Evaluation of image quality on a per-patient,per-vessel,and per-segment basis by noninvasive coronary angiography with 64-section computed tomography: dual-source versus single-source computed tomography

Purpose  

The purpose of this study was to evaluate the image quality (IQ) of dual-source CT (DSCT) versus single-source CT (SSCT).     

Detection of significant coronary artery stenosis with 64-section MDCT angiography

PURPOSE: To prospectively evaluate the diagnostic performance of 64-section multidetector computed tomography (MDCT) to detect significant coronary artery stenosis using conventional coronary angiography (CCA) as the reference standard. MATERIALS AND METHODS: Institutional Review Board approval and informed consent were obtained. In this prospective study, 80 patients (61 male, 19 female, mean age 56) were examined. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. McNemar test was used to search for the significant difference between 64-section MDCT angiography and CCA to detect stenosis. Also, kappa index (kappa) for the agreement between MDCT angiography and CCA was calculated. RESULTS: The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for detecting significant stenosis were 96%, 98%, 91%, 99%, respectively. The sensitivity, specificity, PPV and NPV for classification of patients with or without CAD were 100% for all. McNemar test demonstrated no significant difference between 64-section MDCT angiography and CCA. Also, kappa index (kappa) indicated excellent agreement. CONCLUSION: Sixty-four section MDCT angiography is an effective diagnostic tool for the detection of significant coronary artery stenosis. Especially, the potential to differentiate patients with and without CAD may provide MDCT an important role in the prevention of unnecessary invasive diagnostic procedures.     

Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment

PURPOSE: To prospectively evaluate the accuracy of 64-section computed tomography (CT) for diagnosis of stent restenosis, by using conventional coronary angiography as the reference standard. MATERIALS AND METHODS: The ethics committee granted permission for the study; patients gave written consent. Contrast material-enhanced coronary CT angiography was performed in 53 patients (45 men, eight women; mean age, 54 years +/- 9 [standard deviation]) suspected of having stent restenosis. Coronary CT angiographic findings were compared with conventional coronary angiographic findings. Two physicians analyzed coronary CT angiographic data sets with multiplanar reformatted images and three-dimensional reformations by using a volume-rendering technique and looked for stent detectability, low-attenuation in-stent filling defects, and grades of restenosis. Conventional coronary angiographic results were interpreted by one of several observers in consensus for stent restenosis; they were blinded to coronary CT angiographic data. Statistical software and general estimating equations were used for data analysis. RESULTS: One hundred ten stents were identified in 53 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of coronary CT angiography in detection of in-stent restenosis were 96.9%, 88.0%, 77.5%, 98.5%, and 91%, respectively. Coronary CT angiography depicted in-stent low-attenuation filling defects with an accuracy of 91% and negative predictive value of 98.5% (95% confidence interval: 90.9, 99.9). Coronary CT angiography depicted the status of 97 of 107 stents. There was no significant difference between in-stent lumen visibility and stent diameter (P = .104). Coronary CT angiography helped diagnose 15 of 18 stent restenoses with less than 50% narrowing, five of five stent restenoses with 50%-74% narrowing, and nine of nine (100%) stent restenoses with 75% or greater narrowing or total occlusion of the stent lumen. CONCLUSION: Coronary CT angiography can depict in-stent low-attenuation filling defects, which appear to be a reliable sign of stent restenosis, and 64-section CT depicts such defects with a high degree of accuracy.     

Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1–10, group 3: score 11–100, group 4: score 101–400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk. Authors have no financial conflict of interest. Neither this paper nor any of its content has not been submitted to other journals.     

