Accuracy of Nonstenotic Coronary Atherosclerosis Assessment by Multi-Detector Computed Tomography

Abstract

he ability to evaluate coronary atherosclerotic stenosis using multi-detector computed tomography (MDCT) has been well recognized in the last several years. [1][2][3][4] MDCT has been shown to permit the visualization of the coronary artery lumen and the detection of the plaque morphology with good correlation to intravascular ultrasound (IVUS) after intravenous injection of a contrast agent. 5 In contrast, a number of investigators have demonstrated that plaque burden and the progression of coronary plaque may have a relationship with the risk of cardiovascular events. [6][7][8][9] However, a few reports have shown the accuracy of MDCT to assess the vascular lumen area and plaque area compared with that of IVUS. 10,11 The purpose of the present study was to investigate the accuracy of nonculprit atherosclerotic plaque evaluation in the proximal coronary artery by MDCT. Circulation Journal Vol.71, June 2007 Method PatientsWe retrospectively studied 33 consecutive patients in whom diagnostic MDCT for ischemic coronary artery disease was performed before elective IVUS-guided percutaneous coronary intervention (PCI). Those with unstable clinical conditions, an absence of sinus rhythm, impaired renal function (serum creatinine >1.5 mg/dl), contraindications to iodinated contrast media, heart failure and possible pregnancy were excluded. MDCTMDCT data were acquired using an Aquilion 16 system (Toshiba Medical Systems, Otawara, Japan). Scan parameters were a detector collimation of 16×0.5 mm, a gantry rotation time of 0.4 or 0.5 s, and tube voltage 135 kV. In patients with heart rates >65 beats/min, 20 mg of metoprolol was administrated orally 2 h before MDCT scanning and all patients received sublingual nitroglycerine just before scanning. The mean heart rate during MDCT was 60± 10 beats/min. A bolus of 100 ml of non-ionic contrast material (Iopamiron 370 [iopamidol], Shering, 370 mgI/ml) was administered through an arm vein with a flow rate of 4.0 ml/s. MDCT Data AnalysisThe raw MDCT data were transferred to an image analysis workstation (M900 quadra, ZIOSOFT, Tokyo, Japan). The position of the reconstruction window within the car- Background The ability to evaluate coronary stenosis using multi-detector computed tomography (MDCT) has been well discussed. In contrast, several studies demonstrated that the plaque burden measured by intravascular ultrasound (IVUS) has a relationship to the risk of cardiovascular events. the accuracy of MDCT was studied to determine plaque and vessel size compared with IVUS. Methods and ResultsFifty-six proximal lesions (American College of Cardiology/American Heart Association classification: segment 1, 5, 6) from 33 patients were assessed using MDCT and IVUS. The plaque and vessel area were measured from the cross-sectional image using both MDCT and IVUS. Eight coronary artery lesions with motion artifacts and heavily calcified plaques were excluded from the analysis. The vessel and lumen size evaluated using MDCT were closely correlated with those evaluated by IVUS (R 2 =0.614, 0.75...

Characterization of coronary atherosclerosis by dual-source computed tomography and HU-based color mapping: a pilot study

“…While Achenbach and Leber et al found a comparable degree of correlation with IVUS, both studies report significant biases for overall plaque volume [14,15]. Considerable inter-modality discrepancy has, likewise, been established in a variety of studies quantifying plaque in terms of cross-sectional area [17,18,27].…”

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

“…24 Additionally, recently published studies underline the feasibility of coronary CTA to even detect coronary plaque and therefore clinically silent CAD. [25][26][27] A certain prognostic impact on the detection of coronary calcification and non-obstructive CAD is therefore assumed. [28][29][30] However, in clinical practice 2 major limitations are apparent: Firstly, coronary calcifications lead to overestimation of coronary stenoses because of blurring artefacts and total obstruction of the coronary lumen, and may significantly impair diagnostic accuracy 31,32 and thus lead to unnecessary invasive angiography.…”

Increased Epicardial Fat Volume Quantified by 64-Multidetector Computed Tomography is Associated With Coronary Atherosclerosis and Totally Occlusive Lesions

“…13 MDCT provides noteworthy information about coronary arteries including not only the presence and degree of stenotic lesions but also of subclinical atherosclerotic plaques. [14][15][16][17][18][19] MDCT can identify atherosclerotic plaques, in vessels with only minimal angiographic disease, with high sensitivity and moderate specificity as compared with intravascular ultrasound (IVUS). Moreover, MDCT can detect significant atherosclerotic plaques in vessels with signs of positive remodeling, which tend to be underestimated by conventional coronary angiography (CAG).…”