Comprehensive cardiac CT study: Evaluation of coronary arteries,left ventricular function,and myocardial perfusion—Is it possible?

With advances in multidetector computed tomography (MDCT) technology, the new generation of 64-slice MDCT scanners with submillimeter collimation and a faster gantry ratation allows imaging of the entire heart in a single breath-hold with excellent temporal and spatial resolution. This potentially permits a comprehensive assessment of coronary anatomy, left ventricular function, and myocardial perfusion. As will be seen in this review of the current literature regarding 16- and 64-slice MDCT, there is great promise for a comprehensive cardiac computed tomography (CT) study. The available data support the notion that CT coronary angiography may be an alternative to invasive coronary angiography in symptomatic patients with a low to intermediate likelihood of having coronary artery disease. By use of the same data acquired for CT coronary angiography, evaluation of global and regional left ventricular function and myocardial perfusion can be added to the MDCT evaluation without additional exposure to contrast medium or radiation and may provide a more conclusive cardiac workup in these patients. The potential applications and limitations of coronary stenosis detection, global and regional left ventricular function, and myocardial perfusion assessment by MDCT will be reviewed. The full potential of cardiac MDCT is just beginning to be realized.     

Assessment of global left ventricular function: comparison of cardiac multidetector-row computed tomography with angiocardiography

OBJECTIVE: Evaluation of left ventricular function using electrocardiogram (ECG)-gated multidetector row CT (MDCT) by using 3 different volumetric assessment methods in comparison to assessment of the left ventricular function by invasive ventriculography. METHODS: Thirty patients with suspected or known coronary artery disease underwent MDCT coronary angiography with retrospective ECG cardiac gating. Raw data were reconstructed at the end-diastolic and end-systolic periods of the heart cycle. To calculate the volumes of the left ventricle, 3 methods were applied: The 3-dimensional data set (3D), the geometric hemisphere cylinder (HC), and the geometric biplane ellipsoid (BE) methods. End-diastolic volumes (EDV), end-systolic volumes (ESV), the stroke volumes (SV), and ejection fractions (EF) were calculated. The left ventricular volumetric data from the 3 methods were compared with measurements from left ventriculography (LVG). RESULTS: The best results were obtained using the 3D method; EDV (r = 0.73), ESV (r = 0.88), and EF (r = 0.76) correlated well with the LVG data. The EDV volumes did not differ significantly between LVG and the 3D method (P = 0.24); however, ESV, SV, and EF differed significantly. The ESV were significantly overestimated (P < 0.01), leading to an underestimation of the SV (P < 0.01) and the EF (P < 0.01). The HC method resulted in the greatest overestimation of the volumes. The EDV and the ESV were 31.8 +/- 37.6% and 136.4 +/- 92.9% higher than the EDV and ESV volumes obtained by LVG. Bland-Altman analysis showed systematic overestimation of the ESV using the HC method. CONCLUSION: MDCT with retrospective cardiac ECG gating allows the calculation of left ventricular volumes to estimate systolic function. The 3D method had the highest correlation with LVG. However, the overestimation of the ESV is significant, which led to an underestimation of the SV and the EF.     

Left ventricular function studied with MDCT

Accurate determination of left ventricular (LV) myocardial function is fundamental for clinical diagnosis, risk stratification, and estimation of prognosis in patients with ischemic and nonischemic cardiomyopathy. Primarily, multi-detector-row spiral CT (MDCT) of the heart aimed at detecting coronary artery obstruction and cardiac morphology. Multiple studies have demonstrated that retrospectively, ECG-gated MDCT determination of LV volumes and consequently global LV function parameters is feasible in good agreement with established imaging modalities such as cineventriculography, echocardiography, and cine magnetic resonance imaging (CMR). Post-processing tools allow fast and semi-automatic determination of LV function parameters from MDCT data in analogy to known CMR evaluation approaches. Although MDCT is not considered to be first-line modality for LV function assessment, this technique provides accessory dynamic information in patients undergoing MDCT coronary angiography, contributing to combined assessment of cardiac morphology and function without need of additional radiation exposure. MDCT regional LV wall motion analysis at rest is feasible, but further improvement in temporal resolution seems mandatory to match results obtained from competing modalities. This paper will discuss the diagnostic potential of MDCT for assessment of LV function with regards to accuracy and clinical applications, as well as limitations, particularly in comparison with CMR as modality of reference.     

