The aim of the study was to evaluate the prevalence of collateral findings detected in computed tomography coronary angiography (CTCA) in a multi-center registry.

Computed tomographic (CT) coronary angiography is a well-established, noninvasive imaging modality for detection of coronary stenosis, but it has limited accuracy in demonstrating whether a coronary stenosis is hemodynamically significant. An additional functional test is often required because both anatomic and functional information is needed for guiding patient care. Recent developments in CT technology allow CT evaluation of myocardial perfusion during vasodilator stress, thereby providing information about myocardial ischemia. Investigators in several single-center studies have established the feasibility of performing stress myocardial perfusion CT imaging in small groups of patients and have shown that stress myocardial perfusion CT in combination with CT coronary angiography improved the diagnostic accuracy in comparison with CT coronary angiography alone. However, CT perfusion acquisition protocols must be optimized in terms of acquisition and reconstruction parameters, contrast material protocol injections, and radiation dose. Further research is needed to establish the clinical usefulness of this novel technique. The purpose of this review is to (a) provide an overview of the physiology of coronary circulation and myocardial perfusion; (b) describe the technical prerequisites, challenges, and mathematic modeling related to CT perfusion imaging; (c) note recent advances in CT scanners and CT perfusion protocols; and (d) discuss the interpretation of CT perfusion images. Finally, a review and summary of the current literature are provided, and future directions for research are discussed. (C) RSNA, 2014

To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction.

BackgroundTo determine the comparative effectiveness and costs of a CT-strategy and a stress-electrocardiography-based strategy (standard-of-care; SOC-strategy) for diagnosing coronary artery disease (CAD).MethodsA decision analysis was performed based on a well-documented prospective cohort of 471 outpatients with stable chest pain with follow-up combined with best-available evidence from the literature. Outcomes were correct classification of patients as CAD− (no obstructive CAD), CAD+ (obstructive CAD without revascularization) and indication for Revascularization (using a combination reference standard), diagnostic costs, lifetime health care costs, and quality-adjusted life years (QALY). Parameter uncertainty was analyzed using probabilistic sensitivity analysis.ResultsFor men (and women), diagnostic cost savings were €245 (€252) for the CT-strategy as compared to the SOC-strategy. The CT-strategy classified 82% (88%) of simulated men (women) in the appropriate disease category, whereas 83% (85%) were correctly classified by the SOC-strategy. The long-term cost-effectiveness analysis showed that the SOC-strategy was dominated by the CT-strategy, which was less expensive (−€229 in men, −€444 in women) and more effective (+0.002 QALY in men, +0.005 in women). The CT-strategy was cost-saving (−€231) but also less effective compared to SOC (−0.003 QALY) in men with a pre-test probability of ≥70%. The CT-strategy was cost-effective in 100% of simulations, except for men with a pre-test probability ≥70% in which case it was 59%.ConclusionsThe results suggest that a CT-based strategy is less expensive and equally effective compared to SOC in all women and in men with a pre-test probability <70%.

To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men.

State of the art cardiac computed tomography (CT) enables the acquisition of imaging data of the heart over the entire cardiac cycle at concurrent high spatial and temporal resolution. However, in clinical practice, acquisition is increasingly limited to 3-D images. Estimating the shape of the cardiac structures throughout the entire cardiac cycle from a 3-D image is therefore useful in applications such as the alignment of preoperative computed tomography angiography (CTA) to intra-operative X-ray images for improved guidance in coronary interventions. We hypothesize that the motion of the heart is partially explained by its shape and therefore investigate the use of three regression methods for motion estimation from single-phase shape information. Quantitative evaluation on 150 4-D CTA images showed a small, but statistically significant, increase in the accuracy of the predicted shape sequences when using any of the regression methods, compared to shape-independent motion prediction by application of the mean motion. The best results were achieved using principal component regression resulting in point-to-point errors of 2.3±0.5 mm, compared to values of 2.7±0.6 mm for shape-independent motion estimation. Finally, we showed that this significant difference withstands small variations in important parameter settings of the landmarking procedure.

