Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: Effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy

Brodoefel, Harald; Reimann, Anja; Burgstahler, Christof; Schumacher, Felix; Herberts, Tina; Tsiflikas, Ilias; Schroeder, Stephen; Claussen, Claus D.; Kopp, Andreas F.; Heuschmid, Martin

doi:10.1016/j.ejrad.2007.05.013

Cited by 87 publications

(54 citation statements)

References 30 publications

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“…As reported conventionally, 10,11) correct assessment of coronary lesions in patients with severe coronary calcifications (high CAC scores) is difficult. A report of the American College of Cardiology Foundation, along with key specialty and subspecialty societies, 12) recommended that when the CAC score was used as a prior test for coronary CT angiography, the result of a CAC score ≤ 400 was "appropriate" for using coronary CT angiography.…”

Section: Methodsmentioning

confidence: 99%

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

et al. 2012

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SummaryDiabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis > 70%. High-risk plaque was defined as plaque having both a CT density < 30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P = 0.022). We found significant stenosis even in patients whose CAC score = 0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P = 0.033) and current smoking (P = 0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (Int Heart J 2012; 53: 23-28) Key words: Diabetes mellitus, Coronary CT angiography, Asymptomatic diabetes, Vulnerable plaque A cute coronary syndrome is a major health concern in individuals with type 2 diabetes. The quantitative risk of myocardial infarction or cardiac death in diabetic patients is similar to that of patients with a history of myocardial infarction.1) Diabetic patients are also prone to sudden cardiac death.2) However, many diabetic patients are asymptomatic, or have atypical symptoms of coronary heart disease. The reason is thought to be related to autonomic denervation of the heart.3) Therefore, protection of these patients from cardiac events is difficult, and makes the identification of preclinical atherosclerosis even more pressing in diabetic patients.Acute coronary syndrome is mostly triggered by rupture of vulnerable plaque. Recent technological advances such as contrast-enhanced coronary CT angiography now allow the visualization of coronary artery plaques easily and less-invasively. Several studies have used these new techniques to characterize plaque features that are causally related to acute coronary syndrome.4-6) Therefore, it is quite possible that one can now identify vulnerable plaque on CT images.In this cross-sectional study, we analyzed coronary CT angiography findings of asymptomatic diabetic patients. We paid special attention to the analysis of plaque in terms of vulnerability. We believe our report is unique in assessing plaque vulnerability in asymptomatic diabetes. Methods Study des...

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Section: Methodsmentioning

confidence: 99%

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

et al. 2012

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“…The use of CCTA in patients with suspected or known CAD complicated the exclusion of hemodynamically insignificant coronary stenosis. Those patients were considered to have significant stenoses mainly due to an overestimation of coronary stenosis degree and severely calcified nonevaluable lesions based on CCTA [1][2][3][4]. Based on the increased diagnostic accuracy of stress DECT-MPI and CCTA for identifying hemodynamically significant CAD, combined CCTA/stress DECT-MPI is a potential alternative to combined ICA/CMR-MPI, SPECT, or FFR in patients with suspected or known CAD as it allows a direct comparison of coronary anatomy and myocardial perfusion [19].…”

Section: Discussionmentioning

confidence: 99%

“…However, prior multicenter studies have shown a non-negligible false-positive rate for CCTA-identified coronary stenosis, with diagnostic accuracy limited by severe coronary calcification, intracoronary stents, and coronary motion [1][2][3]. These limitations are associated with a general overestimation of the degree of coronary stenosis based on CCTA compared with invasive coronary angiography (ICA) [4].…”

