Imaging of coronary artery anomalies using ECG-gated 64-row computed tomography angiography

Objective

To shed light on coronary artery anomalies among cardiac patients using ECG-gated 64-row MDCTA during assessment of coronary arteries.

Patients and methods

Study included 840 patients out of whom twenty-one patients have congenital coronary artery anomalies. Patients were examined using ECG gated 64-row MDCT; 80–100 ml contrast agent, followed by a 50 ml saline chaser injected at 5 ml/s, 350 ms gantry rotation time, 0.65 mm detector collimation, ECG tube current modulation and 100–120 kV. Post-processing was done on second workstation including 3D VR, MPR and CMPR images.

Results

Anomalies of the coronary arteries were diagnosed in twenty-one patients. The prevalence of congenital anomalies in this study was 2.5% and included: anomalous origin of right coronary artery in 4 cases (0.48%), anomalous origin of left circumflex artery in 3 cases (0.36%), myocardial bridging of LAD in 12 cases (1.4%) and coronary artery fistula in 2 cases (0.24%).

Conclusion

Coronary artery anomalies are not uncommon among cardiac patients. Myocardial bridging is the most common followed by anomalous origin and proximal course and lastly coronary artery fistula. 64-Row MDCTA is an excellent promising modality and should be the first non-invasive diagnostic tool to rule out such anomalies.     

Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

Objective

Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance.

Material and methods

A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study.

Results

The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen.

Conclusion

Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.     

Sixty four multi-detectors CT coronary angiography: An easy and accurate method to detect graft patency post CABG

Objective

To assess the accuracy of coronary CTA in detection of coronary artery bypass graft patency, occlusion and stenosis.

Patients and methods

Twenty-four patients with past history of coronary bypass surgery were included in this study and underwent MDCT coronary angiography. Invasive coronary angiography was done within 2 weeks of MDCT coronary angiography. All grafts considered patent were then evaluated for the presence of significant stenosis. Significant stenosis was defined as reduction in diameter of more than 50%.

Results

All the MDCT scans were interpretable and a total number of 78 CABG conduits were analyzed. At MDCT angiography 4 (5.2%) grafts were classified as occluded and 74 (94.8%) grafts were patent. Significant stenosis was detected in 7 (9.4%) out of the 74 patent grafts. At invasive coronary angiography; when occlusion and significant stenosis pooled together they were 9 grafts; 4 arterial and 5 venous. All these 9 grafts were detected at MSCT (sensitivity is 100%). In 67 out of 69 grafts occlusion or significant stenosis was correctly ruled out (specificity 97.1%). The diagnostic accuracy of MDCT angiography when compared with invasive angiography was 97.4%. The negative predictive value was 100% and positive predictive value was 81.8%.

Conclusion

MDCT coronary angiography is an accurate imaging technique for the evaluation of CABG patency and in detection of graft stenosis and confirms of previous studies using 64 MDCT.     

Multidetector CT chest with bronchial and pulmonary angiography determining causes,site and vascular origin of bleeding in patients with hemoptysis

Objective

To assess the role of MDCT chest with bronchial and pulmonary angiography in determining the cause, site of bleeding, and its vascular origin in patients presenting with hemoptysis.

Materials and methods

Fifty patients suffering from hemoptysis were evaluated by MDCT with bronchial and pulmonary angiographic techniques.

Results

MDCT chest with angiography revealed the cause in 84% of cases, the site and vascular origin in 76% of cases presenting with hemoptysis.

Conclusion

MDCT of the chest with bronchial and pulmonary angiography is considered a primary noninvasive imaging modality in the evaluation of patients with hemoptysis. It also serves as a guide for other diagnostic or therapeutic procedures.     

Multidetector computed tomography (MDCT) angiography of thoracic aortic coarctation in pediatric patients: Pre-operative evaluation

Objective

The purpose of this study was to evaluate the reliability of 64-slice multi-detector computed tomographic (MDCT) angiography in pre-operative assessment of coarctation of thoracic aorta of pediatric age groups using 64 multislice CT scanner.

Materials and methods

Twenty four patients with clinical suspicion of coarctation of the thoracic aortic anomalies who underwent both Doppler echocardiography and MDCT angiography were included in the study. MDCT angiography findings were compared with both Doppler echocardiography and surgical results.

Results

The overall sensitivity of the MDCT angiography for diagnosis of the extra-cardiac aortic anomalies was 100% which was higher than that of Doppler echocardiography (92%). The overall sensitivity of MDCT angiography for the assessment of cardiac defects was 85% which was lower than that of Doppler echocardiography (100%).

