To evaluate the diagnostic accuracy of 256-slice Multidetector Computerized Tomography (256-MDCT) in detection of coronary graft patency by comparison with the gold standard invasive coronary angiography (ICA). MATERIALS AND METHODS.From January 2009 to April 2011, a total of 29 consecutive patients who had previously had CABG surgery were referred to us for assessment of graft patency. A total of 84 coronary bypass graft conduits (38 arterial graft conduits, 46 venous graft conduits) were studied, using 256-MDCT and ICA with iodine contrast intravenous injection. All patients underwent coronary angiography to either confirm result or PCI of graft disease. The diagnostic accuracy of the 256-MDCT for coronary bypass graft evaluation was assessed by comparing it to the ICA in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
OBJECTIVE: To evaluate whether the new magnetic resonance imaging (MRI) technique related to T1 weighted black blood (T1W BB) signal intensity difference ratio between pre-and post-gadolinium contrast injection can serve as a potential technique for use in differentiating normal and diseased myocardium involving the increasing myocardial extracellular volume (ECV) in terms of sensitivity, specificity and accuracy in comparison with late gadolinium contrast enhancement (LGE) MRI technique. MATERIALS AND METHODS: A retrospective analysis was conducted for a pilot of a total of 14 patients with known and suspected myocardial disease who underwent a cardiovascular magnetic resonance (CMR) scan at Bangkok Heart Hospital, Bangkok, Thailand in the period from September 2016-April 2017. LGE MRI and Spin echo T1W BB MRI in both pre-and post-contrast injection were performed in all patents on short axis view in the same slice position and number of slices. The myocardial signal intensity measurement on the T1W BB in both pre-and post-contrast injection images were acquired on short axis view at the same region of interest (contrast enhancement region and negative enhancement) on LGE MRI images. T1 signal intensity difference ratio (SDR) between pre-and post-contrast were calculated in both LGE positive and negative groups. The mean T1W BB signal intensity difference ratio value > 30% was classified as abnormal increased ECV myocardium. RESULTS: The 14 study population have a mean age of 53.3±11.5 and are 64% male. Five were normal patients with negative LGE and nine were found to have myocardial disease with positive LGE. A total of 61 sample slices on short axis view of the ventricle of each T1W BB pre-and post-contrast were obtained from all patients, 31 of 61 were from diseased myocardium with LGE positive scan and 30 were from normal myocardium with a LGE negative scan. A myocardial T1 signal difference ratio > 30% was found in 2 of 30 slices of normal myocardium with the LGE negative group and 31 of 31 slices of the LGE positive group. The mean signal difference ratio value of normal and diseased myocardium were 19.13±7.5 % and 41.4±7.6% respectively. The sensitivity and specificity and the accuracy of T1W BB difference ratio > 30% in differentiating normal from myocardium with involving increasing ECV were 100%, 93.3% and 96.7% (p=0.72) consecutively compared to the LGE MRI. CONCLUSION: The use of T1W BB in assessing myocardial diseases with either a focal or diffuse involvement demonstrates a higher value ratio of extracellular space pre-and post-contrast study of more than 30% indicating myocardial disease with 100% sensitivity and 93.3% in specificity and 96.7% accuracy that is shown to be comparable to gold standard LGE technique in detecting focal increasing myocardial ECV by statistic chi-square test p =0.72 (not less than 0.05)