To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters.

OBJECTIVES This study sought to analyze the natural history of coronary atherosclerosis by multislice computed tomography (MSCT) and assess the serial changes in coronary plaque burden, lumen dimensions, and arterial remodeling.BACKGROUND MSCT can comprehensively assess coronary atherosclerosis by combining lumen and plaque size parameters.METHODS Thirty-two patients with acute coronary syndromes underwent 64-slice computed tomography angiography after percutaneous coronary intervention at baseline and after a median of 39 months. All patients received contemporary medical treatment. All available coronary segments in every subject were analyzed. The progression of atherosclerosis per segment and per patient was assessed by means of change in percent atheroma volume (PAV), change in normalized total atheroma volume (TAVnorm), and percent change in TAV (% change in TAV). Serial coronary remodeling was also assessed. Measures of lumen stenosis included percent diameter stenosis (%DS), minimum lumen diameter (MLD), percent area stenosis (%AS), and minimum lumen area (MLA). For each patient, the mean of all matched segments was calculated at the 2 time points. Clinical events at follow-up were documented.RESULTS The PAV did not change significantly (-0.15 +/- 3.64%, p = 0.72). The mean change in TAVnorm was 47.36 +/- 143.24 mm(3) (p = 0.071), and the % change in TAV was 6.7% (p = 0.029). The MLD and MLA increased by 0.15 mm (-0.09 to 0.24, p = 0.039) and 0.52 mm(2) (-0.38 to 1.04, p = 0.034) respectively, which was accompanied by vessel enlargement, with 53% of the patients showing expansive positive remodeling. Patients with clinical events had a larger TAVnorm at baseline (969.72 mm(3) vs. 810.77 mm(3), p = 0.010).CONCLUSIONS MSCT can assess the progression of coronary atherosclerosis and may be used for noninvasive monitoring of pharmacological interventions in coronary artery disease. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466) (J Am Coll Cardiol Img 2012;5:528-37) 0 2012 by the American College of Cardiology Foundation

AIMTo assess the attenuation of non-calcified atherosclerotic coronary artery plaques with computed tomography coronary angiography (CTCA).METHODSFour hundred consecutive patients underwent CTCA (Group 1: 200 patients, Sensation 64 Cardiac, Siemens; Group 2: 200 patients, VCT GE Healthcare, with either Iomeprol 400 or Iodixanol 320, respectively) for suspected coronary artery disease (CAD). CTCA was performed using standard protocols. Image quality (score 0-3), plaque (within the accessible non-calcified component of each non-calcified/mixed plaque) and coronary lumen attenuation were measured. Data were compared on a per-segment/per-plaque basis. Plaques were classified as fibrous vs lipid rich based on different attenuation thresholds. A P < 0.05 was considered significant.RESULTSIn 468 atherosclerotic plaques in Group 1 and 644 in Group 2, average image quality was 2.96 ± 0.19 in Group 1 and 2.93 ± 0.25 in Group 2 (P ≥ 0.05). Coronary lumen attenuation was 367 ± 85 Hounsfield units (HU) in Group 1 and 327 ± 73 HU in Group 2 (P < 0.05); non-calcified plaque attenuation was 48 ± 23 HU in Group 1 and 39 ± 21 HU in Group 2 (P < 0.05). Overall signal to noise ratio was 15.6 ± 4.7 in Group 1 and 21.2 ± 7.7 in Group 2 (P < 0.01).CONCLUSIONHigher intra-vascular attenuation modifies significantly the attenuation of non-calcified coronary plaques. This results in a more difficult characterization between lipid rich vs fibrous type.