Conclusion

We concluded that MDCT angiography with multiplanar and three dimensional techniques can be considered the modality of choice for pre-operative assessment of coarctation of the thoracic aorta in pediatric patients.     

Myocardial bridging as evaluated by 16 row MDCT

Purpose

The purpose of this study is to find out the prevalence, appearance and clinical symptoms of myocardial bridging (MB) by MDCT coronary angiography (CTA).

Materials and methods

A total of 280 (50 females) consecutive patients followed with coronary artery disease or postoperative stent and bypass control, underwent CTA performed by 16-MDCT scanner between January 2006 and April 2006. Short axis multiplanar reformatted images were evaluated. MBs were classified as complete and incomplete bridges with respect to continuity of the myocardium over the tunneled segment of left anterior descending artery (LAD) in interventricular groove and the cut-off value is 1.3 mm. Patients diagnosed with MB on CTA who had prior catheter angiography studies were re-evaluated for the presence of MB.

Results

One hundred and twenty MBs [98 (81.6%) on LAD, 2 (1.6%) on diagonal branch, 11 (9.1%) on obtuse marginal, 4 (3.3%) on right coronary artery, 5 (4.1%) on ramus intermedius artery] were detected in 108 (38.5%) patients. Eighty-five (70.8%) of bridged segments in 79 (28.2%) patients were complete and the rest [35 (29.2%) in 34 (12.1%) patients] were incomplete. In 12 patients two MBs (either on different arteries or on the same artery) were detected. The length of bridged segments in patients with complete and incomplete MBs varied between 4–50.9 mm (mean 18 mm) and 4–37.3 mm (mean 13.6 mm), respectively, and the depth of myocardium over the artery ranged between 1–6.4 mm (mean 2.3 mm) and 1–1.2 mm (mean 1 mm), respectively. Thirty (27.7%) out of 108 patients, in whom MB was detected on CTA, were found to have correlative catheter angiography studies, retrospectively and MB was detected only in 4 (13.3%) out of 30 patients.

Conclusion

MDCT coronary angiography is a non-invasive, efficient method in the diagnosis of MB avoiding the procedural risks that catheter angiography carries. MDCT coronary angiography allows direct visualization of the bridge itself and may thus give the opportunity to differentiate between complete and incomplete myocardial bridges.     

Role of multi-slice CT angiography in the evaluation of pulmonary venous anomalies

Purpose and aim

To assess the role of MSCT angiography in evaluation of extra-cardiac vascular abnormalities in pulmonary venous anomalies and compare it with echocardiography.

Materials and methods

This study included 26 patients with an age range of 15 days–25 years. All of these patients underwent MSCT angiography and echocardiography. Only 10 patients underwent cardiac catheterization.

Results

Our initial experience showed that MSCT is capable of complementing echocardiography and replacing diagnostic cardiac catheterization for anatomical delineation if performed with an optimum technique.MSCT angiography proved to be a worthy primary investigation tool in patients whom ECHO has been able to clearly identify the intracardiac anatomy, but not the extra-cardiac vascular anatomy.

Conclusion

MDCT correctly depicted the TAPVR (Total anomalous pulmonary venous return) and PAPVR (Partial anomalous pulmonary venous return) types of pulmonary venous anomalies with sensitivity 100%, and specificity 100%. The specificity of echocardiography was 50% for both findings. Inspite of the risk of ionizing radiation and contrast medium injection the adoption of our minimal invasive, low radiation, non-ECG gated protocol greatly reduces the time, radiation dose, and contrast medium volume needed to perform an optimum CT angiographic technique. Thus, paving a clear road map for pre and post operative assessment of patients with pulmonary venous anomalies.     

Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study

Purpose

To evaluate prospectively the role and impact of multidetector row computed tomography (MDCT) before bronchial artery embolization (BAE) in patients with hemoptysis.

Methods

MDCT of the thorax was performed in 27 patients (21 men, 6 women; age range, 22-70 years; mean, 39 years) with hemoptysis who were referred for BAE. Transverse, multiplanar reconstruction, and 3-dimensional reconstruction (maximum intensity projection and volume rendered) images were analysed to identify the abnormal hypertrophied bronchial and nonbronchial systemic arteries causing hemoptysis, their origin and course were noted. Digital subtraction angiography was performed with the knowledge of findings of MDCT. Selective arteriogram of abnormal bronchial as well as nonbronchial arteries was performed. Embolization was attempted in 25 of these patients (92.6%) by using polyvinyl alcohol particles (350-500 μm), Gelfoam or Embospheres (400-700 μm). Follow-up was done for a mean period of 20.5 months.

