Spiral multislice computed tomography coronary angiography: a current status report

Multislice computed tomography coronary angiography (MSCT-CA) has emerged as a powerful noninvasive diagnostic modality to visualize the coronary arteries and to detect significant coronary stenoses. The latest generation 64-slice computed tomography (CT) scanners is a robust technique which allows high-resolution, isotropic, nearly motion-free coronary imaging. Coronary stenoses are detected with high sensitivity and a normal scan accurately rules out the presence of a coronary stenosis. With the introduction of further novel concepts in CT-technology one may expect that MSCT-CA will become a clinically used diagnostic tool.     

多层螺旋计算机断层扫描血管造影对冠状动脉易损斑块的检测作用

目的 评价多层螺旋计算机断层扫描（computed tomography,CT）血管造影（multislice computed tomography angiography,MSCTA）检测冠状动脉易损斑块的可靠性,建立急性冠脉综合征积分（score system of acute coronary syndromes,SACS）,用于评估冠状动脉粥样硬化性心脏病（冠心病）患者危险分层.方法 研究20例非急性冠脉综合征及41例急性冠脉综合征且冠状动脉MSCTA发现斑块的患者,比较两组斑块CT值、重构指数（RI）等指标,进而构建急性冠脉综合征发病风险预测模型.结果 两组病变血管99支,可分析斑块1 17个,非急性冠脉综合征组36个,以钙化斑块为主（88.9％,32/36）;急性冠脉综合征组81个,以脂质斑块为主（37.0％,30/81）.两组正性重构比例比较,差异有统计学意义（61.1％ vs.32.1％,P＜0.01）;负性重构比例比较,差异有统计学意义（25.0％vs.19.8％,P＜0.01）.由RI建立SACS,所得模型为：SACS=0.003PA＋2.255RI-4.22,预测准确率为76.9％（P＜0.01）,受试者工作曲线下面积为0.815（P＜0.01）.结论 急性冠脉综合征患者冠状动脉斑块多为脂质斑块,以正性重构为主,SACS对急性冠脉综合征发病具有较高的预测价值,有助于临床指导冠心病危险分层及早期干预.     

Noninvasive coronary angiography by contrast-enhanced electron beam computed tomography

Electron beam computed tomography (EBCT) is a cross-sectional imaging method with high temporal and spatial resolution. So far, it has mainly been applied for the detection of coronary artery calcifications which permit the very sensitive detection of coronary atherosclerosis even in the very early stages. However, after intravenous injection of a contrast agent, EBCT also permits the direct visualization of the coronary artery lumen. For these investigations, a volume data set is acquired that consists of 40 axial cross-sections of the heart (3 mm slice thickness). To evaluate the coronary arteries as to the presence of stenoses and occlusions, various forms of postprocessing, including shaded surface display, maximum intensity projection, and multiplanar reconstruction, are applied. The sensitivities and specificities for the detection of coronary artery stenoses and occlusions are about 90%. Best results are obtained for coronary artery bypass grafts, the left main coronary artery, and the left anterior descending coronary artery, while reduced image quality impairs the results for the right coronary artery and the left circumflex coronary artery.     

多层螺旋CT在急性冠状动脉综合征诊断中的应用

急性冠状动脉综合征(ACS)是在动脉粥样硬化的基础上,斑块破裂、表面破损或裂纹引起血栓形成,导致冠状动脉不完全或完全闭塞,使心肌发生缺血或不同程度坏死的一组临床综合征。多层螺旋CT是一种新的无创性影像诊断技术,近年来临床已使用该技术检测冠状动脉狭窄和钙化,多层螺旋CT不仅可以评价冠状动脉狭窄或闭塞,还可以评价冠状动脉斑块的性质和心肌血流灌注情况。本文综述多层螺旋CT在ACS诊断中的作用。     

Coronary angiography by computed tomography: coronary imaging evolves

Rapid technological advances have facilitated high-resolution noninvasive coronary angiography using multislice computed tomography. Appropriateness guidelines recently have been published in the Journal of the American College of Cardiology and endorsed by several imaging specialty societies. Clinical studies are now available supporting the use of this method in selected diagnostic situations, particularly when the exclusion of coronary artery disease is of paramount clinical concern.     

64层CT冠状动脉成像技术和冠状动脉造影对冠状动脉疾病诊断的对照研究

目的比较64层计算机断层摄影扫描冠状动脉成像技术(64-slice computed tomography coronaryangiography,64-SCTCA)和冠状动脉造影(coronary artery angiography,CAG)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的价值。方法回顾性分析126例疑似冠心病的患者64-SCTCA和CAG检查资料,并对两组资料进行对比分析。结果 64-SCTCA和CAG检查结果中可用于评价的病变血管段支数比较,差异无统计学意义(P0.05)。CAG共发现≥50%狭窄节段242个,64-SCTCA共发现≥50%狭窄节段199个,两种检查方法对病变狭窄的显示情况比较,差异无统计学意义(P0.05)。全部126例冠心病患者中有91%通过64-SCTCA发现(110/121)。64-SCTCA诊断冠状动脉病变血管的敏感性、特异性、阳性预测值、阴性预测值分别为81.6%、98.8%、79.5%、99%。结论 64-SCTCA可作为冠心病无创、便捷、可靠的检查方法。     

