Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography

Cademartiri, Filippo; Maffei, Erica; Palumbo, Anselmo Alessandro; Malagò, Roberto; Grutta, Ludovico La; Meiijboom, W. Bob; Aldrovandi, Annachiara; Fusaro, Michele; Vignali, Luigi; Menozzi, Alberto; Brambilla, Valerio; Coruzzi, Paolo; Midiri, Massimo; Kirchin, Miles A.; Mollet, Nico R.; Krestin, Gabriël P.

doi:10.1007/s00330-007-0773-0

Cited by 86 publications

(46 citation statements)

References 19 publications

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“…Despite the relatively small CM volume, consistently strong and homogeneous arterial attenuation was obtained without significant venous contamination throughout the entire arterial tree in all patients. As discussed elsewhere [23] homogeneous arterial enhancement is a fundamental goal of CTA because diagnostic performance is dependent on adequate vascular enhancement during image acquisition. The homogeneous enhancement obtained in our study permitted reconstruction of diagnostic arterial images and a comprehensive whole-body assessment of total atherosclerosis burden.…”

Section: Discussionmentioning

confidence: 99%

Imaging coronary and extracoronary atherosclerosis: feasibility and impact of whole-body computed tomography angiography

et al. 2009

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A comprehensive whole-body approach to noninvasive evaluation of coronary and extracoronary vasculature is currently not available. The objective of our study was to assess the potential of 64-slice computed tomography angiography (64-CTA) for whole-body evaluation of atherosclerosis burden. Seventy-eight patients referred for coronary imaging underwent whole-body 64-CTA using an adjusted strategy for the administration of contrast medium with dose-saving algorithms involving ECG modulation and reduced tube voltage. Arterial segments (15 coronary, 32 systemic) were evaluated for significant (> or =50%) steno-occlusive disease while arterovenous density was evaluated at seven extracoronary locations. Homogeneous attenuation (mean 321 +/- 20 HU) was obtained throughout the systemic vasculature. Atherosclerosis was observed in 238/995 (24%) coronary and 368/2441 (15%) systemic segments. Significant stenoses/occlusions were present in 214 (21%)/24 (2.5%) coronary segments while asymptomatic clinically relevant stenoses were present in 49 systemic segments. Sensitivity, specificity, positive and negative predictive values of coronary 64-CTA among 52 patients who also underwent quantitative coronary angiography were 92%, 95%, 81% and 98%, respectively. ECG modulation decreased radiation exposure to 14.1-15.4 mSv per patient. Comprehensive, noninvasive assessment of atherosclerosis can be performed by whole-body 64-CTA and may have a positive impact on secondary prevention.

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Section: Discussionmentioning

confidence: 99%

Imaging coronary and extracoronary atherosclerosis: feasibility and impact of whole-body computed tomography angiography

et al. 2009

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“…Cademartiri et al [16] investigated the relationship of coronary enhancement and diagnostic accuracy of coronary CT using 64-row CT. They concluded that the sensitivity and specificity was better in patients with higher coronary enhancement (>326 HU) compared with the remaining patients.…”

Section: Discussionmentioning

confidence: 99%

Spiral Flow Fube for Contrast Medium Reduction in Coronary CT Angiography

Tomizawa¹,

Hayakawa²,

Inoh³

et al. 2017

ICFJ

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ObjectivesTo assess the diagnostic performance and enhancement of coronary CT with reduced contrast medium using the spiral flow tube compared with the T-shaped tube.MethodsWe retrospectively included 444 patients who underwent catheter examination within 2 months after coronary CT. The first 222 patients received 21.0 mgI/kg/s of contrast medium using the T-shaped tube and the injected contrast medium was reduced by 6% (19.8 mgI/kg/s) in the last 222 patients using the spiral flow tube. We compared the per vessel diagnostic performance for detecting obstructive stenosis (≥50%) by catheter examination and the enhancement of proximal coronary arteries.ResultsThe sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 96%, 84%, 72%, 98% and 87% using the spiral flow tube and 93%, 83%, 68%, 97% and 86% using the T-shaped tube, respectively, without significance. The enhancement of left main (spiral flow vs T-shape, 407 ± 53 vs 407 ± 62 HU, p = 0.95) and right coronary (419 ± 58 vs 415 ± 61 HU, p = 0.49) arteries did not show significant difference.ConclusionsThe spiral flow tube would maintain the diagnostic performance and coronary enhancement with reduced contrast medium compared with the T-shaped tube.

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“…A phantom study revealed that intracoronary attenuation can significantly affect the measured plaque attenuation, to the extent that accurate plaque tissue differentiation may be influenced [17]. Cademartiri et al [18,24] in an ex vivo coronary specimen studied with 16-slice CT also demonstrated that the attenuation of plaques is significantly modified by intracoronary attenuation by using high-iodinated CM.…”

Section: Discussionmentioning

confidence: 99%

Comparison of iodinated contrast media for the assessment of atherosclerotic plaque attenuation values by CT coronary angiography: observations in anex vivomodel

Grutta¹,

Gallucci²,

Gentile³

et al. 2013

BJR

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Objective: To compare the influence of different iodinated contrast media with several dilutions on plaque attenuation in an ex vivo coronary model studied by multislice CT coronary angiography. Methods: In six ex vivo left anterior descending coronary arteries immersed in oil, CT (slices/collimation 6460.625 mm, temporal resolution 210 ms, pitch 0.2) was performed after intracoronary injection of a saline solution, and solutions of a dimeric isosmolar contrast medium (Iodixanol 320 mgI ml 21) and a monomeric high-iodinated contrast medium (Iomeprol 400 mgI ml Invasive conventional coronary angiography is considered the standard method for the evaluation of vascular lumen and stenoses of coronary artery disease (CAD). However, it is a technique that does not allow direct assessment of the coronary artery wall and plaque composition, which is considered to be a pivotal determinant of acute coronary events [1][2][3]. Intravascular ultrasound (IVUS) allows accurate qualitative and quantitative assessment of coronary atherosclerotic plaques [4]. However, IVUS is an invasive and expensive technique. CT coronary angiography (CTCA) is now widely implemented in the clinical routine [5], especially in patients at intermediate pretest probability of CAD [6]. Several studies comparing CTCA with IVUS have demonstrated the high potential of CTCA for coronary plaque imaging purposes [7][8][9]. It has been shown that CTCA has the potential to detect atherosclerotic plaques [10,11], to quantify their volumes [12], to characterise their composition (based on the X-ray attenuating properties of each structure [13]), and to assess positive remodelling of walls [14]. CTCA may non-invasively provide information on the total plaque burden (calcified and non-calcified components) for individual patients with suspected CAD [15].High-iodinated contrast media (CM) are recommended for optimal coronary contrast intensity of CTCA [16]. However, several technical parameters, including CM influence, and intrinsic limitations may affect the attenuation measurements of coronary plaques [17][18][19][20][21][22]. The aim of our study was to compare two different CM with several dilutions of iodine load in the setting of coronary plaque assessment in an ex vivo model by means of CTCA.

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Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography

Cited by 86 publications

References 19 publications

Imaging coronary and extracoronary atherosclerosis: feasibility and impact of whole-body computed tomography angiography

Imaging coronary and extracoronary atherosclerosis: feasibility and impact of whole-body computed tomography angiography

Spiral Flow Fube for Contrast Medium Reduction in Coronary CT Angiography

Comparison of iodinated contrast media for the assessment of atherosclerotic plaque attenuation values by CT coronary angiography: observations in anex vivomodel

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