCT) technology became available for investigative examination of the heart. Since then, MSCT technology has undergone rapid technical progress; temporal and spatial resolutions have been especially improved. The improved diagnostic image quality has led to more possible uses of MSCT being defined. At present, issues such as visualization of coronary artery bypass grafts, detection of stenoses of native coronary arteries, description of coronary anomalies, and calcium scoring, can be investigated reasonably well. Other features, such as plaque imaging and visualization of intracoronary stents, need further evaluation. A large number of factors, however, such as heart rate, atrial fibrillation, breathing artefacts and severe calcification, still influence image quality and reduce validity. In this article we provide a summary of current fields of application of cardiac MSCT. The word 'indication' is consciously avoided because official guidelines for the use of MSCT in heart examination have not yet been issued. Hopefully, prospective multicenter trials will be performed soon, providing more data with which to establish guidelines for both cardiologist and radiologist.
Collapse
Affiliation(s)
- Torsten Beck
- Department of Internal Medicine, Division of Cardiology, Eberhard-Karls-University Tuebingen, Germany
| | | | | | | | | | | | | |
Collapse
|