Assessment of cardiac function using multidetector row computed tomography

In patients with suspected or documented heart disease, a precise quantitative and qualitative assessment of cardiac function is critical for clinical diagnosis, risk stratification, management and prognosis. Cardiac CT is increasingly being used in diagnosis of coronary artery disease. Initially multi-detector row computed tomography (MDCT) was used chiefly for detecting coronary artery stenosis and assessment of cardiac morphology. Electron beam computed tomography has been shown to provide a highly accurate ejection fraction (+/-1%), with 50 ms image acquisition per image. Retrospective electrocardiographic gating allows for image reconstruction in any phase of the cardiac cycle. Thus, end systolic and end diastolic images can be produced to assess ventricular volumes and function. Despite lower temporal resolution than electron beam computed tomography, the ability of MDCT to assess ejection fraction is preserved. In the assessment of cardiac function, MDCT has been shown to be in good agreement with echocardiography, cineventriculography, single photon emission computed tomography and magnetic resonance imaging. The fast technical development of scanner hardware along with multisegmental image reconstruction has led to rapid improvement of spatial and temporal resolution and significantly faster cardiac scans. The same data that is acquired for MDCT angiography can also be used for evaluation of cardiac function. Considering contrast media application, radiation exposure, and limited temporal resolution, MDCT solely for analysis of cardiac function parameters seems not reasonable at the present time. However, because the data is already obtained during coronary evaluation, the combination of noninvasive coronary artery imaging and assessment of cardiac function with MDCT is a suitable approach to a conclusive cardiac workup in patients with suspected coronary artery disease. MDCT seems suitable for assessment of cardiac function by MDCT when results are held in comparison to magnetic resonance imaging as the reference standard. Given the radiation dose and contrast requirement, referring a patient to MDCT only for evaluation of function is not warranted, but rather adds important clinical information to the already acquired data during retrospective triggering for MDCT angiography.     

Evaluation of global left ventricular myocardial function with electrocardiogram-gated multidetector computed tomography: comparison with magnetic resonance imaging

RATIONALE AND OBJECTIVES: Electrocardiogram-gated 3D volume data from multidetector computed tomography coronary angiography (MDCT-CA) enable image reconstruction in any phase of the cardiac cycle. The objective was to determine left ventricular (LV) function parameters by MDCT in comparison to cine magnetic resonance imaging (MRI). METHOD: Thirty patients with known or suspected coronary artery disease (CAD) underwent MDCT-CA. From multiplanar reformations in short axis orientation end-diastolic and end-systolic LV volumes (LVEDV, LVESV) were determined to calculate LV stroke volume and ejection fraction (LVSV, LVEF) and compared with MRI measurements. RESULTS: LVEDV (147 +/- 27 mL) and LVESV (65 +/- 22 mL) determined by MDCT correlated well to the respective MRI measurements (LVEDV 133 +/- 27 mL, r = 0.80, P < 0.001; LVESV 48 +/- 19 mL, r = 0.89, P < 0.001). LVSV (MDCT 82 +/- 15 mL; MRI 85 +/- 17 mL; r = 0.77, P < 0.001) and LVEF (MDCT 56 +/- 9%; MRI 65 +/- 8%; r = 0.85, P < 0.001) showed a good correlation as well. LVEF was significantly underestimated by MDCT (-8.5 +/- 4.7%, P < 0.001). CONCLUSIONS: Initial experience in patients evaluated for CAD shows that spiral MDCT studies may provide LV functional data in good correlation to Cine MRI.     

