The usefulness of subtraction coronary computed tomography angiography for in-stent restenosis assessment of patients with CoCr stent using 320-row area detector CT

The aim of this study was to assess in-stent restenosis (ISR) of coronary artery for patients with CoCr stent using subtraction coronary computed tomography angiography (CCTA) with one-breath-hold scan on 320-row area detector CT, invasive coronary angiography (ICA) as clinical standard.Patients who were referred for CCTA from January 2020 to May 2021 were retrospectively analyzed. Pre-contrast and CCTA was performed with dedicated one-breath-hold subtraction scan protocol and post processing to get subtracted-CCTA image without stent. Subjective image qualities and diagnosable rate were analyzed for CCTA and subtracted-CCTA respectively. The ISR degree of each stent was evaluated both on CCTA and subtracted-CCTA images. The receiver-operating characteristic curve with sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA in the diagnosis of ISR were calculated with ICA as reference.Forty patients with 85 CoCr coronary stents of 3 to 3.5 mm diameter with ICA confirmation within 1 month were finally included. Subtracted-CCTA showed more diagnosable segments of stent (91.76% [78/85]) than those of CCTA (50.59% [43/85]) (P < .001). The subjective image quality score of CCTA was 2.23 ± 1.32 while 3.41 ± 0.90 on subtracted-CCTA (P < .001). Both subtracted-CCTA and CCTA showed high consistency with ICA (Kappa = 0.795 and 0.918 respectively). The area under the curve was 0.607 for CCTA and 0.757 for subtracted-CCTA (P < .001) for stent based diagnose, respectively. The sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA were 90.0%, 97.0%, 95.3%, and 87.5%, 100.0%, 97.43%, respectively.Subtracted-CCTA showed improved diagnose performance for ISR, which potentially reduce further follow-up ICA procedures for patients with CoCr stents.     

Visceral obesity assessed by computed tomography predicts cardiovascular events in chronic kidney disease patients

Background and AimCardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). Although there is emerging evidence that excess visceral fat is associated with a cluster of cardiometabolic abnormalities in these patients, the impact of visceral obesity evaluated by a gold-standard method on future outcomes has not been studied. We aimed to investigate whether visceral obesity assessed by computed tomography was able to predict cardiovascular events in CKD patients.Methods and ResultsWe studied 113 nondialyzed CKD patients [60% men; 31% diabetics; age 55.3 ± 11.3 years; body mass index (BMI) 27.2 ± 5.3 kg/m²; estimated glomerular filtration rate (GFR) 33.7 ± 13.6 ml/min/1.73 m²]. Visceral and subcutaneous abdominal fat were assessed by computed tomography at L4-L5. Visceral to subcutaneous fat ratio >0.55 (highest tertile cut-off) was defined as visceral obesity. Cardiovascular events including acute myocardial infarction, angina, arrhythmia, uncontrolled blood pressure, stroke and cardiac failure were recorded during 24 months.Cardiovascular events were 3-fold higher in patients with visceral obesity than in those without visceral obesity. The Kaplan–Meier analysis indicated that patients with visceral obesity had shorter cardiovascular event-free time than those without visceral obesity (P = 0.021). In the univariate Cox analysis, visceral obesity was associated with higher risk of cardiovascular events (hazard ratio = 3.4; 95% confidence interval = 1.1–10.5; P = 0.03). The prognostic power of visceral obesity for cardiovascular events remained significant after adjustments for sex, age, diabetes, previous cardiovascular disease, smoking, sedentary lifestyle, BMI, GFR, hypertension, dyslipidemia and inflammation.ConclusionVisceral obesity assessed by computed tomography was a predictor of cardiovascular events in CKD patients.     