Cardiac arrest in a soccer player: a unique case of anomalous coronary origin detected by 16-row multislice computed tomography coronary angiography

Anomalous origin of the coronary arteries may be present in otherwise normal subjects without clinical significance, but can also be the cause of myocardial ischemia and sudden death in both adults and teenagers. In particular, the origin of the left main coronary artery or left anterior descending artery from the right sinus of Valsalva or right coronary artery may result in compression of the vessel during or immediately after exercise. We present a unique case of coronary anomaly with four separate coronary ostia originating from the right coronary sinus in a soccer player with sudden cardiac arrest. Multislice contrast-enhanced computed tomography has emerged as a valid noninvasive method for the diagnosis of coronary artery anomaly.     

多层面螺旋CT冠状动脉成像在冠心病中的应用

目的　评价多层面螺旋CT(MSCT)行冠状动脉血管造影和三维重建在冠心病中的应用价值。方法　对 30例冠心病患者进行了心电门控MSCT增强扫描 ,在工作站对图像资料进行了最大密度投影法 (MIP)三维重建 ,并与冠状动脉造影结果相对照。结果　 30例患者中对 12 0支冠状动脉血管 (左主干、左前降支、回旋支、右冠状动脉 )进行了MSCT三维重建 ,图像质量良好者为 84支 (70 % ) ,影响图像质量的主要因素是心脏搏动造成的伪影 ;9例冠状动脉支架和 5例冠状动脉搭桥术后均可清晰显示支架和血管桥的位置及远端血流情况 ,对于显示近中端高度 (>75 % )或完全梗阻性病有一定的准确性 (敏感性 80 % ,特异性 79.8% )。而不能显示轻度狭窄病变、远端或细小分支病变。结论　MSCT血管造影和三维重建在冠心病诊断和对病变血管的评价 ,以及血运重建术后复查等方面有一定的应用价值。     

Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia

Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.     

Anomalous coronary arteries in adults detected by multislice computed tomography: presentation of cases from multicenter registry and review of the literature

Anomalous coronary arteries are a rare condition, but they may cause myocardial ischemia, heart failure, and sudden death. We evaluated the prevalence and multislice computed tomographic (MSCT) findings of anomalous coronary arteries in a large number of patients from the multicenter registry. At four institutes, 29 (0.74%) out of 3910 patients were found to have anomalous coronary arteries by MSCT. They consisted of 15 patients with anomalous origins of the right coronary artery, 1 with right-sided origin of the left circumflex artery, 1 with right-sided origin of the left main coronary artery, 2 with double right coronary arteries, 2 with the absence of the left circumflex artery, 1 with absence of the right coronary artery, 6 with coronary artery fistulas, and 1 with Bland-White-Garland syndrome. Multislice computed tomography findings were consistent with those obtained by conventional coronary angiography in all 14 patients undergoing both diagnostic procedures. Multislice computed tomography permits three-dimensional comprehension of coronary arteries, which is suitable for the diagnosis of anomalous coronary arteries.     

Left anterior descending coronary artery myocardial bridging detected by 64-multidetector computed tomography

A 59-year-old female came to the clinic to evaluate an operation risk of knee joint arthritis. She has history of hypertension for 6 years. She complained of dyspnea on exercise before. Radionuclide imaging demonstrated large moderate perfusion defect in anterior, anteroseptal, and anterolateral regions with significant reversibility. ECG gated 64-multidetector computed tomography demonstrated the middle third of the left anterior descending coronary artery myocardial bridging. The length of tunneled artery was 23 mm and the depth of tunneled artery was 3 mm. Coronary angiogram confirmed the middle third of the left anterior descending coronary artery myocardial bridging. Multidetector computed tomography is a reliable and noninvasive tool for diagnosing coronary myocardial bridging.     

Accuracy of thin-slice computed tomography in the detection of coronary stenoses.

AIM: Our aim was to investigate the accuracy of multislice spiral computed tomography (MSCT) in the detection of significant (>50%) coronary stenosis using a scanner equipped for 16 x 0.625 mm collimation. METHODS: In 64 patients (59 male, mean age 58 +/- 5 years) with suspected coronary artery disease, MSCT (GE Light Speed-16, collimation: 16 x 0.625 mm) was performed 20 +/- 5 days before coronary angiography (CAG). Only angiographic segments >1.5 mm were considered for analysis. RESULTS: In all patients, MSCT was carried out without complications. Three patients were excluded from the analysis. Of 729 angiographic segments, 613 (84%) were judged evaluable by MSCT. Considering only the segments judged evaluable, the sensitivity was 89%, specificity 98%, positive predictive value 90%, and negative predictive value 98%. Including all segments in the analysis (evaluable and nonevaluable), sensitivity was 78%. CONCLUSIONS: Using a scanner with a collimation of 16 x 0.625 mm, our study confirms the potential role of MSCT in the detection of significant coronary stenosis with a sensitivity of 89% and a very high specificity (98%). Exclusion criteria and less than full evaluability of the coronary arteries must still be considered limitations of the method.     