多层螺旋CT定量评价左心室局部功能的可行性研究

目的:与3-DE对照,探讨多层螺旋CT冠状动脉造影所获得的数据,定量分析左心室局部功能的可行性及准确性。方法:选取临床拟诊或可疑冠心病患者20例,接受64-SCT冠状动脉造影检查后,1周内同时接受3-DE检查,使用设备自带心功能分析软件评价心功能。所有数据均以x±s形式表示,应用配对样本t检验及相关分析检验。结果:20患者采用64-SCT及3-DE两种方法测量乳头肌处左室前壁、侧壁、后壁及室间隔的EST、EDT厚度值,计算其增厚率,并进行配对t检验示左室前壁、侧壁、后壁及室间隔增厚率,差异无显著统计学意义(P>0.05);两种方法所得测量值均有较好的相关性(r分别为0.906,0.976,0.981,0.939),相关性检验有统计学意义,有显著差异性(P<0.05),散点图呈线性趋势。结论:64-SCT定量评价左心室局部功能具有可行性,其结果与3-DE高度相关;与其他影像学相比,64-SCT在一次冠状动脉造影检查的同时兼顾了形态学的显示与功能的分析。     

Assessment of myocardial infarctions using multidetector-row computed tomography

OBJECTIVE: To evaluate the diagnostic power of contrast-enhanced multidetector-row computed tomography (MDCT) in assessing the presence, age, and size of myocardial infarctions. METHODS: One hundred six patients underwent standard MDCT coronary angiography without additional changes in the protocol. In all patients, a complete patient history and left heart catheterization with biplane contrast ventriculography were available. The MDCT images were reviewed for the presence and age of myocardial infarctions in a blinded fashion. Infarct areas were detected as regions of reduced uptake of contrast in the early arterial phase and/or regional wall thinning. Reviewing the computed tomography (CT) images, CT density values (Hounsfield units [HU]) were measured at the site of infarcted and noninfarcted myocardium, and a volumetric assessment of the infarct size was performed. RESULTS: In 27 of 106 patients, myocardial infarctions were present. Multidetector-row computed tomography detected 23 of 27 infarctions (sensitivity of 85%, specificity of 91%, and accuracy of 90%). Comparing the HU of infarcted versus noninfarcted myocardium, the mean HU of infarcted areas was 54 +/- 19 HU versus 117 +/- 28 HU for noninfarcted myocardium (P < 0.01). Multidetector-row computed tomography was able to differentiate between recent and chronic infarctions. The infarct volumes of recent infarctions (6.3 +/- 3.6 cm) showed a negative correlation to the ejection fraction (EF) according to contrast ventriculography (ie, the larger the infarct volumes as measured using MDCT, the worse was the EF [r = -0.72, P < 0.01]). CONCLUSIONS: Performing standard MDCT coronary angiography, areas of infarcted myocardium can be identified with moderate to high sensitivity, without additional scanning or contrast administration. Infarct localization can be assessed accurately as compared with cineventriculography. To some degree, infarct age and infarct volume can be estimated.     

Combined functional and morphological imaging consisting of gated myocardial perfusion SPECT and 16-detector multislice spiral CT angiography in the noninvasive evaluation of coronary artery disease: first experiences

