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.
awasaki disease (KD) is an acute vasculitis of unknown origin that predominantly occurs in young children. It is associated with coronary artery aneurysms (CAA) in approximately 15-25% of untreated cases. 1,2 Rupture and acute thrombosis may occur in the acute phase of illness, but occur rarely in adolescents and young adults. 2 However, approximately 4% of cases subsequently develop stenotic lesions that lead to sudden death from myocardial infarction in adulthood. 2 Serial assessment of the status of the coronary arteries is therefore essential for the management of patients with KD, but evaluation with coronary angiography (CAG) carries risk because of its invasive nature, 3 and it is expensive. Multislice spiral computed tomography (MSCT) has brought a new era of coronary artery imaging because it enables noninvasive visualization of the entire coronary artery system. MSCT can detect obstructive coronary artery disease [4][5][6] and coronary artery plaques. 7 We describe the efficacy of MSCT for detecting coronary artery abnormalities in 4 adolescents with KD.
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