Non-invasive Evaluation of Internal Thoracic Artery Anastomosed to the Left Anterior Descending Artery with 320-Detector Row Computed Tomography and Adenosine Thallium-201 Myocardial Perfusion Scintigraphy

Abstract

Purpose: We evaluated the relationship between internal thoracic artery (ITA) stenosis anastomosed to the left anterior descending artery (LAD) and the degree of LAD stenosis using 320-detector row computed tomography (320-ADCT) and adenosine thallium-201 myocardial perfusion scintigraphy (Tl-201-MPS). Methods: We included 101 patients who underwent coronary artery bypass grafting (CABG) using ITA grafts; 320-ADCT and adenosine Tl-201-MPS were performed 2-3 months after CABG. Clinical parameters, degree of LAD stenosis, and regional myocardial ischemia of the LAD territory were compared between patients without ITA stenosis (Group A) and with ITA stenosis (Group B). Results: Thirty patients (30%) had ≤75% LAD stenosis, and 9 patients (30%) showed significant ITA stenosis. Regional ischemia was noted in 23 patients (23%). There were no differences in clinical parameters between the 2 groups. Twenty-two patients (24%) in Group A and 8 patients (89%) in Group B had ≤75% LAD stenosis (P <0.002). No Group B patients had regional myocardial ischemia of the LAD territory. Conclusion: We concluded that ≤75% LAD stenosis significantly influences ITA stenosis, without associated regional myocardial ischemia of the LAD territory. Non-invasive 320-ADCT and adenosine Tl-201-MPS for ITA evaluation may be useful for long-term follow-up of patients after CABG. Keywords: internal thoracic artery stenosis, coronary artery bypass grafting, left anterior descending artery stenosis, 320-detector row computed tomography, adenosine thallium-201 myocardial perfusion scintigraphy Ann

The efficacy of 320-detector row computed tomography for the assessment of preoperative pulmonary vasculature of candidates for pulmonary segmentectomy

“…The comparison of capabilities for pulmonary vasculature visualization showed that mean scores for pulmonary artery and intersegmental vein assessment by ADCT were significantly higher than those by MDCT. It has been suggested in the last few years that the latest generation ADCT system has significant advantages [4][5][6][7][8][9][10][11][12][13][14][15][16]. It enables the acquisition of all dynamic data within a 16-cm area every 2 s without helical scanning and makes it possible to obtain images of the pulmonary vessels involved in a single rotation.…”

“…It enables the acquisition of all dynamic data within a 16-cm area every 2 s without helical scanning and makes it possible to obtain images of the pulmonary vessels involved in a single rotation. As for the cardiovascular region, it has been reported that ADCT can provide coronary CT angiography images of excellent quality even for patients with atrial fibrillation, because ADCT enables sufficient craniocaudal coverage in a single rotation and allows imaging of the entire coronary tree within a single beat [4,7,12,16]. In addition, electrocardiograph (ECG)gated ADCT scans, which provide ECG-gated volumetric scan data of the whole lung without any additional radiation exposure, feature excellent lung image quality [20].…”

“…Recently, however, significant advances have been made in the form of the latest generation 320-multidetector row CT, also known as area detector CT (ADCT), resulting in high visualization due to almost isotropic volume data acquisition and a reduced radiation dose compared with that for a helical scan for commercially available multidetector row CT (MDCT). While it has been shown in several studies that ADCT is effective for the assessment of brain images, pulmonary nodules, lung parenchyma, coronary artery and small abdominal vasculature [4][5][6][7][8][9][10][11][12][13][14][15][16], there have been no reports about assessment of lung vasculature in lung cancer patients with regard to surgical procedures.…”

A combination of anatomical and functional evaluations improves the prediction of cardiac event in patients with coronary artery bypass

“…Volumetric data were reconstructed with half or segmented reconstruction. 19 All scans were performed during a single breath-hold. Isosorbide dinitrate spray 1.25 mg was provided immediately before CTA.…”

“… 22 The Tl-201 uptake was graded subjectively in three orthogonal planes (short axis, horizontal long axis, vertical long axis) divided into 17 segments on a five-point scale (4=absent uptake; 3=severely, 2=moderately, 1=mildly decreased uptake; 0=normal uptake, respectively) on the post-stress and delayed images displayed side by side by the consensus of two experienced observers (MS and HK) unaware of the clinical history and CTA findings of the patients. 19 The segmental perfusion scores during stress and rest were added together to calculate the summed stress score (SSS), the summed rest score (SRS) and the summed difference score (SDS).…”