Multidetector-row computed tomography to detect coronary artery disease: the importance of heart rate

Introduction: The purpose of this study was to test the hypothesis that cardiac multidetector-row computed tomography (MDCT) technology can assess myocardial perfusion quantitatively using adenosine triphosphate (ATP) load technique. Methods: Ten patients (median age 71 (range 65–79) years) who were scheduled for surgical revascularization, underwent cardiac electrocardiography-gated MDCT using ATP-load technique. The patients with unstable angina and myocardial infraction were excluded. Myocardial infarction was detected by late gadolinium enhancement MRI which was assessed before MDCT. Myocardial blood flow (MBF) was estimated from the slope of the linear regression equation with Patlak plots analysis. MBF results were compared to the presence of stenoses more than 75% on coronary angiography (CAG) and moderate to severe myocardium ischemia on stress thallium-201 myocardial perfusion scintigraphy (MPS). Results: The overall mean MBF was 1.64±0.61 ml/g/min. Mean MBF in territories with stenosis on CAG was 0.81±0.49 ml/g/min, while mean MBF in territories without stenosis was 1.83±0.64 ml/g/min (p<0.01). Mean MBF in territories with moderate to severe ischemia on MPS was 0.76±0.49 ml/g/min, while mean MBF in territories without ischemia was 2.15±0.66ml/g/min (p<0.01). When the cut off value of MBF was set at 1.5 ml/g/min, there was good correlation between MBF vs CAG, and MBF and MPS. MBF vs CAG: sensitivity=71.4%, specificity=82.6%; MBF vs MPS: sensitivity=85.7%, specificity=87.0%. Conclusions: This study proposed the possibility of MDCT to quantify myocardial blood flow using ATP in coronary artery disease. Our data suggested that the ATP stress MDCT has an advantage in the assessment of CAD to evaluate both coronary artery stenoses and myocardial perfusion information in one modality.

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Noninvasive Assessment of Coronary Artery Disease with Multidetector-Row Computed Tomography: Current Status and Future Perspective

Nihon Ika Daigaku Igakkai Zasshi ◽

10.1272/manms.4.19 ◽

2008 ◽

Vol 4 (1) ◽

pp. 19-24

Author(s):

Hiromitsu Hayashi

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Current Status ◽

Future Perspective ◽

Multidetector Row Computed Tomography ◽

Multidetector Row ◽

Noninvasive Assessment ◽

Artery Disease

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Multidetector-row Computed Tomography in the Assessment of Coronary Artery Disease – New Techniques and Insights

European Cardiology Review ◽

10.15420/ecr.2010.6.2.43 ◽

2010 ◽

Vol 6 (2) ◽

pp. 43 ◽

Cited By ~ 1

Author(s):

Andreas H Mahnken ◽

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Data Acquisition ◽

Temporal Resolution ◽

High Temporal Resolution ◽

Multidetector Row ◽

Ct Scanners ◽

Artery Disease ◽

Cardiac Mdct

Over the last decade, cardiac computed tomography (CT) technology has experienced revolutionary changes and gained broad clinical acceptance in the work-up of patients suffering from coronary artery disease (CAD). Since cardiac multidetector-row CT (MDCT) was introduced in 1998, acquisition time, number of detector rows and spatial and temporal resolution have improved tremendously. Current developments in cardiac CT are focusing on low-dose cardiac scanning at ultra-high temporal resolution. Technically, there are two major approaches to achieving these goals: rapid data acquisition using dual-source CT scanners with high temporal resolution or volumetric data acquisition with 256/320-slice CT scanners. While each approach has specific advantages and disadvantages, both technologies foster the extension of cardiac MDCT beyond morphological imaging towards the functional assessment of CAD. This article examines current trends in the development of cardiac MDCT.

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Prognostic outcome of routine clinical noninvasive multidetector-row computed tomography coronary angiography in patients with suspected coronary artery disease: a 2-year follow-up study

La radiologia medica ◽

10.1007/s11547-011-0655-z ◽

2011 ◽

Vol 116 (4) ◽

pp. 521-531 ◽

Cited By ~ 6

Author(s):

L. La Grutta ◽

G. Runza ◽

G. Gentile ◽

E. Russo ◽

G. Lo Re ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Suspected Coronary Artery Disease ◽

Multidetector Row Computed Tomography ◽

Follow Up Study ◽

Prognostic Outcome ◽

Artery Disease

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Limitations of 64-detector-row computed tomography coronary angiography: Calcium and motion but not short experience

Acta Radiologica ◽

10.1080/02841850802647013 ◽

2009 ◽

Vol 50 (2) ◽

pp. 174-180 ◽

Cited By ~ 7

Author(s):

H. Mir-Akbari ◽

J. Ripsweden ◽

J. Jensen ◽

P. Pichler ◽

C. Sylvén ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Heart Rate ◽

Coronary Artery ◽

Coronary Angiography ◽

Predictive Value ◽

Coronary Stenosis ◽

Diagnostic Performance ◽

Motion Artifacts ◽

Artery Disease

Background: Recently, 64-detector-row computed tomography coronary angiography (CTA) has been introduced for the noninvasive diagnosis of coronary artery disease. Purpose: To evaluate the diagnostic capacity and limitations of a newly established CTA service. Material and Methods: In 101 outpatients with suspected coronary artery disease, 64-detector-row CTA (VCT Lightspeed 64; GE Healthcare, Milwaukee, Wisc., USA) was performed before invasive coronary angiography (ICA). The presence of >50% diameter coronary stenosis on CTA was rated by two radiologists recently trained in CTA, and separately by an experienced colleague. Diagnostic performance of CTA was calculated on segment, vessel, and patient levels, using ICA as a reference. Segments with a proximal reference diameter <2 mm or with stents were not analyzed. Results: In 51 of 101 patients and 121 of 1280 segments, ICA detected coronary stenosis. In 274 of 1280 (21%) segments, CTA had non-diagnostic image quality, the main reasons being severe calcifications (49%), motion artifacts associated with high or irregular heart rate (45%), and low contrast opacification (14%). Significantly more women (43%) had non-diagnostic scans compared to men (20%). A heart rate above 60 beats per minute was associated with significantly more non-diagnostic patients (38% vs. 18%). In the 1006 diagnostic segments, CTA had a sensitivity of 78%, specificity of 95%, positive predictive value (PPV) of 54%, and negative predictive value (NPV) of 98% for detecting significant coronary stenosis. In 29 patients, CTA was non-diagnostic. In the remaining 72 patients, sensitivity was 100%, specificity 65%, PPV 79%, and NPV 100%. The use of a more experienced CTA reader did not improve diagnostic performance. Conclusion: CTA had a very high negative predictive value, but the number of non-diagnostic scans was high, especially in women. The main limitations were motion artifacts and vessel calcifications, while short experience in CTA did not influence the interpretation.

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