HomeRadiologyVol. 263, No. 3 Previous CommunicationsLetters to the EditorLow-Dose Scan Protocols in Dual-Source CT Coronary AngiographyMin Li, Gang SunMin Li, Gang SunAuthor AffiliationsDepartment of Medical Imaging, Jinan Military General Hospital, 25 Shifan Rd, Jinan, Shandong, China 250031 e-mail: [email protected]Min LiGang SunPublished Online:Jun 1 2012https://doi.org/10.1148/radiol.12112369MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References1 Neefjes LA, Dharampal AS, Rossi A, et al.. Image quality and radiation exposure using different low-dose scan protocols in dual-source CT coronary angiography: randomized study. Radiology 2011;261(3):779–786. Link, Google Scholar2 Weustink AC, Mollet NR, Pugliese F, et al.. Optimal electrocardiographic pulsing windows and heart rate: effect on image quality and radiation exposure at dual-source coronary CT angiography. Radiology 2008;248(3):792–798. Link, Google Scholar3 Hurwitz LM, Reiman RE, Yoshizumi TT, et al.. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology 2007;245(3):742–750. Link, Google Scholar4 Einstein AJ, Elliston CD, Arai AE, et al.. Radiation dose from single-heartbeat coronary CT angiography performed with a 320-detector row volume scanner. Radiology 2010;254(3):698–706. Link, Google Scholar5 Huda W. Computing effective doses from dose-length product in CT. Radiology 2008;248(1):321; author reply 321–322. Link, Google ScholarArticle HistoryPublished online: June 2012Published in print: June 2012 FiguresReferencesRelatedDetailsCited ByComputed Tomography in Adult Congenital Heart DiseasePraveenRanganath, SatinderSingh, SuhnyAbbara, Prachi P.Agarwal, PrabhakarRajiah2019Jan1 | Radiologic Clinics of North America, Vol. 57, No. 1Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenosesM.Koplay, H.Erdogan, A.Avci, M.Sivri, K.Demir, I.Guler, L.S.Demir, Y.Paksoy2016Apr1 | Diagnostic and Interventional Imaging, Vol. 97, No. 4Questionnaire Survey of SPECT Studies after the Supply Shortage of Tc-99m and Model Analysis Concerning Earnings and Expenditure of Generator UseRyoKINOSHITA, ShigeruKOSUDA, KatsumiKOIKE, TakashiARAI2012Jan1 | RADIOISOTOPES, Vol. 61, No. 12Recommended Articles Imaging the Infant Chest without Sedation: Feasibility of Using Single Axial Rotation with 16-cm Wide-Detector CTRadiology2017Volume: 286Issue: 1pp. 279-285Advanced CT Techniques for Decreasing Radiation Dose, Reducing Sedation Requirements, and Optimizing Image Quality in ChildrenRadioGraphics2019Volume: 39Issue: 3pp. 709-726Milestones in CT: Past, Present, and FutureRadiology2023Volume: 309Issue: 1The Effect of Contrast Material on Radiation Dose at CT: Part II. A Systematic Evaluation across 58 Patient ModelsRadiology2017Volume: 283Issue: 3pp. 749-757Atrial Fibrillation: Diagnostic Accuracy of Coronary CT Angiography Performed with a Whole-Heart 230-µm Spatial Resolution CT ScannerRadiology2017Volume: 284Issue: 3pp. 676-684See More RSNA Education Exhibits Demystifying the CT Dose Sheet and Image HeadersDigital Posters2020Clinical Implementation Of A First-generation Dual Source Photon Counting Detector CT: First Experience And Perspective For Clinical UseDigital Posters2021New CT Technology: A Practical Approach to Convert CT Acquisition Protocols from Energy Integrating Detector (EID) CT to Photon Counting Detector (PCD) CTDigital Posters2022 RSNA Case Collection Takayasu ArteritisRSNA Case Collection2020Cystic adventitial disease of the popliteal arteryRSNA Case Collection2020Subclavian Stenosis with Pre-StealRSNA Case Collection2021 Vol. 263, No. 3 Metrics Altmetric Score PDF download