INTRODUCTION: Appropriate diagnosis and therapy of coronary artery disease (CAD) frequently require information about both the functional and morphological status of the coronary artery tree. We hypothesized that the combination of multislice spiral CT (MDCT) angiography and myocardial perfusion SPECT (MPI) provides accurate allocation of perfusion defects (PD) to their determining coronary lesion. METHODS: Twenty patients (14 male, mean age 64+/-9.2 years) with known CAD were retrospectively studied. Gated MPI, CT angiography using a 16-detector CT scanner, and conventional coronary angiography (CCA) were performed in each patient. Reversible and fixed PD were subsequently allocated to their determining lesion separately by different observers for MDCT angiography and CCA. RESULTS: All patients showed significant CAD in CCA; six patients with one-, six with two-, six with three-, and two with four-vessel disease; three patients had bypass grafts; and five patients had prior myocardial infarction. Correct diagnosis of CAD was stated in 14 of 20 patients by MDCT angiography. Five reversible and five fixed PD were detected in 9 of 20 patients; one patient showed both reversible and fixed PD. Five of five reversible PD could be allocated to appropriate coronary artery stenoses in CCA. In MDCT angiography, five of five reversible PD were allocated to the same lesions; all lesions were rated as >/=50%. CONCLUSIONS: The preliminary results of the present study show high accuracy for multislice spiral CT angiography to allocate reversible perfusion defects in myocardial scintigraphy to their determining coronary artery lesions in a small patient collective with known coronary artery disease.     

左心房粘液瘤320层CT影像分析

目的:评价320层CT诊断左心房粘液瘤的临床应用价值。方法:分析45例超声心动图检查诊断为左心房粘液瘤的患者,男28例,女17例,年龄49~79岁,平均59.2岁。应用320层CT心功能扫描模式,获得粘液瘤形态学影像,同时显示冠状动脉各分支图像,观察瓣膜开闭功能。结果:45例患者CT显示左心房内不规则肿块样充盈缺损,29例呈均匀软组织密度,16例伴有不规则高密度钙化。其中6例患者诊断为左心房粘液瘤合并冠心病,8例患者诊断为左心房粘液瘤伴二尖瓣关闭不全。结论:应用320层CT心功能扫描模式,不但可以显示左房粘液瘤心态特点,还可同时观察冠状动脉及二尖瓣的情况,为患者术前提供综合全面的影像学信息。减短患者术前检查时间,可使患者获得全面、有效的治疗。     

Measurement of coronary artery bifurcation angles by multidetector computed tomography

OBJECTIVE: Optimal stent deployment in coronary artery bifurcations requires information about the angle between main vessel and side branch. We evaluated the accuracy and interobserver variability of bifurcation angle measurements by contrast-enhanced 16-slice multidetector computed tomography (MDCT) in comparison with invasive angiography and examined the average angles of 4 main coronary bifurcations. METHODS: To determine the accuracy of MDCT for measurement of bifurcation angles, we scanned a coronary artery phantom containing 6 bifurcations (2-mm metal rods with angles between 25 degrees and 90 degrees ) using MDCT, and angles determined in the MDCT data set were compared with the true values. To assess interobserver variability of angle measurements in comparison to invasive angiography, the angles of 3 bifurcation sites (left anterior descending and left circumflex coronary artery [LAD/LCX], LAD and first diagonal branch [LAD/Diag 1], and posterior descending coronary artery and right posterolateral branch [PDA/Rpld]) were determined in 15 patients both in 16-detector row MDCT data sets and invasive coronary angiograms by 2 independent observers each. To assess the natural distribution of the 4 main coronary artery bifurcation angles (LAD and LCX, LAD and Diag 1, LCX and OM1, PDA and Rpld), the average angles of these bifurcations were determined in 16-slice MDCT data sets acquired for coronary artery visalization in a group of 100 consecutive patients with suspected coronary artery disease. RESULTS: The phantom study revealed a mean difference between measured and true angles of 0.7 +/- 0.5 degrees . In the comparison MDCT versus invasive angiography, the 45 angles were significantly lager in MDCT (mean: 66 +/- 20 degrees vs. 56 +/- 24 degrees , P = 0.027). Interobserver variability was significantly lower in MDCT (r = 0.91) than invasive angiography (r = 0.62). Analysis of the natural distribution of bifurcation angles by MDCT revealed average values of 80 +/- 27 degrees (LAD/LCX), 46 +/- 19 degrees (LAD/Diag1), 48 +/- 24 degrees (LCX/OM1), and 53 +/- 27 degrees (PDA/Rpld), respectively. CONCLUSION: MDCT allows assessment of coronary bifurcation angles with high accuracy, which may be of future potential for planning interventional treatment.     

