Coronary CT Angiography to Guide Percutaneous Coronary Intervention

Abstract

C oronary CT angiography (CCTA) has become an established first-line noninvasive imaging modality for the evaluation of patients with suspected, but not yet confirmed, coronary artery disease (CAD) (1,2). Current guidelines highlight the high negative predictive value of CCTA to exclude obstructive coronary stenosis (3). Moreover, identification of atherosclerosis at CCTA provides prognostic information that can be used to stratify cardiovascular risk and guide medical therapy (4). Over the last decade, the assessment of the hemodynamic relevance of CAD, as measured by CT-derived fractional flow reserve (FFR CT ), has been validated and introduced into clinical practice to help accurately determine the impact on physiology from each lesion (5) and better identify those patients who may benefit from revascularization or those in whom invasive coronary angiography (ICA) can be deferred (6,7).Beyond diagnostic accuracy, CCTA provides incremental information that can be of clinical value for both guiding referrals for ICA and helping plan coronary interventions. Integration of CCTA in the procedural planning of patients considered for an invasive evaluation could potentially facilitate the course of ICA, enhance diagnostic and therapeutic intervention, and improve clinical outcomes. Importantly, with CCTA being used more routinely in the evaluation of symptomatic patients, the opportunity to expand its use to help plan and guide coronary intervention involves understanding how to use the existing data rather than ordering an additional test. This review provides practical recommendations on integrating CCTA into the planning of percutaneous coronary interventions (PCI).

An Experimental Study of a 3D Bone Position Estimation System Based on Fluoroscopic Images

“…In particular, the development of cross-modality applications, which actively use image information obtained by CT and MRI for diagnostic procedures using fluoroscopy, has made remarkable progress. There have been reports of applications that obtains a three-dimensional image of an object, and a method of superimposing on an X-ray fluoroscopic image to determine the additional information of anatomical positions of the organs [ 10 , 11 , 12 , 13 ]. Many of these applications have been reported in fluoroscopy using flat panel detectors.…”

A fully automated deep learning approach for coronary artery segmentation and comprehensive characterization

“…Our methods perform coronary artery segmentation, compute the vessel centerline, and automatically extract anatomical of interest that are clinically relevant in the planning of percutaneous coronary interventions, such as CAC burden and location, and vessel tortuosity. 23 The analysis of such parameters generally requires specific commercial software and is performed by expert radiologists, potentially introducing inter-operator variability in the measures. Our framework does not require any input from the operator and is thus objective and repeatable in all its steps.…”

Photon counting computed tomography of in-stent-stenosis in a phantom: Optimal virtual monoenergetic imaging in ultra high resolution

“…Two experienced readers (5 and 7 years of experience in cardiac CT) performed ROI-based measurements according to prior studies [ 11 ]. In the longitudinal reconstruction, the first ROI [ 1 ] was set in the contrast-filled tube outside the stent, the second ROI [ 2 ] within the visible stent lumen prior to the stenosis, ROI [ 3 ] within the plaque and ROI [ 4 ] within the surrounding saline. Every ROI's mean density and its standard deviation were documented for every available VMI ranging from 40 keV to 190 keV.…”

“…For example, the assessment of the hemodynamic relevance of stenoses using CT-derived fractional flow reserve has already been validated and introduced into clinical practice. The use of CCTA for planning percutaneous coronary interventions is also promising [ 3 ]. As a result, more and more patients with known CAD and often with coronary stents are examined using CCTA.…”