With use of a reduced-order algorithm, computation of the FFR from coronary CT angiography data can be performed locally, at a regular workstation. The diagnostic accuracy of coronary CT angiography-derived computational FFR for the detection of functionally important coronary artery disease (CAD) was good and was incremental to that of coronary CT angiography within a population with a high prevalence of CAD.

Objective-In a previous in vitro study we have demonstrated that atherosclerotic plaque components can be characterized with multidetector computed tomography (MDCT) based on differences in Hounsfield values (HV). Now we evaluated the use of MDCT in vivo to characterize and quantify atherosclerotic carotid plaque components compared with histology as reference standard. Methods and Results-Fifteen symptomatic patients with carotid stenosis (Ͼ70%) underwent MDCT angiography before carotid endarterectomy (CEA). From each CEA specimen 3 histological sections and corresponding MDCT images were selected. The HV of the major plaque components were assessed. The measured HV were: 657Ϯ416HU, 88Ϯ18HU, and 25Ϯ19HU for calcifications, fibrous tissue, and lipid core, respectively. The cut-off value to differentiate lipid core from fibrous tissue and fibrous tissue from calcifications was based on these measurements and set at 60 HU and 130 HU, respectively. Regression plots showed good correlations (R 2 Ͼ0.73) between MDCT and histology except for lipid core areas, which had a good correlation (R 2 ϭ0.77) only in mildly calcified (0% to 10%) plaques. Conclusions-MDCT is able to quantify total plaque area, calcifications, and fibrous tissue in atherosclerotic carotid plaques in good correlation with histology. Lipid core can only be adequately quantified in mildly calcified plaques. Key Words: carotid stenosis Ⅲ computerized tomography Ⅲ magnetic resonance imaging Ⅲ imaging T he severity of luminal stenosis, caused by the atherosclerotic plaque in the carotid bifurcation, is an important risk factor for (recurrent) stroke and is used in therapeutic decision making: ie, patients with symptomatic or asymptomatic carotid stenosis above a certain degree are considered candidates for carotid intervention such as carotid endarterectomy (CEA) or stent placement. 1 However, morphology studies on carotid atherosclerotic plaque have revealed that plaque morphology could be an important additional feature in the risk assessment of patients with carotid stenosis. 2,3 Computed tomography angiography (CTA) is an accurate modality to grade the severity of stenosis 4 and is increasingly used in the evaluation of stroke patients. The question then arises whether CT can also provide detailed information about plaque morphology.Earlier studies in which 3-mm-thick single-slice CT images were compared with histology sections of CEA specimens yielded confusing results. 5,6 Multidetector CT (MDCT) allows evaluating carotid atherosclerosis with thinner slices (0.5 to 1.0 mm) and less volume averaging. More detailed analysis of plaque composition may now become possible.A previous in vitro validation study showed that thin-section MDCT is capable of characterizing and quantifying calcifications and lipid core regions in CEA specimens based on differences in Hounsfield values (HV). 7 However, in vitro studies have inherent limitations attributable to the presence of air around the specimen and the absence of contrast in the vessel lumen. The purpose ...

Long-term survival after Mustard repair is clearly diminished and morbidity is substantial. Early postoperative arrhythmias are a predictor for heart failure and late arrhythmias.

Debris is captured with filter-based embolic protection in the vast majority of patients undergoing TAVR. Tissue-derived material is found in 63% of cases and is more frequent with the use of balloon-expandable systems and more oversizing.