64层螺旋CT冠状动脉造影对冠状动脉狭窄的诊断价值

目的：评价64层螺旋CT冠状动脉造影（64-slice CTCA）诊断冠状动脉狭窄的临床应用价值。方法：对120例临床怀疑冠状动脉疾病及支架置入术、冠脉搭桥术后的患者进行64层螺旋CT冠状动脉成像。采用回顾性心电门控扫描,并采用曲面重建、多平面重组,容积再现及最大密度投影技术显示冠状动脉主干及分支,其中30例患者近期行传统冠状动脉造影（CCA）。结果：120例患者可评价冠脉节段1377个,可满足诊断的冠脉节段1341个,占97．39％。30例患者近期行CCA检查,MSCTCA诊断冠脉狭窄节段103个与CCA相符,占88．03％,显示轻、中、重度狭窄及血管闭塞与CCA符合率分别为77．8％、93．3％、91．6％、77．8％,得出64SCTCA诊断冠脉狭窄敏感性97．52％,特异性96．02％,阳性预测值95．16％,阴性预测值96．01％。结论：64层螺旋CT冠状动脉造影在诊断冠状动脉疾病方面有很高的诊断价值,可以成为筛查、排除冠状动脉病变及支架、搭桥术后随访的常规检查方法。     

Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography

PURPOSE: To prospectively evaluate the enhancement of coronary, pulmonary, and thoracic aortic vasculature by using biphasic single-acquisition 64-section computed tomographic (CT) angiography and to prospectively evaluate if differences in right side of the heart and coronary venous enhancement interfere with interpretation of coronary arteries. MATERIALS AND METHODS: With internal review board approval and HIPAA compliance, 50 patients (16 men, 34 women; mean age, 51.5 years; range, 30-75 years) with atypical chest pain were referred from the emergency department and were imaged with a 64-section CT scanner after premedication with oral atenolol and/or intravenous metoprolol. Thoracic CT angiography with retrospective gating was subsequently performed with a single biphasic injection of 130 mL of iso-osmolar contrast material (100 mL at 5 mL/sec and 30 mL at 3 mL/sec) in caudal-to-cranial acquisition. Coronary, aortic, and pulmonary arterial attenuation values were obtained. Coronary venous and right atrial enhancement were evaluated to assess whether there was interference with coronary artery evaluation. A two-tailed Friedman test was used to evaluate differences among segments within each artery. RESULTS: Mean coronary arterial, pulmonary arterial, and aortic attenuation values were significantly higher than the 250-HU threshold (P < .05). Mean pooled coronary arterial (288.9 HU +/- 64.8), pulmonary arterial (316.4 HU +/- 79.9), and aortic (329.9 HU +/- 63.3) attenuation values were significantly higher than the 250-HU threshold (P < .0001). Coronary venous enhancement did not affect depiction or interpretation of coronary arteries. Right atrial streak artifact focally traversed the right coronary artery in only one study. CONCLUSION: The aforementioned thoracic CT angiographic protocol provides enhancement of coronary, aortic, and pulmonary vasculature in a single breath hold without interference from right side of the heart streak artifact or coronary venous enhancement.     

CT angiography of the artery of Adamkiewicz with 64-section technology: first experience in children

BACKGROUND AND PURPOSE: Preoperative localization of the artery of Adamkiewicz (AKA) may be useful in selected children in prevention of ischemic spinal complications of spinal or thoracoabdominal aortic surgery. The aim of our study was to investigate the ability of 64-section CT for assessing the AKA in children. MATERIALS AND METHODS: Forty children (mean age, 7.5 +/- 5 years) underwent thoracic imaging with a 64-section CT scanner after intravenous injection of 1.5 mL/kg of contrast agent. Volumetric reconstructions were obtained for every patient. Identification of the AKA was performed on the basis of continuity from the aorta to the anterior spinal artery with a characteristic hairpin turn. Identification of the AKA and determination of its origin and course were analyzed by 2 independent radiologists. RESULTS: The AKA was successfully visualized in 38 patients (95%). Twenty-seven (71.1%) AKAs originated on the left side, whereas 11 (28.9%) originated on the right side. It was seen to originate at the level of the left 5th intercostal artery in 1 patient, the left 8th in 4, the left 9th in 15, the left 10th in 5, the left 11th in 2, the right 8th in 2, the right 9th in 6, the right 10th in 2, and the right 12th in 1. CONCLUSION: Sixty-four-section CT angiography depicted the AKA in a very high percentage (95%) of children. The results of this study suggest that 64-section CT angiography is a viable noninvasive technique that could be an alternate to selective angiography for delineating the AKA.     