Coronary computed tomography angiography in patients with stable coronary artery disease

The treatment of coronary artery disease (CAD), which is defined by stable anatomical atherosclerotic and functional alterations of epicardial vessels or microcirculation, focuses on managing intermittent angina symptoms and preventing major adverse cardiovascular events with optimal medical therapy. When patients with known CAD present with angina and no acute coronary syndrome, they have historically been evaluated with a variety of noninvasive stress tests that utilize electrocardiography, radionuclide scintigraphy, echocardiography, or magnetic resonance imaging for determining the presence and extent of inducible myocardial ischemia. Patient event-free survival, however, is largely driven by the coronary atherosclerotic disease burden, which is not directly assessed by functional testing. Direct evaluation of coronary atherosclerotic disease by coronary computed tomography angiography (coronary CTA) has emerged as the first line noninvasive imaging modality as it improves diagnostic accuracy and positively influences clinical management. Compared to functional assessment of CAD, coronary CTA-guided management results in improved patient outcomes by facilitating prevention of myocardial infarction. Other strengths of coronary CTA include detailed atherosclerotic plaque characterization and the ability to assess functional significance of specific lesions, which may further improve risk assessment and prognosis and lead to more appropriate referrals for additional testing, such as invasive coronary angiography.     

Comparison of echocardiography and 320-row multidetector computed tomography for the diagnosis of congenital heart disease in children

IntroductionEchocardiography (echo) is the primary non-invasive imaging modality for the assessment of congenital heart disease (CHD). Computed tomography angiography (CTA) also has potential to examine the anatomy of complex heart anomalies as well as extracardiac involvement.ObjectivesThe aim of this study is to determine the impact of new CTA technology in the diagnosis of CHD and to compare echo and CTA in terms of diagnostic accuracy.MethodsForty-five patients who underwent preoperative echo and CTA assessment in the intensive care unit were included in this study. The results were assessed for three main types of CHD (cardiac malformations, cardiac-major vessel connections and major vessels). The main groups were also divided into subgroups according to surgical features in order to assess them more objectively. Imaging methods were compared for diagnostic accuracy, sensitivity and specificity, while surgical findings were accepted as the gold standard.ResultsPatients’ median age and weight were two months (three days-eight years) and 12 kg (2.5-60 kg), respectively. In 45 operated cases, 205 subgroup malformations were assessed. Diagnostic accuracy was significantly greater in echo (echo vs. CTA: 98.4% and 96.2% [chi-square=6.4, p=0.011]). During surgery, 84 cardiac malformations (echo vs. CTA: 97.4% and 95.1% [chi-square=4.9, p=0.03]), 47 cardiac-major vessel connections (echo vs. CTA: 98.3% and 95.4% [chi-square=7.5, p=0.03]), and 74 major vessel malformations (echo vs. CTA: 96% and 98% [chi-square=1.8, p=0.48]) were confirmed.ConclusionEchocardiography and CTA are imaging methods with high diagnostic accuracy in children with CHD. The use of echocardiography together with CTA, especially for the visualization of extracardiac anatomy, provides additional information for clinicians.     

320排CT冠状动脉血管成像与冠状动脉造影评估冠状动脉支架内再狭窄程度的对比分析

目的评价320排CT冠状动脉血管成像(CCTA)在冠状动脉支架内再狭窄评估中的临床应用价值。方法以选择性冠状动脉造影(CAG)为金标准,应用320排CCTA评价100例患者冠状动脉支架内再狭窄的程度。将冠状动脉支架内管径分为无狭窄、轻度狭窄(≤50%)、中度狭窄(51%～75%)和重度狭窄或闭塞(76%～100%)4个等级,分析320排CCTA与CAG评估狭窄程度的一致性。其中再狭窄≥50%为阳性,包括支架内及支架两端5mm范围内的血管段。统计学方法采用Kappa评价方法。结果 100例患者中共评价分析175枚支架,CAG示冠状动脉支架内再狭窄44枚,320排CCTA正确诊断42枚,漏诊2枚,误诊10枚,敏感度为95.45%、特异度为92.37%、准确度为70.29%、阳性预测值为80.77%、阴性预测值为98.37%。在P<0.05的检验标准上,Kappa值为0.5688,320排CCTA和CAG对支架内狭窄程度评估一致性好。结论 320排CCTA能够准确显示支架内再狭窄的部位及程度,而且无创、重复性好,图像直观可信,具有很高的临床应用价值。     

