Coronary plaque burden in patients with stable and unstable coronary artery disease using multislice CT coronary angiography

PURPOSE

We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris.

MATERIALS AND METHODS

Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS).

RESULTS

Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05).

CONCLUSIONS

MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.

Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data on the comparison between male and female population

PURPOSE

This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in a male and female population.

MATERIAL AND METHODS

A total of 1,372 patients (882 men, 490 women; mean age 59.3 ± 11.9 years) in sinus rhythm imaged with CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR+ and LR-) of CTCA were assessed against CAG for the male and female populations.

RESULTS

The prevalence of obstructive disease was 53% (men 58%; women 43%). CAG demonstrated the absence of significant coronary artery disease (CAD) in 47% (men 42%; women 56%), single-vessel disease in 25% (men 36%; women 22%) and multivessel disease in 29% (men 32%; women 23%) of patients. In the per-patient analysis, sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of CTCA were 99% (men 98%; women 100%), 92% (men 92%; women 92%), 94% (men 95%; women 90%) and 99% (men 98%; women 100%), respectively. The per-patient likelihood ratios (LR) in the total population (LR+=12.4 and LR-=0.011), the male (LR+=12.9 and LR-=0.016) and female (LR =11.9 and LR-=0) populations were very good. We observed no significant differences in diagnostic accuracy between male and female populations.

CONCLUSIONS

CTCA is a reliable diagnostic modality with high sensitivity and NPV in the female population.

Impact of tube current in the quantitative assessment of acute reperfused myocardial infarction with 64-slice delayed-enhancement CT: a porcine model

PURPOSE

This study evaluated the impact of tube current (mAs) in delayed-enhancement computed tomography (CT) imaging for assessing acute reperfused myocardial infarction in a porcine model.

MATERIALS AND METHODS

In five domestic pigs (mean weight 24 kg), the circumflex coronary artery was balloon-occluded for 2 h and then reperfused. After 5 days, CT imaging was performed following administration of iodinated contrast material. A 64-slice CT system was used to perform first-pass coronary angiography with a tube current of 15 mAs/kg [Arterial Phase (ART)] followed by two delayed-enhancement (DE) scans 15 min after contrast material administration, with a tube current of 15 mAs/kg and 37.5 mAs/kg, respectively (DE(1) and DE(2)). The mean heart rate decreased to 51±9 beats/min after administration of zatebradine (10 mg/kg IV). The data set was reconstructed during the end-diastolic phase of the cardiac cycle. Areas with DE, no reflow and remote myocardium [remote left ventricular (LV)] were calculated. CT values expressed in Hounsfield units (HU) were measured using five regions of interest (ROI): DE, no reflow, remote LV, LV cavity (LV lumen) and in air, respectively. Differences, correlations, image quality [signal-to-noise ratio (SNR)] and contrast resolution [contrast-to-noise ratio (CNR)] were calculated.

RESULTS

Significant differences were found between attenuation of areas of DE, no reflow and remote LV (p<0.001) within the different scans. There was a fair correlation between DE and no-reflow attenuation (r=0.6; p<0.001). In DE(1) vs. DE(2), areas of DE and no reflow were not significantly different (p>0.05). The SNR and CNR were not significantly different in DE(1) vs. DE(2) (p>0.05).

CONCLUSIONS

Tube current does not significantly affect infarction area, image quality or contrast resolution of DE imaging with CT.

Impact of contrast material volume on quantitative assessment of reperfused acute myocardial infarction using delayed-enhancement 64-slice CT: experience in a porcine model

PURPOSE

Our purpose in this study was to compare the impact of contrast material volume in delayed-enhancement computer tomography (CT) imaging for assessing acute reperfused myocardial infarction.