64层螺旋CT与DSA在冠状动脉造影中的应用分析

目的 探讨并对比64层螺旋CT （MSCT）冠状动脉造影与DSA对冠状动脉各节段病变的检测情况.方法 收集2010年12月～2011年12月我院收治的92例患者64层螺旋CT和DSA检查临床资料.观察并比较两种方法对冠状动脉各阶段狭窄病变的检测情况.结果 CT检出冠脉狭窄的敏感度、特异度、阳性预测值和阴性预测值分别为91.1％、94.6％、90.0％和95.3％.经过与DSA对照,MSCT检测出的冠状动脉各段病变数、钙化斑块及非钙化斑块数与DSA相近.结论 64层螺旋CT与DSA在诊断冠状动脉各段病变及狭窄程度上准确度相似,具有一致性.64层CT在冠脉狭窄病变中具有重要的临床价值,值得在临床上广泛应用.     

64层螺旋CT冠状动脉成像评价冠状动脉钙化与狭窄的临床应用研究

目的探讨64层螺旋CT冠状动脉成像评价冠状动脉钙化和狭窄的临床应用价值。方法对32例临床确诊或疑诊冠状动脉粥样硬化性心脏病患者行64层螺旋CT冠状动脉成像。利用平扫图像进行钙化积分测量,冠状动脉CTA扫描后进行多平面重建（MPR）、曲面重建（CPR）及容积再现（VRT）,其中,9例行常规冠状动脉造影作对照,总结CTA的评价方法和显示情况,分析影响冠状动脉成像质量的因素。结果64层螺旋CT平扫能测定钙化积分,而MPR、CPR及VRT能多角度显示冠状动脉主干及主要分支,MPR与CPR对显示冠状动脉病变优于VRT。本组患者中,冠状动脉管壁欠光滑见于10例,管壁钙化11例,非钙化斑块15例,管腔狭窄18例。影响图像质量的因素主要是心率、心律及呼吸运动。结论64层螺旋CT冠状动脉成像是一种安全、快速、无创的诊断冠状动脉粥样硬化性心脏病的方法,也可作为筛查公众中冠状动脉病变的重要手段。     

定量评估64层螺旋CT血管成像与DSA显示冠状动脉狭窄的能力和可靠性

目的定量评估64层螺旋CT（MSCT）与DSA2种成像方法显示冠状动脉狭窄及支架内再狭窄的能力和可靠性。方法应用心脏动态体模，设定心率为0、50、70、90次／min，对内径3mm的模拟冠状动脉（内设25％、50％、75％3段狭窄）及内径4mm的模拟带支架冠状动脉（支架段内设50％、75％2段狭窄）分别进行MSCT与DSA成像，将MSCT与DSA对应数据进行分析。结果（1）MSCT对25％、50％、75％3段狭窄的平均测量值为（30．0±1．4）％、（49．5±1．3）％、（72．9±3．9）％（P值分别为0．005、0．531、0．369）；DSA分别为（24．8±2．0）％、（48．2±2．1）％、（75．3±2．4）％（P值分别为0．883、0．180、0．796）。（2）MSCT图像伪影随心率增快而增加，心率≥70次／min影响变明显；DSA不受心率影响，所有心率下都可清晰地显示狭窄程度，无伪影。（3）MSCT与DSA测量血管狭窄程度有较好的相关性（r=0．995，P=0．000）。（4）MSCT可同时显示支架及支架内狭窄，但显示支架内狭窄能力有限，对50％狭窄分别显示为（46．4±4．5）％（心率为0）和（43．6±5．7）％（心率为50次／min），与标准值（50％）相比，差异有统计学意义（P〈0．05）。DSA可清晰显示支架内狭窄，但不能很好显示支架形态。结论（1）MSCT与DSA评价冠状动脉狭窄结果可靠，MSCT受心率的影响大，时间分辨率有待提高，作为排除性诊断有很高的临床应用价值；MSCT对于支架内再狭窄的判断尚有一定局限性，但在管径较粗和低心率条件下评价支架内再狭窄有一定价值。     

64排螺旋CT血管成像在锁骨下动脉狭窄中的应用

目的 探讨64排螺旋CT对锁骨下动脉狭窄疾病的应用及诊断价值.方法 对临床怀疑锁骨下动脉狭窄患者8例进行64排CTA锁骨下动脉增强扫描,将获得的数据进行容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)、曲面重建(CPR),分析锁骨下动脉狭窄的部位及程度.结果 8例均获得清晰影像,锁骨下动脉均显示中重度狭窄,其中左侧5例,右侧3例;6例为单侧近端狭窄,2例为单侧近段和中段狭窄;有软斑块3例,硬斑块5例.结论 64排螺旋CT血管造影能快速、准确、清晰、无创地显示锁骨下动脉狭窄并评价狭窄性质、范围和程度,为临床进一步治疗提供重要信息.     