心律失常患者冠状动脉CTA成像

冠状动脉CT血管造影(CTA)目前已广泛应用于临床,但心律失常患者一直是此项技术的瓶颈。由于传统的螺旋CT及双源CT的技术限制,对心律失常患者扫描过程中往往因为心脏运动不规律,导致图像不连续。心电编辑技术可解决部分此类问题,改善图像的质量,提高诊断的灵敏度。宽探测器CT(如320排螺旋CT)在低心率条件下可在一个心动周期成像,能消除此类伪影,但时间分辨力尚待提高。     

64层双源螺旋CT与血管内超声对冠状动脉粥样硬化斑块性质的对比研究

目的对比冠状动脉血管内超声(IVUS)与64层双源螺旋CT(64-sCT)检查对冠状动脉粥样硬化斑块特征判定的准确性。方法选择35例不稳定性心绞痛患者行64-sCT与IVUS检查,分别测定同一病变同一位置的血管横截面积、管腔横截面积、斑块负荷;采用IVUS判定斑块性质,64-sCT测定其CT值。结果 45支血管(左前降支23支;左回旋支15支;右冠状动脉7支)的72个不同截面行IVUS与64-sCT检查,在可用于评估的68个截面中,64-sCT对51个存在斑块的截面,正确显示49个存在斑块(敏感性96%),对提示17个无斑块的截面,正确显示16个无斑块存在(特异性94%)。脂质斑块(25±14)HU、纤维斑块(90±20)HU、钙化斑块(530±185)HU;混合斑块中,钙化-脂质斑块(540±175)HU、钙化-纤维斑块(540±195)HU、纤维-脂质斑块(91±22)HU。纤维-脂质斑块与纤维斑块差异无统计学意义;钙化-脂质斑块、钙化-纤维斑块与钙化斑块差异无统计学意义。靶血管外弹力膜截面积、管腔截面积、斑块负荷、狭窄程度之间差异无统计学意义。结论对比IVUS与64-sCT检查能够定性及定量分析冠状动脉粥样硬化斑块,但其精确度仍有一定的限制。     

Relationship between abdominal aortic and coronary artery calcification as detected by computed tomography in chronic kidney disease patients

The purpose of this study was to investigate the relationship between abdominal aortic calcification (AAC) and coronary artery calcification (CAC) in chronic kidney disease (CKD) patients. We evaluated 126 asymptomatic CKD patients (mean estimated glomerular filtration rate: 36.1 ± 14.1 mL/min/1.73 m², mean age 70.3 ± 10.1 years). A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) and CAC score, and this relationship was investigated. Among the subjects, AAC was present in 109 patients (86.5 %) as defined by ACI >0 and median ACI was 11.7 %. ACI increased in accordance with advances in CAC score grades (3.0, 5.2, 17.2, and 32.8 % for CAC score 0, 1–100, 101–400, and 401 or more, respectively, p < 0.001). Even after multivariate adjustment, ACI was independently associated with severe CAC score as defined by CAC score >400 [odds ratio 1.08, 95 % confidence interval (CI) 1.04–1.12, p < 0.001]. Receiver-operating curve analysis showed that the ACI optimal cut-off value predicting severe CAC score was 16.5 % (area under the curve = 0.79, 95 % CI 0.69–0.90, p < 0.001). The C statics for predicting CAC score was significantly increased by adding ACI values to the model including other risk factors (0.853 versus 0.737, p = 0.023). In conclusion, the ACI value of 16.5 % allows us to predict the presence of severe CAC in CKD patients, and that the addition of ACI to the model with traditional risk factors significantly improves the predictive ability of severe CAC score. These data reinforce the utility of ACI as a screening tool in clinical practice.     