Objectives To develop prediction models that better estimate the pretest probability of coronary artery disease in low prevalence populations. Design Retrospective pooled analysis of individual patient data. Setting 18 hospitals in Europe and the United States. Participants Patients with stable chest pain without evidence for previous coronary artery disease, if they were referred for computed tomography (CT) based coronary angiography or catheter based coronary angiography (indicated as low and high prevalence settings, respectively). Main outcome measures Obstructive coronary artery disease (≥50% diameter stenosis in at least one vessel found on catheter based coronary angiography). Multiple imputation accounted for missing predictors and outcomes, exploiting strong correlation between the two angiography procedures. Predictive models included a basic model (age, sex, symptoms, and setting), clinical model (basic model factors and diabetes, hypertension, dyslipidaemia, and smoking), and extended model (clinical model factors and use of the CT based coronary calcium score). We assessed discrimination (c statistic), calibration, and continuous net reclassification improvement by cross validation for the four largest low prevalence datasets separately and the smaller remaining low prevalence datasets combined. Results We included 5677 patients (3283 men, 2394 women), of whom 1634 had obstructive coronary artery disease found on catheter based coronary angiography. All potential predictors were significantly associated with the presence of disease in univariable and multivariable analyses. The clinical model improved the prediction, compared with the basic model (cross validated c statistic improvement from 0.77 to 0.79, net reclassification improvement 35%); the coronary calcium score in the extended model was a major predictor (0.79 to 0.88, 102%). Calibration for low prevalence datasets was satisfactory. Conclusions Updated prediction models including age, sex, symptoms, and cardiovascular risk factors allow for accurate estimation of the pretest probability of coronary artery disease in low prevalence populations. Addition of coronary calcium scores to the prediction models improves the estimates.

AIMSOnly few preliminary experimental studies demonstrated the feasibility of adenosine stress CT myocardial perfusion imaging to calculate the absolute myocardial blood flow (MBF), thereby providing information whether a coronary stenosis is flow limiting. Therefore, the aim of our study was to determine whether adenosine stress myocardial perfusion imaging by Dual Source CT (DSCT) enables non-invasive quantification of regional MBF in an animal model with various degrees of coronary flow reduction.METHODS AND RESULTSIn seven pigs, a coronary flow probe and an adjustable hydraulic occluder were placed around the left anterior descending coronary artery to monitor the distal coronary artery blood flow (CBF) while several degrees of coronary flow reduction were induced. CT perfusion (CT-MBF) was acquired during adenosine stress with no CBF reduction, an intermediate (15-39%) and a severe (40-95%) CBF reduction. Reference standards were CBF and fractional flow reserve measurements (FFR). FFR was simultaneously derived from distal coronary artery pressure and aortic pressure measurements. CT-MBF decreased progressively with increasing CBF reduction severity from 2.68 (2.31-2.81)mL/g/min (normal CBF) to 1.96 (1.83-2.33) mL/g/min (intermediate CBF-reduction) and to 1.55 (1.14-2.06)mL/g/min (severe CBF-reduction) (both P < 0.001). We observed very good correlations between CT-MBF and CBF (r = 0.85, P < 0.001) and CT-MBF and FFR (r = 0.85, P < 0.001).CONCLUSIONAdenosine stress DSCT myocardial perfusion imaging allows quantification of regional MBF under various degrees of CBF reduction.

We propose a 3D+t/2D+t registration strategy to relate preoperative CTA to intraoperative X-ray angiography for improved image guidance during coronary interventions. We first derive 4D coronary models from CTA and then align these models both temporally and spatially to the intraoperative images. Temporal alignment is based on aligning ECG signals, whereas the spatial alignment uses a similarity metric based on centerline projection and fuzzy X-ray segmentation. In the spatial alignment step we use information from multiple time points simultaneously and take into account rigid respiratory motion. Evaluation shows improved performance compared to a 3D/2D approach with respect to both registration success and reproducibility.

