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.

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oninvasive imaging of the coronary artery has now become available through the recent development of imaging modalities, including high resolution magnetic resonance imaging (MRI) and electron beam computed tomography (EBCT). Nevertheless, there are still limitations in image quality for adequate evaluation of the anatomy of the coronary artery and for the detection and quantification of the coronary artery plaque. More specifically, the spatial resolution of the currently available 1.5 Tesla MRI is up to 1.0 mm, which is theoretically capable of evaluating the major coronary arteries, but it has not gained clinical acceptance because of the low signal-tonoise ratio. 1-3 EBCT gives high temporal resolution and Circulation Journal Vol.67, February 2003 enables quantitative assessment of coronary artery calcium, 4-6 high-grade stenoses 7 and congenital anomalies. 8 However, because of limited spatial resolution related to the limited z axis resolution, it does not allow direct visualization of the coronary artery system and therefore, has not gained widespread clinical use. [9][10][11] During the past years, multislice spiral computed tomography (MSCT), which simultaneously acquires 4 sections, has 0.5 s gantry rotation and up to 125 ms temporal resolution, has been introduced 12,13 and initial results indicate that this technique enables visualization of the major coronary artery branches in normal subjects, 14 as well as coronary artery stents and vessels with significant luminal narrowing distal to the stent. 15 Moreover, a recent study by Schroeder et al demonstrated that MSCT can detect coronary artery soft plaques as validated by intracoronary ultrasound. 16 These preliminary data give substantial optimism for the noninvasive comprehension of coronary artery anatomy in the near future. However, limitations still exist with the reproducibility of images that are satisfactory for Although the excellent spatial resolution of multislice spiral computed tomography (MSCT) enables the coronary arteries to be visualized, its limited temporal resolution results in poor image reproducibility because of cardiac motion artifact (CMA) and hence limits its widespread clinical use. A novel retrospectively ECG-gated reconstruction method has been developed to minimize CMA. In 88 consecutive patients, the scan data were reconstructed using 2 retrospectively ECG-gated reconstruction methods. Method 1: the end of the reconstruction window (250 ms) was positioned at the peak of the P wave on ECG, which corresponded to the end of the slow filling phase during diastole immediately before atrial contraction. Method 2 (conventional method): relative retrospective gating with 50% referred to the R-R interval was performed so that the beginning of the reconstruction window (250 ms) was positioned at the halfway point between the R-R intervals of the heart cycle. The quality of the coronary artery images was evaluated according to the presence or absence of CMA. The assessment was applied to the left main coronary artery (LMCA), th...

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A transient left ventricular apical ballooning (so-called "ampulla" or "Takotsubo-shaped" cardiomyopathy) with type I CD36 deficiency is described in a 71-year-old woman. The patient was referred because of chest pain and worsening of dyspnea. Electrocardiogram showed T-wave inversions on the precordal leads, and acute coronary syndrome was suspected. Left ventricular apical ballooning was observed by echocardiogram and left ventriculography, and coronary arteriography did not reveal any significant stenosis. Left ventricular motion normalized at the follow-up period and there were no increases in specific markers for myocardial damage, such as myocardial band fraction of creatine kinase and troponin T, through out the admission. 123I-metaiodobengylguanidine myocardial single photon emission computed tomography (SPECT) revealed decreased accumulation areas at the apex, while 201Tl SPECT showed normal accumulation. An abnormal metabolism of cardiac free fatty acid was suggested by lack of accumulation of 123I beta-methyliodophenyl pentadecanoic acid (BMIPP) SPECT. No CD36 expression in either platelets or monocytes/macrophages was shown using flow cytometer analysis and type I CD36 deficiency was diagnosed. DNA sequencing showed that the patient had compound heterozygosity of the CD36 gene (a nucleotide change in C478T and an adenine insertion at nucleotide 1159 in exon 10). Although CD36 deficiency is thought to be involved with many cardiovascular disease and metabolic abnormalities, Takotsubo-shaped cardiomyopathy with CD36 deficiency had not been reported. Further studies of Takotsubo-shaped cardiomyopathy and CD36 deficiency may reveal an association between this cardiomyopathy and specific genetic profiles.

The high spatial resolution of multislice computed tomography (MSCT) permits direct visualization of the coronary artery system. In this report, we describe coronary artery abnormalities in a young adult with Kawasaki disease. MSCT detected a giant coronary artery aneurysm, coronary artery stenosis in the first diagonal artery, and a multi-layered structure in the right coronary artery and the left circumflex artery. These findings corresponded well to those obtained by coronary angiography. MSCT has the potential to be the standard diagnostic tool for the follow-up evaluation of coronary artery disease in adolescents and young adults with Kawasaki disease.

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