Aims To investigate the association between pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation derived from coronary computed tomography angiography (CTA) and coronary flow reserve (CFR) by positron emission tomography (PET) in patients with suspected coronary artery disease (CAD). Methods and results PCAT CT attenuation was measured in proximal segments of all major epicardial coronary vessels of 105 patients with suspected CAD. We evaluated the relationship between PCAT CT attenuation and other quantitative/qualitative CT-derived anatomic parameters with CFR by PET. Overall, the mean age was 60 ± 12 years and 93% had intermediate pre-test probability of obstructive CAD. Obstructive CAD (≥50% stenosis) was detected in 37 (35.2%) patients and impaired CFR (<2.0) in 32 (30.5%) patients. On a per-vessel analysis (315 vessels), obstructive CAD, non-calcified plaque volume, and PCAT CT attenuation were independently associated with CFR. In patients with coronary calcium score (CCS) <100, those with high-PCAT CT attenuation presented significantly lower CFR values than those with low-PCAT CT attenuation (2.47 ± 0.95 vs. 3.13 ± 0.89, P = 0.003). Among those without obstructive CAD, CFR was significantly lower in patients with high-PCAT CT attenuation (2.51 ± 0.95 vs. 3.02 ± 0.84, P = 0.021). Conclusion Coronary perivascular inflammation by CTA was independently associated with downstream myocardial perfusion by PET. In patients with low CCS or without obstructive CAD, CFR was lower in the presence of higher perivascular inflammation. PCAT CT attenuation might help identifying myocardial ischaemia particularly among patients who are traditionally considered non-high risk for future cardiovascular events.

Objective: Qualitative and quantitative image analysis between Iopamidol-370 and Ioversol-320 in stents´ evaluation by coronary computed tomography angiography (CTA). Methods: Sixty-five patients with low-risk stable angina undergoing stent follow-up with coronary CTA were assigned to Iopamidol I-370 (n = 33) or Ioversol I-320 (n = 32) in this prospective, double-blind, non-inferiority, randomized trial. Stent lumen image quality was graded by 5-point Likert Scale. Lumen mean attenuation was measured at native coronary segments: pre-stent, post-stent, distal segments and at coronary plaques. Lumen attenuation increase (LAI) ratio was calculated for all stents. Heart rate (HR) variation, premature heart beats (PHB), heat sensation (HS), blooming and beam hardening were also assessed. Results: Image quality was similar between groups, with no significant difference (Likert score 4.48 ± 0.75 vs 4.54 ± 0.65, p = 0.5). There were similarities in LAI ratio between I-370 and I-320 (0.39 ± 0.42 vs 0.48 ± 0.44 HU, p = 0.08). Regarding lumen mean attenuation at native coronary segments, a significant difference was observed, with I-320 presenting lower values, including contrast mean attenuation in distal segments. After statistical multivariate analysis, three variables correlated with stent image quality: 1) stent diameter, 2) HR variation and 3) stent lumen LAI ratio. Conclusions: There was no significant difference between Iopamidol-370 mgI ml−1 and Ioversol-320 mgI ml−1 contrasts regarding overall stent lumen image quality, which was mainly influenced by stent diameter, HR and LAI ratio. Advances in knowledge: Coronary CTA allows adequate stents' visualization and image quality is influenced by stent diameter, HR variation and LAI ratio. Stents' image quality showed no difference between different concentration contrasts (I-370 vs. I-320); however, higher concentration contrasts may provide an improved overall visualization, especially regarding coronary distal segments.

Objectives To provide clinical validation of a recent 2D SENSE-based accelerated cardiovascular magnetic resonance (CMR) sequence (accelerated k-t SENSE), investigating whether this technique accurately quantifies left ventricle (LV) volumes, function, and mass as compared to 2D cine steady-state free precession (2D-SSFP). Methods Healthy volunteers ( n = 16) and consecutive heart failure patients ( n = 26) were scanned using a 1.5 T MRI system. Two LV short axis (SA) stacks were acquired: (1) accelerated k-t SENSE (5–6 breath-holds; temporal/spatial resolution: 37 ms/1.82 × 1.87 mm; acceleration factor = 4) and (2) standard 2D-SSFP (10–12 breath-holds; temporal/spatial resolution: 49 ms/1.67 × 1.87 mm, parallel imaging). Ascending aorta phase-contrast was performed on all volunteers as a reference to compare LV stroke volumes (LVSV) and validate the sequences. An image quality score for SA images was used, with lower scores indicating better quality (from 0 to 18). Results There was a high agreement between accelerated k-t SENSE and 2D-SSFP for LV measurements: bias (limits of agreement) of 2.4% (− 5.4% to 10.1%), 6.9 mL/m 2 (− 4.7 to 18.6 mL/m 2 ), − 1.5 (− 8.3 to 5.2 mL/m 2 ), and − 0.2 g/m 2 (− 11.9 to 12.3 g/m 2 ) for LV ejection fraction, end-diastolic volume index, end-systolic volume index, and mass index, respectively. LVSV by accelerated k-t SENSE presented good agreement with aortic flow. Interobserver and intraobserver variabilities for all LV parameters were also high. Conclusion The accelerated k-t SENSE CMR sequence is clinically feasible and accurately quantifies LV volumes, function, and mass, with short acquisition time and good image quality.