Coronary-to-bronchial artery fistula: demonstration by 64-multidetector computed tomography with retrospective electrocardiogram-gated reconstructions

OBJECTIVE: The aim of this study was to evaluate the incidence of coronary-to-bronchial artery fistula (CBF) and clinical significance in 1300 patients examined with 64-multidetector computed tomography (MDCT) coronary angiography. METHODS: One thousand three hundred ten patients underwent coronary MDCT for atypical chest pain or screening. Volume-rendering and multiplanar reconstruction images were reviewed, and subsequent cineangiographies were compared. RESULTS: Eight cases of CBF were detected-6 originated from the left circumflex artery, and 2 originated from the right coronary artery. A hypertrophied anomalous branch of left circumflex artery was observed in 1 case, and underlying bronchiectasis was noted. Seven cases had a thin-wall communicating vessel. Subsequent cineangiography revealed identical appearance with MDCT reconstruction images. CONCLUSIONS: The incidence of CBF (0.61%) in this study is similar to those of a few cineangiographic studies in the literature. Our study showed that 64-MDCT coronary angiography is an accurate and noninvasive tool for detection of CBF.     

Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences.

Compared with conventional coronary angiography, spiral multidetector CT (MDCT) angiography has delivered promising accuracy in the detection and validation of coronary lesions. Myocardial perfusion imaging (MPI) using SPECT is an established method for noninvasively assessing the functional significance of coronary stenoses and delivers valuable information for risk stratification. This retrospective analysis compared the accuracies of MDCT angiography and MPI in the detection of hemodynamically relevant lesions of the coronary arteries. METHODS: Twenty-five patients with suspected or known coronary artery disease were studied. Electrocardiographically gated MPI and 16-MDCT angiography were performed. Myocardial perfusion images were analyzed by 2 experienced observers, and reversible and fixed perfusion defects were detected and allocated to their corresponding coronary vessels. For the evaluation of MDCT angiography, image quality was determined, and lesions > or = 50% and luminal narrowing < 50% were visually assessed and characterized by 2 independent observers unaware of the results of MPI. RESULTS: Ninety-nine coronary vessels were analyzed, and the quality of MDCT angiography images was assessed for 330 coronary segments. Coronary artery diameter was interpretable for 231 (70%) of 330 segments, whereas in 99 (30%) of 330 segments, vessel diameter could not be evaluated because of heavy calcifications, blurring, motion artifacts, or intracoronary stents. MDCT angiography detected stenoses > or = 50% in 15 of 100 coronary arteries. Eight (53%) of 15 stenoses > or = 50% showed reversible or fixed perfusion defects in the corresponding myocardial areas on MPI. Sensitivity, specificity, and negative and positive predictive values were 100%, 87%, 100%, and 29%, respectively, for the ability of MDCT angiography to detect reversible perfusion defects in the corresponding myocardial areas. CONCLUSION: MDCT angiography detected myocardial ischemia, as defined by reversible perfusion defects on MPI, with a positive predictive value of 29% in a nonselected study cohort. Compared with MPI alone, MDCT angiography added important morphologic information, but MPI remains mandatory for evaluating the functional relevance of coronary artery lesions.     

双源CT与超声心动图定量评价冠心病左心功能的比较研究

目的:以超声心动图为对照标准,探讨双源CT定量评价左心功能的可行性和准确性及其优势。方法:选取2011年1月～6月冠心病患者58例,其中合并II型糖尿病患者29例。全部病例于3天内行心脏双源CT及超声心动图检查。比较双源CT与超声心动图所测得的左心功能各参数。结果:双源CT和超声心动图所测左心功能各指标EDV、ESV、SV、EF相关性高(r=0.702～0.898),差异无统计学意义(P>0.05)。两种方法所测冠心病合并II型糖尿病组左心功能指标EDV、ESV值均较非糖尿病组测值高,EF值较低,差异均有统计学意义(P<0.05)。结论:两种方法评价左心功能相关性好,双源CT是一种评价左心功能准确可行的方法,一次冠状动脉造影所获得的数据,不但可评价左心功能,还可评价冠脉狭窄情况,无需额外增加对比剂和辐射剂量。     