To study the accuracy of the 256 Multi-detector Computerized Tomography (MDCT) in detecting coronary artery stenosis. MATERIALS AND METHODS.We retrospectively analyzed angiographic findings of patients who underwent both 256 MDCT and invasive coronary angiography (ICA). All epicardial arteries, regardless of calcium burden, were segmented into proximal, mid and distal part for comparative analysis. Significant coronary artery stenosis was defined as the reduction of luminal diameter being equal to or more than 50%. The diagnostic accuracy of 256 MDCT in coronary artery stenosis evaluation was assessed by comparing its' sensitivity, specificity, positive and negative predictive values to the gold standard ICA. RESULTS.From January to December 2009, a total of 147 consecutive patients (124 male, 23 female, mean age of 60 ±12 years) underwent both MDCT and ICA were enrolled. Of total 1470 coronary segments (147 segments of LMA, 441 segments of the LAD, 441 segments of the LCx, 441 segments of the RCA), 98.9% were eligible to be assessed and only 1.1% (15/1470) were ineligible due to very high calcium clumps and severe motion artifacts. Compared to the ICA, the overall sensitivity of the 256 MDCT in detecting coronary stenosis was 88.3 %, specificity was 96.1%, positive predictive value was 88.1 % and the negative predictive value was 96.2% with an overall accuracy of 94.2% (p=0.20). In massive calcium scoring cases (calcium scoring ≥400 U), the sensitivity of 256 MDCT in detecting coronary artery stenosis was 90.3%, specificity was 96.1%, positive predictive value was 87.5% and the negative predictive value was 95.5%; the overall accuracy was 92.9%. In nonmassive calcium scoring cases (calcium scoring <400 U), sensitivity for classifying coronary stenoses was 89.2 %, specificity was 97.2%, positive predictive value was 88.7 % and the negative predictive value was 97.4 %; the overall accuracy was 94.9%.CONCLUSION. The 256 MDCT, regardless of calcium burden, offers a reliable diagnostic accuracy in assessing coronary artery stenosis.N owadays, the 64 slice MDCT has become a reliable, standard tool for diagnosing coronary stenosis in mild to moderate risk patients. The overall reported sensitivity and specificity were reasonably accepted. 4,5 However, several limitations of the 64 MDCT existed, which included a long acquisition time, and the often required administration of beta-blockades to lower the motion artifacts from patients with high heart rates. With the new 256 MDCT, more data was collected within a shorter time, patients received reduced doses of radiation and the image quality was also much improved.
To study the accuracy of the 256 Multi-detector Computerized Tomography (MDCT) in detecting coronary artery stenosis. MATERIALS AND METHODS. We retrospectively analyzed angiographic findings of patients who underwent both 256 MDCT and invasive coronary angiography (ICA). All epicardial arteries, regardless of calcium burden, were segmented into proximal, mid and distal part for comparative analysis. Significant coronary artery stenosis was defined as the reduction of luminal diameter being equal to or more than 50%. The diagnostic accuracy of 256 MDCT in coronary artery stenosis evaluation was assessed by comparing its' sensitivity, specificity, positive and negative predictive values to the gold standard ICA. RESULTS. From January to December 2009, a total of 147 consecutive patients (124 male, 23 female, mean age of 60 ±12 years) underwent both MDCT and ICA were enrolled. Of total 1470 coronary segments (147 segments of LMA, 441 segments of the LAD, 441 segments of the LCx, 441 segments of the RCA), 98.9% were eligible to be assessed and only 1.1% (15/1470) were ineligible due to very high calcium clumps and severe motion artifacts. Compared to the ICA, the overall sensitivity of the 256 MDCT in detecting coronary stenosis was 88.3 %, specificity was 96.1%, positive predictive value was 88.1 % and the negative predictive value was 96.2% with an overall accuracy of 94.2% (p=0.20). In massive calcium scoring cases (calcium scoring ≥400 U), the sensitivity of 256 MDCT in detecting coronary artery stenosis was 90.3%, specificity was 96.1%, positive predictive value was 87.5% and the negative predictive value was 95.5%; the overall accuracy was 92.9%. In nonmassive calcium scoring cases (calcium scoring <400 U), sensitivity for classifying coronary stenoses was 89.2 %, specificity was 97.2%, positive predictive value was 88.7 % and the negative predictive value was 97.4 %; the overall accuracy was 94.9%. CONCLUSION. The 256 MDCT, regardless of calcium burden, offers a reliable diagnostic accuracy in assessing coronary artery stenosis.
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