Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Abstract

712SATO A et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp for detecting coronary artery stenosis has been compared with ICA. Several studies have demonstrated the ability of CCTA to detect anatomically significant CAD with high negative predictive value (NPV). The CORE 64 study demonstrated that the patient-based diagnostic accuracy of quantitative CCTA for detecting stenoses ≥50% according to ICA revealed an area under the curve (AUC) of 0.93, with sensitivity of 85%, specificity of 90%, positive predictive value (PPV) of 91%, and NPV of 83%. 7 The 64-slice CCTA is accurate in identifying coronary stenoses and characterizing disease severity in symptomatic patients who have coronary artery calcium scores (CACS) <600. Given its PPV of 91% and NPV of 83%, 64-slice CCTA cannot replace conventional ICA. The substudy of CORE 64 showed that the AUC for diagnostic accuracy was similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pretest probability for CAD, and known CAD, whereas the NPV was different (0.90, 0.83, and 0.50, respectively). For excluding obstructive CAD, CCTA was less effective in patients with calcium score ≥600 and high pretest probability for obstructive CAD. 13 In the CONFIRM study, the prevalence of observed CAD with either ≥50% diameter stenosis (CAD50) or 70% diameter stenosis (CAD70) was substantially lower than predicted by guideline probabilities in the overall population (18% vs. 51% for CAD50, 10% vs.ultidetector computed tomography (MDCT) is well established for more precise evaluation of coronary stenosis relative to electron-beam CT. 1-3 Multicenter studies have confirmed the accuracy of 64-slice MDCT for directly visualizing and detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). 4-7 Furthermore, dual-source CT (DSCT), 256-slice, and 320-detector scanner were developed to significantly improve scan times, volume coverage, and spatial resolution. 8-12 With improvement in the technical aspects of coronary computed tomography angiography (CCTA), clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion imaging (MPI), and patient outcomes. In this review, we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion. Diagnosis of CAD Role of Cardiac Multidetector Computed Tomography Beyond Coronary AngiographyAkira Sato, MD; Kazutaka Aonuma, MD, PhDCardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinica...

Epicardial Adipose Tissue Accumulation Is Associated With Renal Dysfunction and Coronary Plaque Morphology on Multidetector Computed Tomography

“…Several studies have suggested the potential usefulness of MDCT for the assessment of EAT biological characteristics. 40, 41 Future studies are necessary to investigate qualitative differences in EAT between CKD and non-CKD patients.…”

Comparison of coronary arterial lumen dimensions on angiography and plaque characteristics on optical coherence tomography images and their changes induced by statin

“…FCT and lipid burden are incontrovertible crucial factors for the rupture of lipid atherosclerotic plaque [12, 25]. The intravascular modality validated by OCT assessment and histological examination of the fibrous-cap thickness were highly consistent [26], while CAG had limitations to evaluate the microstructures and vulnerability of plaque [15, 24, 27]. Even so, in this study, we found a statistically significant but weak correlation between diameter stenosis by the standard method of evaluating lumen dimension with CAG and the maximum lipid arc with OCT at baseline but not at follow-up.…”

Improvement in Microvascular Ischemia After Enzyme Replacement Therapy in Anderson-Fabry Disease — Computed Tomography Myocardial Perfusion Imaging —

“…4 Integrated CTP and CCTA were reportedly associated with improved diagnostic accuracy for the detection of significant ischemia. 5, 6 The usefulness for the detection of…”