64层螺旋CT冠状动脉成像临床应用

目的：探讨64层螺旋CT（MSCT）冠状动脉成像方法显示冠状动脉狭窄的能力及可靠性。方法：对26例临床怀疑冠心病的患者行心脏冠状动脉CT成像（CTA）并与常规冠状动脉造影（CAG）结果进行比较分析。结果：以冠状动脉血管造影（CAG）为金标准,冠状动脉CTA影像判断血流动力学相关性冠状动脉狭窄（≥50%）的敏感度0.933、特异度0.974、准确度0.968、阳性预测值0.857、阴性预测值0.989。结论：64层螺旋CT冠状动脉成像是一种无创、简便、优良的冠状动脉成像方法,可作为冠状动脉粥样硬化的筛选手段及冠状动脉术后复查的首选方法。     

Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality

PURPOSE: To evaluate prospectively the effect of average heart rate and heart rate variability on image quality at 64-section computed tomographic (CT) coronary angiography. MATERIALS AND METHODS: The study protocol had local ethics committee approval; written informed consent was obtained. There were 125 patients (45 women, 80 men; mean age, 59.9 years +/- 12.9 [standard deviation]; 79 receiving beta-blockers) who underwent 64-section CT coronary angiography with retrospective electrocardiographic gating. Data sets were reconstructed in 5% steps from 20% to 80% of R-R interval. Heart rate variability was calculated as 1 standard deviation from mean rate during scanning. Two observers rated image quality of each coronary segment at least 1.5-mm diameter (1 = no motion artifacts, 5 = not evaluative). Repeated analysis of variance measurements were performed to evaluate quantitative parameters. Pearson correlation analysis was performed to compare image quality in each patient with average heart rate and heart rate variability. RESULTS: Average heart rate was 63.3 beats per minute +/- 13.1, with variability of 3.2 beats per minute +/- 2.1. Diagnostic image quality (score < or = 3) was attained in 1821 of 1836 segments at the best reconstruction interval. There was no correlation between mean heart rate and image quality for all segments of the right coronary and left anterior descending arteries, but there was a significant correlation for left circumflex artery (r = 0.33, P < .05). Heart rate variability was correlated with image quality overall (r = 0.75, P < .001) and for each coronary artery. Heart rate was less variable and image quality was better (P < .05) in patients receiving beta-blockers. Best image quality was obtained in diastole with heart rate less than 80 beats per minute and in systole with faster heart rate. CONCLUSION: Coronary angiography with 64-section CT provides diagnostic image quality within a wide range of heart rates. Reducing average heart rate and heart rate variability is beneficial for reducing artifacts.     

双能量冠状动脉CT成像定量评估冠状动脉钙化

摘要目的评价双能量CT成像应用虚拟非对比增强(VNC)CT序列量化冠状动脉钙化的可行性。材料与方法本研究获得伦理审查委员会的批准,并符合HIPAA规定。所有病人均签署书面知情同意书。对36例病人进行非对比增强CT钙化评分,随后行双能量冠状动脉CT成像。     

64层螺旋CT冠状动脉造影对冠状动脉瘘的诊断

先天性冠状动脉瘘(coronary artery fistula, CAF)是一种较为罕见的先天畸形,占先天性心脏病的0.2%~0.4%[1],临床表现缺乏特异性,常因心前区不适被误诊为冠心病.随着CT设备的飞速发展,多排螺旋CT诊断冠状动脉病变具有独特优势.本文收集冠状动脉CTA检查发现的10例冠状动脉瘘患者资料,旨在分析其CT影像特征及临床应用价值.