MATERIALS AND METHODS

In five domestic pigs (20-30 kg), the circumflex coronary artery (CX) was balloon-occluded for 2 h followed by reperfusion. After 5 days, CT imaging was performed after intravenous administration of iodinated contrast material (Iomeprol 400 mgI/ml; Bracco, Italy). A 64-slice multidetector CT (MDCT) (Sensation 64, Siemens) scanner was used for imaging, with standard angiography characteristics. Three scans were performed: first, coronary angiography at first pass with 1.25 gI/kg of contrast material (ART); and remaining delayed-enhancement (DE(1)-DE(2)) 15 min after administration of 1.25 (DE(1)) and 15 min after additional administration of 2.50 gI/kg (=total 3.75 gI/kg - DE(2)). Mean heart rate decreased to 51+/-9 bpm after intravenous administration of Zatebradine (10 mg/kg). Data sets were reconstructed during the end-diastolic phase of the cardiac cycle. Areas of infarction-enhanced (DE), no-reflow (no-reflow) and remote myocardial [remote left ventricle (LV)] were manually contoured. CT attenuation values (Hounsfield units) were measured using five regions of interest: DE, no-reflow, remote LV, left ventricular cavity (lumen LV) and in air. Differences, correlations, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.

RESULTS

We found significant differences between the attenuation of DE, no-reflow and remote LV (p<0.001). DE and no-reflow size were assessed accurately with DEMDCT. In particular, SNR and CNR showed higher values in DE(2) (approximately 6.0 and 3.5, respectively; r(2)=0.90) vs. DE(1) (approximately 4.0 and 2.2, respectively; r(2)=0.85).

CONCLUSIONS

The increase of contrast material volume determines a significant improvement in myocardial infarction image quality with DE-MDCT.

Dose reduction in spiral CT coronary angiography with dual-source equipment. Part I. A phantom study applying different prospective tube current modulation algorithms

PURPOSE

The authors sought to compare different algorithms for dose reduction in retrospectively echocardiographically (ECG)-gated dual-source computed tomography (CT) coronary angiography (DSCT-CA) in a phantom model.

MATERIALS AND METHODS

Weighted CT dose index (CTDI) was measured by using an anthropomorphic phantom in spiral cardiac mode (retrospective ECG gating) at five pitch values adapted with two heart-rate-adaptive ECG pulsing windows using four algorithms: narrow pulsing window, with tube current reduction to 20% (A) and 4% (B) of peak current outside the pulsing window; wide pulsing window, with tube current reduction to 20% (C) and 4% (D). Each algorithm was applied at different heart rates (45, 60, 75, 90, 120 bpm).

RESULTS

Mean CTDI volume (CTDIvol) was 36.9+/-9.7 mGy, 23.9+/-5.6 mGy, 49.7+/-16.2 mGy and 38.5+/-12.3 mGy for A, B, C and D, respectively. Consistent dose reduction was observed with protocols applying the 4% tube current reduction (B and D). Using the conversion coefficient for the chest, the mean effective dose was the highest for C (9.6 mSv) and the lowest for B (4.6 mSv). Heart-ratedependent pitch values (pitch=0.2, 0.26, 0.34, 0.43, 0.5) and the use of heart-rate-adaptive ECG pulsing windows provided a significant decrease in the CTDIvol with progressively higher heart rates (45, 60, 75, 90, 120 bpm), despite using wider pulsing windows.

CONCLUSIONS

Radiation exposure with DSCT-CA using a narrow pulsing window significantly decreases when compared with a wider pulsing window. When using a protocol with reduced tube current to 4%, the radiation dose is significantly lower.

Computed tomography coronary angiography vs. stress ECG in patients with stable angina

PURPOSE

This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain.

MATERIALS AND METHODS

MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8+/-7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate>or=70 beats/minute. In order to identify or exclude patients with significant stenoses (>or=50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test.

RESULTS

The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) for the stress test and 10.0 (95% CI: 1.8-78.4) and 0.0 (95% CI: 0.0-infinity) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD.

CONCLUSIONS

Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD.

Spiral multislice computed tomography coronary angiography: a current status report

Multislice computed tomography coronary angiography (MSCT-CA) has emerged as a powerful noninvasive diagnostic modality to visualize the coronary arteries and to detect significant coronary stenoses. The latest generation 64-slice computed tomography (CT) scanners is a robust technique which allows high-resolution, isotropic, nearly motion-free coronary imaging. Coronary stenoses are detected with high sensitivity and a normal scan accurately rules out the presence of a coronary stenosis. With the introduction of further novel concepts in CT-technology one may expect that MSCT-CA will become a clinically used diagnostic tool.