Remarkable anatomic anomalies of coronary arteries and their clinical importance: a multidetector computed tomography angiographic study

OBJECTIVE: An anomalous origin and course of the coronary arteries can be benign or life threatening. Recently, because of new advances in computed tomography technology, radiologists have begun to interpret the diseases of coronary arteries. We aimed to demonstrate some remarkable anomalies of coronary arteries, some of which were not shown by multidetector computed tomography (MDCT) coronary angiography previously, and to discuss the clinical importance of these anomalies. MATERIALS AND METHODS: Seven hundred twenty-five consequent patients referred to Florence Nightingale Hospital and Atatürk University Hospital for MDCT coronary angiography were included in this study. The patients were between the ages of 33 and 78 years (mean +/- SD, 59 +/- 13.86 years). Four hundred ninety-seven patients (68.6%) were men, and 228 (31.4%) were women. All the examinations were evaluated by both a radiologist and a cardiologist. RESULTS: The incidence of anomalous anatomical origin and course of the coronaries found in our study group was 5.79% (n = 42). The anomalies found in our study are absence of the right coronary artery (RCA; n = 1, 0.13%), ectopic origin of RCA from the left anterior descending (LAD) artery (n = 1, 0.13%), absence of the left main coronary artery (n = 4, 0.52%), ectopic origin of the left main coronary artery from the right sinus of Valsalva (n = 1, 0.13%), double LAD and ectopic origin of LAD from RCA (n = 1, 0.13%), ectopic origin of the left circumflex artery from the right sinus of Valsalva (n = 3, 0.39%), ectopic origin of the left circumflex artery from RCA (n = 2, 0.26%), and myocardial bridging (n = 29, 4%). CONCLUSIONS: An anomalous origin of the coronary anatomy must be present in the interpretations because of its importance for patients, cardiologists, and surgeons. As a conclusion, our study showed that MDCT, especially volume rendering and maximum intensity projection techniques, may be useful for assessment of complex variations, when the conventional angiography may not be sufficient.     

Detection,visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT

Early identification and evaluation of relatively frequent anomalous coronary anatomy is quite relevant because of the occurrence of sudden cardiac death or related symptoms of myocardial ischemia. Selective coronary angiography (CAG) is invasive, expensive and cannot always provide the required information adequately. Recently, non-invasive imaging techniques such as magnetic resonance imaging and multidetector-row computed tomography (MDCT) have been shown to provide a good anatomical view of the coronary artery tree. This study aims to demonstrate the value of 16-MDCT for evaluation of anomalous coronary anatomy. In 13 patients scanned using 16-MDCT, six different coronary anomalies were diagnosed [two absent left main, one single vessel left coronary artery (LCA), three LCA originating from the right (two with interarterial course), six right coronary artery originating from the left, one double left anterior descending (LAD)]. Mean diagnostic quality, recorded by two observers using a 5-point scale (1= non-diagnostic to 5= excellent diagnostic quality), resulted in a mean score of 3.73 (SD 1.19) without any non-diagnostic result. MDCT offers an accurate diagnostic modality to visualize the origin and course of anomalous coronary arteries by a three-dimensional display of anatomy. Shortcomings in CAG can be overcome by the use of contrast-enhanced MDCT.     

Assessment of Left Ventricular Function and Volume in Patients Undergoing 128-Slice Coronary CT Angiography with ECG-Based Maximum Tube Current Modulation: a Comparison with Echocardiography

Objective

To compare multi-detector CT (MDCT) using 128-slice coronary CT angiography (Definition AS+, Siemens Medical Solution, Forchheim, Germany) with ECG-based maximum tube current modulation with echocardiography for the determination of left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV), as well as assessing coronary artery image quality and patient radiation dose.