ObjectiveTo assess the influence of sex on the diagnostic performance of computed tomography coronary angiography (CTCA). MethodsA total of 916 symptomatic patients (30.5% women) without earlier history of coronary artery intervention underwent both CTCA and invasive coronary angiography. Descriptive diagnostic parameters, to detect obstructive coronary artery disease (CAD; ≥50% lumen diameter narrowing) on CTCA, were compared between women and men on a per-patient, per-vessel, and per-segment level. Adjusted values were calculated for clustered segments and differences in sex variables using logistic multivariate regression models in general estimated equations. ResultsWomen were older, had less typical chest complaints, and had a lower prevalence, extent, and severity of CAD compared with men. Multivariate analysis on a per-patient level revealed no difference in sensitivity (98 vs. 99%, P=0.15), specificity (78 vs. 82%, P=0.65), positive predictive value (PPV; 87 vs. 95%, P=0.10), negative predictive value (NPV; 97 vs. 98%, P=0.63), and diagnostic odds ratio (DOR; 198 vs. 721, P=0.07). No difference was found on per-vessel level analysis (sensitivity 95 vs. 97%, P=0.14; specificity 89 vs. 87%, P=0.93; PPV 73 vs. 79%, P=0.06; NPV 98 vs. 98%, P=0.72; and DOR 143 vs. 240, P=0.08). Per-segment analysis revealed a lower sensitivity (88 vs. 94%, P<0.001) and DOR (163 vs. 302, P=0.002) in women compared with men, without a difference in specificity (96 vs. 95%, P=0.19), PPV (64 vs. 69%, P=0.07), and NPV (99 vs. 99%, P=0.08). ConclusionCTCA can accurately rule out obstructive CAD in both women and men. CTCA is less accurate in women to detect individual obstructive disease.

To describe a method for the estimation of transaortic flow from multidetector computer tomography (MDCT).

PURPOSE:To determine and compare the prognostic value of cardiac computed tomographic (CT) angiography, coronary calcium scoring, and exercise electrocardiography (ECG) in patients with chest pain who are suspected of having coronary artery disease (CAD).MATERIALS AND METHODS:This study complied with the Declaration of Helsinki, and the local ethics committee approved the study. Patients (n = 471) without known CAD underwent exercise ECG and dual-source CT at a rapid assessment outpatient chest pain clinic. Coronary calcification and the presence of 50% or greater coronary stenosis (in one or more vessels) were assessed with CT. Exercise ECG results were classified as normal, ischemic, or nondiagnostic. The primary outcome was a major adverse cardiac event (MACE), defined as cardiac death, nonfatal myocardial infarction, or unstable angina requiring hospitalization and revascularization beyond 6 months. Univariable and multivariable Cox regression analysis was used to determine the prognostic values, while clinical impact was assessed with the net reclassification improvement metric.RESULTS:Follow-up was completed for 424 (90%) patients; the mean duration of follow-up was 2.6 years. A total of 44 MACEs occurred in 30 patients. Four of the MACEs were cardiac deaths and six were nonfatal myocardial infarctions. The presence of coronary calcification (hazard ratio [HR], 8.22 [95% confidence interval {CI}: 1.96, 34.51]), obstructive CAD (HR, 6.22 [95% CI: 2.77, 13.99]), and nondiagnostic stress test results (HR, 3.00 [95% CI: 1.26, 7.14]) were univariable predictors of MACEs. In the multivariable model, CT angiography findings (HR, 5.0 [95% CI: 1.7, 14.5]) and nondiagnostic exercise ECG results (HR, 2.9 [95% CI: 1.2, 7.0]) remained independent predictors of MACEs. CT angiography findings showed incremental value beyond clinical predictors and stress testing (global χ(2), 37.7 vs 13.7; P < .001), whereas coronary calcium scores did not have further incremental value (global χ(2), 38.2 vs 37.7; P = .40).CONCLUSION:CT angiography findings are a strong predictor of future adverse events, showing incremental value over clinical predictors, stress testing, and coronary calcium scores.SUPPLEMENTAL MATERIAL:http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110744/-/DC1.