Results

Based on MDCT, 2 of 27 patients were found unsuitable for BAE. On computed tomography, 38 arteries (27 bronchial and 11 nonbronchial systemic arteries) were identified as abnormal hypertrophied vessels. On angiography, 34 of these arteries (25 bronchial and 9 nonbronchial systemic arteries) were found to be responsible for hemoptysis. Three of these arteries could not be evaluated during angiography, and 1 artery that was identified as abnormal on computed tomography was found normal on angiography. All 25 bronchial and 9 nonbronchial systemic arteries that cause hemoptysis were detected at MDCT. Embolization was successful in 23 of 25 patients.

Conclusion

MDCT enables detection and depiction of all bronchial and nonbronchial systemic arteries causing hemoptysis.     

Feasibility of gadolinium-diethylene triamine pentaacetic acid enhanced multidetector computed tomography for the evaluation of coronary artery disease

Background

Multidetector computed tomography (MDCT) has been proposed as a noninvasive method for the diagnosis of obstructive coronary artery disease (CAD). In patients with high risk of iodinated contrast adverse effects such as acute allergic-type reactions, the use of gadolinium could be an alternative.

Objective

We sought to evaluate the feasibility of gadolinium-enhanced MDCT for the diagnosis of obstructive CAD.

Methods

Twenty patients (mean age, 61 years; range, 50-73 years) referred for X-ray coronary angiography were studied by both gadolinium and iodine-enhanced 16-row MDCT coronary angiography. The degree of enhancement and the accuracy for detection of obstructive CAD (>50% diameter reduction) were evaluated with X-ray coronary angiography as the standard. Renal nephrotoxicity was strictly monitored.

Results

Gadolinium- and iodine-enhanced MDCT showed adequate visualization of the coronary arteries in 310 of the 312 coronary artery segments that were available by X-ray angiography, respectively. The average density of the coronary arteries in both iodine and gadolinium CT scans was 253.65 Hounsfield unit (HU) and 135.20 HU, respectively. In a per-coronary segment analysis, gadolinium- and iodine-enhanced MDCT showed sensitivities of 89% vs 84%, specificities of 96% vs 95%, and negative predictive values of 97% vs 96%, respectively. In a per-patient analysis, both gadolinium- and iodine-enhanced MDCT showed sensitivities of 92.85% vs specificities of 83.33%. Intermethod agreement between gadolinium- and iodine-enhanced MDCT (κ) was 0.95 (P < 0.0001).

Conclusion

Our preliminary results indicate lower attenuation with gadolinium but similar diagnostic accuracy for the detection of obstructive CAD when compared with iodine-enhanced MDCT. Therefore, gadolinium is a feasible alternative contrast agent for patients with iodine contrast allergy referred for MDCT coronary angiography.     

The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography

Objective

To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population.

Methods

We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded.

Results

The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p = 0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p = 0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p = 0.037) and more often women (51% vs. 86%, p = 0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects.

Conclusions

IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis.     

Evaluation with 64-slice CT of the prevalence of coronary artery variants and congenital anomalies: a retrospective study of 3,236 patients

Purpose

This study retrospectively evaluated the prevalence of anatomical coronary artery variants and congenital anomalies in 3,236 patients imaged with 64-slice computed tomography (CT).

Materials and methods

Over a period of 4 years, 3,236 patients underwent CT coronary angiography performed with the standard protocol. We assessed coronary artery dominance, presence of the intermediate branch, presence and number of diagonal and marginal branches and coronary anomalies subdivided into anomalies of origin and course, intrinsic anomalies and termination anomalies.

Results

Coronary dominance was right-sided in 88.1% of patients; the intermediate branch was present in 21.3%, the number of diagonal and marginal branches was one to two in >90%, and the number of coronary anomalies was 224 (89 of origin and course, 129 intrinsic anomalies and six termination anomalies).

Conclusions

Sixty-four-slice CT coronary angiography provides accurate three-dimensional evaluation of the coronary artery tree with correct visualisation of any coronary anomalies, a relatively common finding that had a prevalence of 5.7% in our study population.     

Value of MDCT as a non- invasive modality in evaluation of pediatric congenital cardiovascular anomalies

Objective

Assessing the role of MSCT compared to TTE in pediatric patients with congenital heart diseases especially the thoracic congenital vascular anomalies.