Coronary arterial plaque characterized by multislice computed tomography predicts complications following coronary intervention

BACKGROUND: A reliable, noninvasive assessment of plaque configuration would constitute an important step forward for predicting complications following percutaneous coronary intervention (PCI). Multislice computed tomography (MSCT) holds promise with respect to allowing for differentiation of coronary lesion configuration. However, it has not yet been clarified whether the characteristics of coronary artery plaque measured by MSCT predict complications after PCI. The aim of this study was to investigate the relationship between plaque configuration and complications after coronary intervention in patients with stable angina pectoris. METHODS: MSCT was performed in patients with angina pectoris who were scheduled for PCI prospectively, and 26 patients (70 +/- 11 years, 18 males) with coronary artery plaque in a stenotic coronary artery measured by MSCT were recruited for this study. Thirty-five plaques in the stenotic coronary lesions were divided into 3 groups based on the CT density as soft, intermediate, and hard, and were compared with the complications after PCI. RESULTS: The soft plaque group before PCI (n = 11) was significantly associated with the appearance of slow flow (n = 4) or a compromised side branch (n = 1) after PCI, whereas the hard plaque group before PCI (n = 17) was associated with the appearance of dissection (n = 2) or perforation (n = 1) after PCI (P = 0.004). The intermediate plaque group (n = 7) had only one complication, a compromised side branch (n = 1). CONCLUSION: Coronary arterial plaque characterized by MSCT can predict intervention-related complication. It may be important for the risk stratification of the patients scheduled to undergo PCI to investigate plaque configuration by MSCT.     

Double aortic arch and left superior vena cava persistence visualized by 16-row detector multi-slice computed tomography

A 38-year-old woman (F.N.) suffering from dysphagia underwenta gastroduodenoscopy. An external compression of the middleportion of the oesophagus was demonstrated. The patient thenunderwent a 16-row detector multislice computed tomography     

Reproducible coronary plaque quantification by multislice computed tomography.

BACKGROUND: The aim of this study was to investigate reproducibility and accuracy of computer-assisted coronary plaque measurements by multislice computed tomography coronary angiography (QMSCT-CA). METHODS AND RESULTS: Forty-eight patients undergoing MSCT-CA and coronary arteriography for symptomatic coronary artery disease and quantitative intravascular ultrasound (IVUS, QCU) were examined. Two investigators performed the QMSCT-CA twice and a third investigator performed the QCU, all blinded for each other's results. There was no difference found for the matched region of interest (ROI) lengths (QCU 29.4 +/- 13 mm vs. QMSCT-CA 29.6 +/- 13 mm, P = 0.6; total length = 1,400 mm). The comparison of volumetric measurements showed (lumen QCU 267 +/- 139 mm(3) vs. mean QMSCT-CA 177 +/- 91 mm(3), P < 0.001; vessel 454 +/- 194 mm(3) vs. 398 +/- 187 mm(3), P <0.001; and plaque 189 +/- 93 mm(3) vs. 222 +/- 121 mm(3); investigator 1, P = 0.02; and investigator 2, P = 0.07) significant differences. Automated lumen detection was also applied for QMSCT-CA (218 +/- 112 mm(3), P < 0.001 vs. QCU). The interinvestigator variability measurements for QMSCT-CA showed no significant differences. CONCLUSION: QMSCT-CA systematically underestimates absolute coronary lumen- and vessel dimensions when compared with QCU. However, repeated measurements of coronary plaque by QMSCT-CA showed no statistically significant differences, although, the outcome showed a scattered result. Automated lumen detection for QMSCT-CA showed improved results when compared with those of human investigators.     

Coronary computed tomography angiography in coronary artery disease

AIM: To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature.METHODS: A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from f ive main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques.RESULTS: One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source anddual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the f ive radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively.CONCLUSION: This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction.