Prognostic Value of Stress Dynamic Computed Tomography Perfusion With Computed Tomography Delayed Enhancement

Nakamura, Satoshi; Kitagawa, Kakuya; Goto, Yoshitaka; Takafuji, Masafumi; Nakamori, Shiro; Kurita, Tairo; Dohi, Kaoru; Sakuma, Hajime

doi:10.1016/j.jcmg.2019.12.017

Cited by 24 publications

(8 citation statements)

References 18 publications

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“…In addition, it can be combined with other measures like CT derived delayed enhancement to obtain additional prognostic information. 131 Combining physiology through FFR CT and stress-CTP, with anatomy during a CTA study is an evolving area and future studies will provide more granular data about its best use. There is clinical study evidence for some of these approaches while others like TAG have not borne out in terms of clinical utility.…”

Section: Ct Myocardial Perfusionmentioning

confidence: 99%

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Narula

Chandrashekhar

Ahmadi

et al. 2021

Journal of Cardiovascular Computed Tomography

214

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2.1.2. Diagnostic performance of functional imaging and CTA compared to >50% diameter stenosis by ICA The National Cardiovascular Data Registry 9 suggested that functional testing is suboptimal for detecting significant coronary stenoses. Of the 661,063 patients undergoing elective catheterization, 64% had testing before the invasive coronary angiogram (ICA); of those, only 51.9% were abnormal. The percentages of patients with <50% DS on subsequent ICA ranged from 55 to 56% after an abnormal exercise treadmill test (ETT), stress echocardiography (SE), single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); for resting CTA, the percentage was 30%. In the oldest report, Fleischmann et al. evaluated 5874 patients in 41 studies from 1990 to 1997, and reported sensitivity and specificity of 85% and 77% for SE and 87% and 64% for SPECT, with 52% and 71% for exercise ECG. 10 DeJong et al. (Table 2A), in a meta-analysis of 5088 patients in 51 studies from 2000 to 2011 evaluated MRI, SE and SPECT with >50%DS by ICA as reference. 11 MRI was the most sensitive and specific (91% and 80%), with SE (87% and 72%) and SPECT (83% and 77%) roughly similar. Jaarsma et al. (Table 2B), reported on SPECT, MRI and positron emission tomography (PET) in 141 per-patient studies and 70 per-vessel studies. 12 Per-patient diagnostic odds ratio (DOR) was highest for PET (36.47) followed by MRI (26.42) and SPECT (16.31). In pervessel analysis, PET and MRI were equal (24.74 and 24.11), while SPECT was lowest (11.75). In a meta-analysis limited to 26 studies in which CTA was compared to either ETT or SPECT in the same group of patients, Nielsen et al. 13 (Table 2C) reported CTA sensitivities of 95e99%, specificities of 68e93% and DOR of 128e728. Corresponding ranges for ETT were 65e70%, 24e60% and 0.7e4 and for SPECT were 67e73%, 48e52% and 2e4. It is important to understand that available meta-analyses are also challenged by the small numbers of patients in some of the individual reports, potential referral bias, and often include a mixture of newer and older technology (e.g., planar and SPECT imaging). Finally, in a paper published too recently for meta-analysis inclusion, 391 symptomatic patients, 52% with intermediate and 46% with high risk pre-test probability, who were scheduled for ICA, underwent both CTA and SPECT with >50%DS by ICA as reference. 14 Sensitivity, specificity, positive and negative predictive values were 0.92, 0.75, 0.84 and 0.87 for CTA and 0.62, 0.68, 0.74 and 0.55 for SPECT. AUC was significantly higher for CTA (0.91 versus 0.69, p < 0.001.

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Section: Ct Myocardial Perfusionmentioning

confidence: 99%

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Narula

Chandrashekhar

Ahmadi

et al. 2021

Journal of Cardiovascular Computed Tomography

214

View full text Add to dashboard Cite

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“…A reliable standardization of radiological reports is helpful for the doctor in making medical treatment or ICA decision. 11,12 In our study, the high level of CAD-RADS Long-Term Prognosis Altay CAD-RADS is sufficient evidence for invasive procedures in cases. In these cases, the expectation of MACE at follow-up has increased.…”

Section: Discussionmentioning

confidence: 57%

“…Clinical monitoring and treatment planning of coronary CTA patients are important. 8,11 With its increasing use in reporting, CAD-RADS guideline is gaining more and more importance daily (5). A reliable standardization of radiological reports is helpful for the doctor in making medical treatment or ICA decision.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Standard Coronary Computed Tomography Angiography Reporting System (CAD-RADS)

Altay

2021

Indian Journal of Radiology and Imaging

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Aims This study evaluated the clinical prospects of Coronary Artery Disease—Reporting and Data System (CAD-RADS) scoring in coronary computed tomography angiography (CTA). The aim of the study was to determine the guidance value of CAD-RADS scoring in patient follow-up after CTA. Methods and Materials Reports of cases reported between 2010 and 2013 were reevaluated with CAD-RADS scoring. Clinical risk analysis was performed with initial forms of anamnesis. Clinical follow-up was performed on 7 to 10 years (mean: 8 years, 4 months) hospital records. Univariate and multivariate Cox modeling was performed with Kaplan–Meier method to define the relationship between clinical (age, gender, diabetes mellitus, hypertension, smoking, family history) and CAD-RADS variables, and for risk analysis based on these causes. Cox proportional-hazards analysis results were presented as a hazard ratio with a 95% confidence interval. CAD-RADS scores were evaluated as meaningful determinants of univariate and multivariate Cox proportional survival analysis. Results Totally, 359 cases were evaluated in the study. Severe coronary pathology development rate was observed as CAD-RADS 0to 1%, CAD-RADS 1 to 3%, CAD-RADS 2 to 4%, CAD-RADS 3 to 9%, CAD-RADS 4A to 21%, 4B to 25%, CAD-RADS 5 to 50%. There were no coronary artery deaths in CAD-RADS 1,2,3 cases in 10 years of follow-up. Two cases with CAD-RADS 4 A score, three cases with 4 B score, and four patients with CAD-RADS 5 had a history of death as a result of coronary disease. Conclusions The cases with a high risk of side effects with CAD-RADS scores were clearly shown. CAD-RADS score accurately identifies risks in postimaging follow-up and is a reliable reporting system in the required treatment planning.

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“…2 ), likely reflecting the younger age of coronary CT and a more established attitude of cardiologists to use a nonionizing “echocardiography-like” imaging method. This scenario is likely to change in the next future, as a consequence of the development and standardization of new promising CT-derived techniques, such as CT perfusion [ 36 ], CT delayed enhancement [ 37 , 38 ], CT-based extracellular volume quantification [ 39 ] and CT-based fractional flow reserve [ 40 ].…”

Section: Final Remarksmentioning

confidence: 99%

The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging-guided precision medicine

et al. 2020

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The purpose of this article is to provide an overview on the role of CT scan and MRI according to selected guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA). ESC and ACC/AHA guidelines were systematically reviewed for recommendations to CT and MRI use in specific cardiovascular (CV) clinical categories. All recommendations were collected in a dataset, including the class of recommendation, the level of evidence (LOE), the specific imaging technique, the clinical purpose of the recommendation and the recommending Society. Among the 43 included guidelines (ESC: n = 18, ACC/AHA: n = 25), 26 (60.4%) contained recommendations for CT scan or MRI (146 recommendations: 62 for CT and 84 for MRI). Class of recommendation IIa (32.9%) was the most represented, followed by I (28.1%), IIb (24%) and III (11.9%). MRI recommendations more frequently being of higher class (I: 36.9%, IIa: 29.8%, IIb: 21.4%, III: 11.9%) as compared to CT (I: 16.1%, IIa: 37.1%, IIb: 27.4%, III: 19.4%). Most of recommendation (55.5%) were based on expert opinion (LOE C). The use of cardiac CT and cardiac MR in the risk assessment, diagnosis, therapeutic and procedural planning is in continuous development, driven by an increasing need to evolve toward an imaging-guided precision medicine, combined with cost-effectiveness and healthcare sustainability. These developments must be accompanied by an increased availability of high-performance scanners in healthcare facilities and should emphasize the need of increasing the number of radiologists fully trained in cardiac imaging.

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Prognostic Value of Stress Dynamic Computed Tomography Perfusion With Computed Tomography Delayed Enhancement

Cited by 24 publications

References 18 publications

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Prognostic Value of Standard Coronary Computed Tomography Angiography Reporting System (CAD-RADS)

The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging-guided precision medicine

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