Multi-detector row CT angiography in the assessment of coronary in-stent restenosis: a systematic review

Purpose

The aim of this study was to perform a systematic review of the diagnostic accuracy of multi-detector row computed tomography angiography (MDCT) for detection of coronary in-stent restenosis in patients treated with coronary stenting when compared to invasive catheter angiography.

Materials and methods

A search of PUBMED and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing 16- or more detector rows MDCT angiography with invasive catheter angiography in the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model.

Results

15 studies met selection criteria for inclusion in the analysis. There were eight studies performed with 16-detector row CT scanners, and five studies with 64-detector row scanners and one study with a 40-detector scanner. The remaining study was performed with a mixture of 16-and 64-detector row scanners. Prevalence of in-stent restenosis following coronary stenting was 18% (95% CI: 13, 24%). Pooled estimates of the sensitivity and specificity of overall MDCT angiography for the detection of coronary in-stent restenosis was 85% (95% CI: 78, 90%) and 97% (95% CI: 95, 98%), respectively. No significant difference was found between 16- and 64-detector row scanners regarding the sensitivity and specificity of MDCT for assessment of in-stent restenosis (p > 0.05).

Conclusion

The results showed that MDCT angiography (with 16 or more detector rows) has moderate sensitivity and high specificity for the detection of coronary in-stent restenosis when compared to invasive catheter angiography. A high specificity value of MDCT may be most valuable as a non-invasive technique of excluding coronary stent restenosis or occlusion. The main factors affecting visualization are stent diameters and stent materials.     

Diagnostic value of MDCT angiography in assessment of coronary artery bypass graft

Purpose

To evaluate the diagnostic value of MDCT angiography in assessment of coronary bypass grafts. We studied 51 patients from April 2008 to October 2011. All patients gave written informed consent, and the study protocol was approved by the Institutional Review Board. 96 grafts including 35 left internal mammary artery (LIMA) grafts, 5 radial artery grafts, and 56 saphenous vein grafts (SVG) were assessed by 64-MDCT and the results were compared with conventional coronary angiography as reference standard.

Results

The diagnostic value of multi-detector computed tomography for graft occlusion was: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% sensitivity, 96% specificity, 87.5% positive predictive value, and 100% negative predictive value, and 96.4% accuracy.

Conclusion

Multi-detector computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. In addition, multidetector CT has the added advantage over traditional angiographic evaluation of simultaneously allowing evaluation for alternate postoperative complications that may also manifest with chest pain and dyspnea, thereby mimicking recurrent angina.     

Prospectively ECG gated CT pulmonary angiography versus helical ungated CT pulmonary angiography: impact on cardiac related motion artifacts and patient radiation dose

Objective

To compare prospectively ECG gated CT pulmonary angiography (CTPA) with routine helical ungated CTPA for cardiac related motion artifacts and patient radiation dose.

Subjects and methods

Twenty patients with signs and symptoms suspicious for pulmonary embolism and who had a heart rate below 85 were scanned with prospectively ECG gated CTPA. These gated exams were matched for several clinical parameters to exams from twenty similar clinical patients scanned with routine ungated helical CTPA. Three blinded independent reviewers subjectively evaluated all exams for overall pulmonary artery enhancement and for several cardiac motion related artifacts, including vessel blurring, intravascular shading, and double line. Reviewers also measured pulmonary artery intravascular density and image noise. Patient radiation dose for each technique was compared. Fourteen clinical prospectively ECG gated CTPA exams from a second institution were evaluated for the same parameters.

Results

Prospectively ECG gated CTPA resulted in significantly decreased motion-related image artifact scores in lung segments adjacent to the heart compared to ungated CTPA. Measured image noise was not significantly different between the two types of CTPA exams. Effective dose was 28% less for prospectively ECG gated CTPA (4.9 mSv versus 6.8 mSv, p = 0.02). Similar results were found in the prospectively ECG gated exams from the second institution.

Conclusion

Compared to routine helical ungated CTPA, prospectively ECG gated CTPA may result in less cardiac related motion artifact in lung segments adjacent to the heart and significantly less patient radiation dose.     

The value of 16-slice multidetector computed tomographic angiography in preoperative appraisal of vascular anatomy in potential living renal donors

Background

Comprehensive preoperative appraisal of potential living renal donors is the key for selecting a proper donor and a suitable kidney.

Objective

To prospectively assess the diagnostic value of 16-slice multidetector computed tomography (MDCT) in preoperative appraisal of vascular anatomy in potential living renal donors.