Section: Introductionmentioning

confidence: 99%

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Song

Hwang

et al. 2017

Cardiovasc Imaging Asia

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Objective:We determined the diagnostic performance of stress dual-energy computed tomography-myocardial perfusion imaging (DECT-MPI) for diagnosing coronary artery stenoses causing ischemia. Materials and Methods:Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. One hundred ninety-two consecutive patients (135 males, 63.1±8.0 years) underwent coronary computed tomography angiography (CCTA), stress DECT-MPI, and a combined invasive coronary angiography (ICA)/cardiac magnetic resonance-myocardial perfusion imaging (CMR-MPI) for further comparison. Stress DECT-MPI and CMR-MPI were evaluated for perfusion deficits, whereas CCTA and ICA were evaluated for coronary stenosis ≥50%. The primary endpoint was the diagnostic performance of combined CCTA/stress DECT-MPI compared with combined ICA/CMR-MPI at the per-vessel level. Individual direct comparisons of CCTA to ICA and stress DECT-MPI to CMR-MPI were explored. Results:One hundred forty-four (75%) patients and 257 (45%) vascular territories manifested ischemia-causing coronary stenoses based on combined ICA/CMR-MPI. Per-vessel sensitivity, specificity, positive predictive value, and negative predictive value of combined CCTA/stress DECT-MPI were 88, 82, 79, and 89%, respectively, compared with combined ICA/ CMR-MPI. The values for CCTA alone were 95, 45, 63, and 94%, respectively, and the values for stress DECT-MPI alone were 91, 75, 75, and 92%, respectively. The area under the receiver operating characteristics curve for combined CCTA/stress DECT-MPI was higher than that for CCTA alone (0.85 vs. 0.75, p=0.001). Conclusion:When compared with combined ICA/CMR-MPI, combined CCTA/stress DECT-MPI improved the predictive value for coronary stenoses causing ischemia compared with CCTA, but only mildly improved the diagnostic performance of stress DECT-MPI alone.

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“…Kalbin tamamını bir defada görüntülemek amacıyla, z ekseninin kapsama alanını arttırmak için, daha büyük dedektör panelleri olan yeni tarayıcılar geliştirilmiştir. Z ekseninin genişletilmesi, kalbin tamamının tek seferde görüntülenmesi, tek kalp atımında koroner BTA yapılabilmesi, aritmi ve hareket artefaktı etkisinin en aza indirilebilmesi ve radyasyon dozunun azaltılabilmesine olanak sağlayarak kardiyak görüntüleme için önemli avantajlar oluşturur [3]. Çok kesitli BT ile zamansal çözünürlükteki artma kardiyak BT'yi mümkün kılan en önemli gelişmedir.…”

Section: Bt'de Kesit Mücadelesiunclassified

Kardiyak Bilgisayarlı Tomografi (BT)’de Buluşlar: Kesit Mücadelesi, Dual Enerji, Miyokardiyal Perfüzyon Spesifik Kontrast Maddeler

Kantarcı¹,

Okur²

2013

Trd Sem

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GirişÇok kesitli bilgisayarlı tomografi (ÇKBT) teknolojisinin hızla gelişmesi ile birlikte, kardiyak incelemeler bilgisayarlı tomografinin (BT) en yaygın uygulama alanlarından biri haline gelmiştir. Bilgisayarlı tomografi teknolojisindeki en son gelişmeler; doz azaltılması, görün-tü kalitesinin arttırılması ve daha hızlı çekim-ler üzerinde yoğunlaşmıştır. Kalp ve vasküler yapılar, çok kısa sürede, oldukça yüksek uzaysal çözünürlükle, üstün kalitede ve noninvazif olarak değerlendirilebilmektedir. Gelişen BT anjiyografi (BTA) tekniği ile vasküler yapıla-rın değerlendirilmesinde kateter anjiyografiyle karşılaştırılabilecek düzeye gelinmiştir. Hatta noninvazif olması, seçilmiş olgularda avantaj sağlayabilmektedir. Dual enerjili BT (DEBT), daha düşük doz ile yüksek kaliteli çekimler ve materyal karakterizasyon yapılmasına olanak sağlamaktadır. Perfüzyon BT'nin, miyokart canlılığını değerlendirmede bilgisayarlı tek foton emisyon tomografisine (SPECT) yakın sensitivite ve spesifiteye sahip olmasının yanı sıra, koroner anatomiyi de değerlendirilebilmesi üs-tünlüğüdür. Akut koroner sendromun erken tespitinde, yardımcı yeni kontrast maddeler, riskli aterosklerotik plakların değerlendirilmesi amacıyla geliştirilmiştir. BT'de Kesit MücadelesiBilgisayarlı tomografi tekniğinde gelişmeler baş döndürücü hızla devam etmektedir. Spiral BT ile tüpün hasta etrafında bir kez dönüşünde tek kesit görüntü alınabilirken, ÇKBT ile tek rotasyonda 4 veya daha fazla sayıda (8,16, 32, 40, 64, 256, 320) kesit alınabilmektedir. Temel prensip aynı olmakla birlikte, spiral BT'den

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Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: Effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy

Cited by 87 publications

References 30 publications

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Kardiyak Bilgisayarlı Tomografi (BT)’de Buluşlar: Kesit Mücadelesi, Dual Enerji, Miyokardiyal Perfüzyon Spesifik Kontrast Maddeler

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