Comparison of intravenous coronary angiography using synchrotron radiation with selective coronary angiography

Abstract

Intravenous coronary angiography with synchrotron radiation is a novel and minimally invasive technique for coronary imaging. At the Hamburger Synchrotronstrahlungslabor HASYLAB at DESY, a dedicated angiography system has been developed, which has been shown to provide detailed images of coronary artery segments. For each scan, two monochromatic X-ray images below and above the K-edge of iodine were recorded simultaneously. The two images were subtracted logarithmically to produce a maximal contrast enhancement of the iodine. To date, the procedure has been carried out on 379 outpatients. No complications occurred during or after the angiographic procedure, and hospitalization was not required in any subject. The acceptance by patient is extremely high. Five outside reviewers, blinded as to the clinical data or prior angiographic interpretation, reviewed the images for the presence or absence of 70% or more occlusion of a vessel. They reached a sensitivity of 79% and a specificity of 99%. The study has demonstrated that the synchrotron method has satisfactory sensitivity and very high specificity for severe stenoses. The new method has several advantages over magnetic resonance imaging (MRI), electron beam computed tomography (EBCT), and multi-slice computed tomography (MSCT). Neither vascular calcification (CT) nor the presence of metal stents (MRI) impairs the evaluation of perfusion of segments of the coronary arteries. Furthermore, the spatial resolution is three or four times higher using synchrotron angiography, and problems due to respiratory motion are eliminated.

Synchrotron radiation in radiology: radiology techniques based on synchrotron sources

“…Wavelength tunability is also the essential ingredient of another emerging technique: dichromography [8][9][10][11][12]. This approach is used for coronary angiography during intravenous injection of contrast material.…”

“…Several synchrotron facilities are actively engaged in experimental angiography programs based on dichromography [8][9][10][11][12]. The approach of centers like HASYLAB in Hamburg and Brookhaven [8,9]schematically illustrated in Fig.…”

“…The approach of centers like HASYLAB in Hamburg and Brookhaven [8,9]schematically illustrated in Fig. 3a-is based on "line scanning."…”

“…The digital subtraction enhances once again the iodine-containing features and is not affected by the motion of the heart Fig. 3 a Scheme of a system for digital subtraction angiography performed with the dichromography approach (see [8,9]). b Intravenous synchrotron angiogram of venous coronary artery bypass grafts to right coronary artery (CABG-RCA) and marginal branch (CABG-M1) in left anterior oblique projection taken with the NIKOS system at HASYLAB.…”

“…On the contrary, their conceptual basis is quite simple and can be explained in elementary terms: this is the scope of part II of our review. We will discuss, in particular, the following techniques: onewavelength mammography [4-7, and references cited in 7], two-wavelength digital subtraction angiography [8][9][10][11][12], phase-contrast/edge-enhancement imaging [13][14][15][16][17][18][19][20][21][22], diffraction-enhanced imaging (DEI) [23,24] and phase-contrast microtomography [25][26][27]. The objective of our presentation is to provide for non-specialized readers a simple picture of each technique: we neither intend to present a detailed report on the results of each technique nor a complete list of references.…”