Materials and methods

Preoperative angiography using a 16-slice MDCT scanner was performed in 68 consecutive potential living renal donors. The MDCT angiography included unenhanced and contrast-enhanced multiphasic scans. The MDCT images were reviewed for the number and branching pattern of the renal arteries and for the number and presence of major or minor variants of the renal veins. The results were compared with the actual anatomy at the open donor nephrectomy as the diagnostic standard of reference.

Results

The sensitivity and the specificity of MDCT angiography for the detection of various anatomic variants of renal arteries as well as renal venous anomalies were 100%. The anatomic variants of renal arteries included accessory arteries (n = 7) and early arterial branching (n = 10). Whereas, the detected venous anomalies were of major category of the circumaortic left renal vein anomaly (n = 2). No minor renal venous anomaly was identified in any subject.

Conclusion

16-Slice MDCT angiography is highly accurate for preoperative assessment of diverse anomalies of the renal vascular anatomy in potential living renal donors; in consequence, it markedly affects the surgical planning.     

Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts

Purpose

The purpose of the study was to compare the diagnostic value of color Doppler ultrasonography (CDUS) and multidetector computed tomography (MDCT) angiography against that of digital subtraction angiography (DSA) or surgery in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs).

Materials and methods

CDUS and MDCT angiography were performed with 41 patients (24 men, 17 women; mean age 55.8) with dysfunctional hemodialysis fistulas. The presence of stenosis, thrombosis, aneurysm, pseudoaneurysm and seroma were recorded. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of CDUS and MDCT angiography were calculated both individually and in combination for the detection of vascular segments with significant stenosis, thrombosis, aneurysms, pseudoaneurysms, perivascular complications and stenosis subgroups.

Results

Sixty-four segmental lesions were diagnosed by DSA or surgery. Sensitivity, specificity, PPV, NPV and accuracy of CDUS for all vascular tree lesions were 85.9%, 99.2%, 96.4%, 96.7% and 94.5%, respectively. For MDCT angiography the figures were 96.8%, 99.6%, 98.4%, 99.2% and 98.5%, respectively. When both tests were used in combination, sensitivity, specificity, PPV, NPV and accuracy for all vascular tree lesions rose to 100%.

Conclusion

Combined use of MDCT and CDUS for diagnosis of AVF dysfunctions is of equivalent value to surgery or DSA, a gold standard technique.     

Role of 128 slice MSCT angiography in evaluation of congenital extra-cardiac intra-thoracic vascular anomalies in children

Purpose

To investigate the value and highlight the role of multi slice computed tomography (MSCT) angiography in evaluation of extra-cardiac intra thoracic vascular anomalies in children.

Does the anatomic distribution of acute pulmonary emboli at MDCT pulmonary angiography in oncology-population differ from that in non-oncology counterpart?

Objective

To compare the prevalence and the anatomic distribution of acute PE in oncology patients with those of non oncology patients using multidetector CT (MDCT) pulmonary angiography.

Material and methods

We prospectively reviewed 80 consecutive patients having pathologically proven neoplasms and clinically suspected to have acute PE. Similarly, the other group included 80 consecutive age-matched patients with the clinical suspicion of acute PE, nonetheless, with irrelevant oncologic history. All patients underwent MDCT pulmonary angiography. The PE involvement according to pulmonary arterial level was classified. Lobar location was also recorded using standard nomenclature.

Results

Twenty six patients (33%) of the 80 oncology patients compared to 19 patients (24%) of the 80 non oncology group had acute PE at pulmonary MDCT angiographic examinations. Among the oncology patients, acute PE was located in the main pulmonary artery in 7 (13%), the lobar pulmonary artery in 22 (40%), the segmental pulmonary artery in 17 (31%) and the subsegmental pulmonary artery in 9 (16%) patients. Whereas in the non oncology group, the level of involvement of PE was the main pulmonary artery in 4 (10%) patients, the lobar pulmonary artery in 17 (40%), the segmental pulmonary artery in 15 (36%) and the subsegmental pulmonary artery in 6 (14%). Alternatively, there was a lower lobar predominance in both groups.

Conclusion

The prevalence of acute PE is more common among oncology patients than previously reported and has a slight predilection to a central distribution.     

Role of 320-slice multislice computed tomography coronary angiography in the assessment of coronary artery stenosis

Objective

To evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis.

Patients and methods

The study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography.

Results

The positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively.

Conclusion

In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.