The present study was designed to investigate the accuracy of multislice spiral computed tomography (MSCT) in detecting coronary artery disease, compared with coronary angiography (CAG), using a new retrospectively ECG-gated reconstruction method that reduced cardiac motion artifact. The study group comprised 54 consecutive patients undergoing MSCT and CAG. MSCT was performed using a SOMATOM Volume Zoom (4-detector-row, Siemens, Germany) with slice thickness 1.0 mm, pitch 1.5 (table feed: 1.5 mm per rotation) and gantry rotation time 500 ms. Metoprolol (20-60 mg) was administered orally prior to MSCT imaging. ECG-gated image reconstruction was performed with the reconstruction window (250 ms) positioned immediately before atrial contraction in order to reduce the cardiac motion artifact caused by the abrupt diastolic ventricular movement occurring during the rapid filling and atrial contraction periods. Following inspection of the volume rendering images, multiplanar reconstruction images and axial images of the left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCx) and right coronary artery (RCA) were obtained and evaluated for luminal narrowing. The results were compared with those obtained by CAG. Of 216 coronary arteries, 206 (95.4%) were assessable; 10 arteries were excluded from the analysis because of severe calcification (n=4), stents (n=3) or insufficient contrast enhancement (n=3). The sensitivity to detect coronary stenoses>or=50% was 93.5% and the specificity to define luminal narrowing <50% was 97.2%. The positive predictive value and the negative predictive value were 93.5% and 97.2%, respectively. The sensitivity was still satisfactory (80.6%) even when non-assessable arteries were included in the analysis. The new retrospectively ECG-gated reconstruction method for MSCT has excellent diagnostic accuracy in detecting significant coronary artery stenoses.
isruption of coronary artery plaque and subsequent thrombosis has been identified as a primary cause of acute coronary syndrome (ACS), which includes acute myocardial infarction and unstable angina, 1-4 and thus, reliable noninvasive detection of plaque is extremely important in patients who have coronary risk factors.Multislice spiral computed tomography (MSCT), which provides simultaneous acquisition of 4-16 sections and 0.4-0.5 s gantry rotation, has been recently developed and initial results indicate that this technique allows visualization of the coronary arteries in both normal subjects and patients with coronary artery disease. 5-9 Moreover, Schroeder et al reported that MSCT can detect coronary artery plaques by demonstrating good agreement of plaque texture between the computed tomography (CT) density of the plaque and that observed by intracoronary ultrasound (ICUS): plaques with a low CT density (0-40 Hounsfield units (HU)) corresponded to those containing a lipid core, and plaques with a medium CT density corresponded to fibrous plaques. 10 Previous pathological and ICUS studies have consistently documented that rupture-prone, vulnerable coronary artery plaques are characterized by the presence of a lipid-rich core and thin fibrous cap. 11-13 Thus, we hypothesized that plaque vulnerability could be evaluated in patients with coronary artery disease by measuring the CT density, so we compared the CT density of the plaque in culprit lesions between patients with ACS and those with stable angina (SA), as well as the CT density between the ACS-related, culprit coronary segment and non-culprit segment in a series of patients with ACS who had multiple plaques.
Methods
PatientsForty two patients (35 males, 7 females; mean age, 60.0±11.5 years (range: 32-78 years)) with angiographically documented coronary artery disease underwent MSCT. Patients who had undergone previous coronary artery bypass surgery or any kind of percutaneous coronary intervention, including stent implantation and percutaneous transluminal balloon angioplasty, were excluded, as were patients with atrial fibrillation, other supraventricular or ventricular arrhythmias, renal dysfunction (serum creatinine >1.5 mg/dl) or severe left ventricular dysfunction (left ventricular ejection fraction <30%). The final study group consisted of 20 patients (19 males, 1 female; age 54.7±12.3 years) with ACS (17 with acute myocardial infarction, 3 with unstable angina). There were 22 patients with SA (16 males, 6 females; mean age, 64.9±8.4 years). ACS was prospectively defined to satisfy guidelines established by the American College of Cardiology and the American Heart Association (ACC/AHA) 14 with the following modifications. Possible or probable ACS required resting chest pain compatible with myocardial ischemia ≥30 min duration, non ST-segment elevation myocardial infarction required abnormal serial troponin-T (>1.96 g/dl) with a
Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.
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