Materials and Methods

Thirty consecutive patients (M:F = 20:10; mean age, 57.9 ± 11.4 years) were referred for MDCT for evaluation of atypical chest pain. EF, EDV and ESV were determined for both MDCT and echocardiography, and the correlation coefficients were assessed. Coronary artery segment subjective image quality (1, excellent; 4, poor) and radiation dose were recorded.

Results

Left ventricular EF, EDV, and ESV were calculated by MDCT and echocardiography and the comparison showed a significant correlation with those estimated by echocardiography (p < 0.05). Consistently, the LVEFs calculated by MDCT and echocardiography were not statistically different. However, LV, EDV and ESV from MDCT were statistically higher than those from echocardiography (p < 0.05). The average image quality score of the coronary artery segment was 1.10 and the mean patient radiation dose was 3.99 ± 1.85 mSv.

Conclusion

Although LV volume was overestimated by MDCT, MDCT provides comparable results to echocardiography for LVEF and LVV, with a low radiation dose.     

Multidetector CT arteriography with volumetric three-dimensional rendering to evaluate patients with metastatic colorectal disease for placement of a floxuridine infusion pump

OBJECTIVE: We sought to evaluate the usefulness of multidetector CT (MDCT) arteriography with volumetric three-dimensional (3D) rendering to depict the hepatic vascular anatomy. Our study population was patients who had undergone arterial mapping in preparation for placement of a hepatic arterial floxuridine infusion pump for treatment of metastatic hepatic colorectal carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 26 patients with hepatic colorectal metastases who had been scheduled for implantation of a hepatic artery pump. Before surgery, all patients underwent MDCT arteriography with volumetric 3D rendering of the hepatic vessels. The axial and 3D arteriograms were evaluated for their usefulness in depicting hepatic arterial anatomy. Subsequently, three patients also underwent catheter angiography. Twenty-two of the 26 patients imaged had a hepatic artery floxuridine infusion pump implanted. Results of the CT arteriography were correlated with findings at surgery or on catheter angiography if surgery was not performed. RESULTS: MDCT arteriography correctly revealed hepatic arterial anatomy in all 25 patients with angiographic or surgical confirmation. One patient with aberrant hepatic arterial anatomy did not have angiographic or surgical confirmation. Classic hepatic arterial anatomy was identified in 16 (64%) of 25 patients. The following hepatic arterial variants were found in one patient each: the common hepatic artery arising directly from the aorta; a replaced left hepatic artery; an accessory right hepatic artery; a replaced left hepatic artery and accessory right hepatic artery; a replaced right hepatic artery; a right hepatic arterial branch arising early (before the origin of the gastroduodenal artery); and replaced right and left hepatic arteries. Three patients were not suitable candidates for placement of a hepatic artery floxuridine pump. The patient who had no angiographic or surgical confirmation was also not considered a good surgical candidate because of replaced right and left hepatic arteries. Two patients (8%) had an accessory left hepatic artery. CONCLUSION: MDCT arteriography with volumetric 3D rendering is an accurate, noninvasive method of depicting hepatic arterial anatomy and, therefore, of selecting patients with colorectal metastatic disease who could benefit from hepatic artery pump implantation. Catheter angiography provides no additional information, and we have eliminated it as a routine preoperative imaging examination.     