冠状动脉多层螺旋CT成像及冠脉造影对冠脉搭桥术后桥血管的评价

目的观察冠状动脉多层螺旋CT成像及冠脉造影对冠脉搭桥手术后桥血管的评价作用。方法33例冠脉搭桥手术患者,术前常规冠脉造影检查,手术行不停跳冠脉搭桥术,手术后1 a行冠状动脉多层螺旋CT成像,并于冠状动脉多层螺旋CT成像复查后1周内行冠脉造影检查。结果33例患者共行冠脉搭桥101支,冠状动脉多层螺旋CT成像能够成功显示99支,显示率为98.02%。冠状动脉多层螺旋CT成像与冠脉造影结果对比,其对冠脉搭桥手术后桥血管狭窄和阻塞评价敏感度达100%。结论应用冠状动脉多层螺旋CT成像对冠脉搭桥术后桥血管评价简便、无创,具有较好的可信性和可行性。     

冠状动脉CT造影评估冠状动脉钙化进展及临床意义

冠状动脉粥样硬化是冠心病的病理学基础,而冠状动脉钙化是粥样硬化病变的重要标志。检测和评估冠状动脉钙化不仅对预测心血管事件有重要意义,还有助于了解疾病进展,从而更好地指导临床诊治。冠状动脉CT造影(CCTA)是对冠状动脉钙化斑块进行精确量化评估的无创检查手段,其对于定量冠状动脉钙化以及预后评估具有重要的临床价值。本文对冠状动脉钙化CCTA检测方法及其临床应用等进行综述。     

Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography (CCTA).METHODS: A total of 350 CCTA of Saudi patients were included in this study (236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications (typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association.RESULTS: Myocardial bridging was found in 89 of 350 (22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending (LAD) (24.6%), followed by distal LAD (3.7%), diagonal branches (2%), ramus intermedius artery (1.4%) and obtuse marginal artery (0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females (P = 0.14). Coronary artery atherosclerosis was found in 51 of 89 (57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35 (94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries.CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.     

A new method of three‐dimensional coronary artery reconstruction from X‐ray angiography: Validation against a virtual phantom and multislice computed tomography

Objective : To develop and implement a method for three‐dimensional (3D) reconstruction of coronary arteries from conventional monoplane angiograms. Background : 3D reconstruction of conventional coronary angiograms is a promising imaging modality for both diagnostic and interventional purposes. Methods : Our method combines image enhancement, automatic edge detection, an iterative method to reconstruct the centerline of the artery and reconstruction of the diameter of the vessel by taking into consideration foreshortening effects. The X‐Ray‐based 3D coronary trees were compared against phantom data from a virtual arterial tree projected into two planes as well as computed tomography (CT)‐based coronary artery reconstructions in patients subjected to coronary angiography. Results : Comparison against the phantom arterial tree demonstrated perfect agreement with the developed algorithm. Visual comparison against the CT‐based reconstruction was performed in the 3D space, in terms of the direction angle along the centerline length of the left anterior descending and circumflex arteries relative to the main stem, and location and take‐off angle of sample bifurcation branches from the main coronary arteries. Only minimal differences were detected between the two methods. Inter‐ and intraobserver variability of our method was low (intra‐class correlation coefficients > 0.8). Conclusion : The developed method for coronary artery reconstruction from conventional angiography images provides the geometry of coronary arteries in the 3D space. © 2008 Wiley‐Liss, Inc.     

64层螺旋CT与冠状动脉造影诊断冠状动脉狭窄的对比研究

目的评价64层螺旋CT冠状动脉成像(64-slice spiral computed tomographic coronary angiography,64-SCTCA)对冠状动脉各节段狭窄病变的诊断价值。方法85例疑诊为冠状动脉性心脏病(冠心病)患者,先后行64-SCTCA和冠状动脉造影(coronary angiography,CAG)检查,评价64-SCTCA诊断冠状动脉各节段狭窄病变的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果①在CAG可清晰显影的744个节段中,64-SCTCA造影可清晰显示和评价的占639段(85.89%),另外105段(14.11%)显影不清。左主干和前降支可评价节段的比例显著高于左回旋支和右冠状动脉(P0.001),同一支血管中近段可评价的比例显著高于远段(P0.001);②64-SCTCA诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为96.23%、90.63%、94.44%、93.55%、94.12%。按可评价节段计算,64-SCTCA诊断冠状动脉各节段有意义狭窄病变总的敏感性、特异性、准确性、阳性和阴性预测值分别为89.06%、95.89%、84.44%、95.33%、94.32%;③按可评价节段计算,64-SCTCA对诊断左主干、左前降支、左回旋支和右冠状动脉各节段病变的价值相似,但检测冠状动脉近中段病变的价值高于远段(χ2=4.66,P=0.03)。结论64-SCTCA对冠状动脉狭窄病变有较好的诊断价值,其检测左主干和左前降支病变的价值高于左回旋支和右冠状动脉,对冠状动脉近段病变的诊断价值高于远段,适合于冠心病的筛查。