Assessment of left ventricular function by ECG-gated myocardial perfusion scintigraphy with image inversion technique: Comparison with equilibrium radionuclide angiography

BACKGROUND: Inversion of gated myocardial perfusion imaging has been proposed for the evaluation of left ventricular function. This study compared the results of inversion technique of gated left anterior oblique 45 degrees images (G-LAO 45 degrees) with those provided by equilibrium radionuclide angiography in the assessment of global left ventricular function in the same patients with suspected or known coronary artery disease. METHODS AND RESULTS: A total of 107 patients (85 men and 22 women, mean age 59 +/- 9 years) with suspected or documented coronary artery disease were studied. Eighty-seven underwent a 2-day stress/rest technetium-99m sestamibi single photon emission computed tomography with acquisition of G-LAO 45 degrees images on the day of rest, and 20 underwent thallium-201 stress/redistribution single photon emission computed tomography with G-LAO 45 degrees image acquisition immediately after redistribution imaging. An excellent correlation (P < .001) with no significant differences was found between left ventricular ejection fraction values provided by inversion G-LAO 45 degree and radionuclide angiography in 87 patients studied with Tc-99m sestamibi and 20 patients studied with TI-201. The Bland-Altman analysis demonstrated the difference in absolute ejection fraction values obtained by inversion G-LAO 45 degree images and radionuclide angiography as <8%. The inversion G-LAO 45 degrees left ventricular ejection fraction distinguishes the patients with myocardial infarction (ejection fraction = 43% +/- 13%) and without myocardial infarction (ejection fraction = 60% +/- 5%) (P < .001). In patients with left ventricular ejection fraction <40%, inversion G-LAO 45 degree images provide evaluation of left ventricular function comparable with that obtained by RNA. CONCLUSIONS: Semiautomated myocardial perfusion gated inversion technique analyzed with a count-based method is useful in the evaluation of left ventricular function and provides similar results to those of radionuclide angiography.     

冠心病患者左室Tei指数与左室心肌质量的相关性分析

目的:探讨冠心病患者左室Tei指数与左室心肌质量的相关性。方法:应用脉冲多普勒超声测量34例冠心病患者和34例正常人的左室Tei指数,并进行比较。应用实时三维超声心动图(RT-3DE)测量34例冠心病患者的左室心肌质量(LVM)、左室心肌质量指数(LVMI),分析冠心病患者Tei指数与LVM、LVMI的相关性。结果:冠心病患者的Tei指数明显大于正常对照组(P<0.001)。冠心病患者Tei指数的升高与LVM和LVMI的增加呈正相关(r=0.784,r=0.808)。结论:冠心病患者Tei指数与LVM密切相关,可以综合反映冠心病患者左室功能。     

Three-dimensional fusion of coronary arteries with myocardial perfusion distributions: clinical validation.

Clinical decisions regarding diagnosis and effective treatment of coronary artery disease frequently require integration of information from various imaging modalities, which are acquired, processed, and read at different physical locations and times. We have developed methods to integrate the information in 2 cardiac imaging studies, perfusion SPECT and coronary angiography. Three-dimensional (3D) models of the coronary artery tree created from biplane angiograms were automatically aligned with 3D models of the left ventricular epicardial surface created from perfusion SPECT. Myocardial mass at risk was used as a unique measure to validate the accuracy of the unification. METHODS: Thirty patients were injected with the perfusion agent (99m)Tc-tetrosfosmin during balloon occlusion while undergoing percutaneous transluminal coronary angioplasty for single-vessel coronary artery disease. Thus, a single, severe perfusion defect was induced by a single coronary artery occlusion of known severity and placement. The accuracy of the unification was measured by computing the overlap between physiologic area at risk, determined using SPECT perfusion quantification techniques only, and anatomic area at risk, determined using coronary artery anatomy aligned with the epicardial surface of the left ventricle. RESULTS: The unification resulted in an 80% overlap of areas at risk, and an overlap of 84% of normal areas, for all coronary artery distributions. The mass at risk measured based on the unified anatomic information correlated with the physiologically based mass at risk as y = 0.92x + 10.3 g; r = 0.76, SEE = 10.4 g. CONCLUSION: A unification algorithm for automatically registering 3D models of the epicardial surface from perfusion SPECT and 3D coronary artery trees from coronary angiography has been presented and validated in 30 patient studies.