Multidetector CT coronary angiography: have we found the holy grail of non-invasive coronary imaging?

Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ?50%, stenosis >50%, and stenosis >75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis. DOI: http://dx.doi.org/10.3329/bmrcb.v40i1.20334 Bangladesh Med Res Counc Bull 2014; 40: 31-35

Download Full-text

Role of multidetector CT Coronary Angiography in Assessment of the prevalence and plaque composition between dyslipidemic and non dyslipidemic patients

QJM ◽

10.1093/qjmed/hcaa068.002 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S A Elsaed ◽

K E Allam ◽

E A S Geneidi ◽

A S Abdelrahman

Keyword(s):

Coronary Angiography ◽

Multidetector Ct ◽

Multislice Ct ◽

Coronary Plaque ◽

Distal Segment ◽

Ct Coronary Angiography ◽

Plaque Burden ◽

Plaque Composition ◽

New Applications

Abstract Purpose To highlight the role of multislice CT coronary angiography with its new applications such as reformatted images, and high resolution imaging, regarding coronary plaque composition and prevalence in dyslipidemic and non dyslipidemic patients Methods The study included 30 patients, 15 non dyslipidemic and 15 dyslipidemic patients. Each patient included in the study was subjected to full history taking, reviewing medical sheet. CTCA was performed for all patients followed by analysis of the plaque composition and percent stenosis using the axial images and multiplanar reconstruction. Results It was found that dyslipidemic patients had more plaque burden than non dyslipidemic. The dyslipidemic patients were more liable for multiple and soft plaques, mainly appreciated at the distal segment of the coronary arteries while non dyslipidemic were more liable for single and calcific/mixed plaques. Thus, may encourage the clinician to use lipid lower drugs as primary or secondary intervention for CAD.

Download Full-text

Non invasive cardiac vein mapping: Role of multislice CT coronary angiography

European Journal of Radiology ◽

10.1016/j.ejrad.2012.03.007 ◽

2012 ◽

Vol 81 (11) ◽

pp. 3262-3269 ◽

Cited By ~ 13

Author(s):

Roberto Malagò ◽

Andrea Pezzato ◽

Camilla Barbiani ◽

Giuseppe Sala ◽

Giulia A. Zamboni ◽

...

Keyword(s):

Coronary Angiography ◽

Multislice Ct ◽

Ct Coronary Angiography ◽

Non Invasive

Download Full-text

Diagnostic accuracy of 256-row multidetector CT coronary angiography with prospective ECG-gating combined with fourth-generation iterative reconstruction algorithm in the assessment of coronary artery bypass: evaluation of dose reduction and image quality

La radiologia medica ◽

10.1007/s11547-017-0800-4 ◽

2017 ◽

Vol 122 (12) ◽

pp. 893-901 ◽

Cited By ~ 5

Author(s):

Davide Ippolito ◽

Davide Fior ◽

Cammillo Talei Franzesi ◽

Luca Riva ◽

Alessandra Casiraghi ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Multidetector Ct ◽

Artery Bypass ◽

Reconstruction Algorithm ◽

Ct Coronary Angiography ◽

Fourth Generation ◽

Ecg Gating ◽

Iterative Reconstruction Algorithm ◽

Prospective Ecg Gating

Download Full-text

Cirsoid Aneurysm of Coronary Arteries Associated with Arterioventricular Fistula Evaluated by 64-Multidetector CT Coronary Angiography: Depiction of a Case

CardioVascular and Interventional Radiology ◽

10.1007/s00270-008-9416-3 ◽

2008 ◽

Vol 32 (3) ◽

pp. 539-542

Author(s):

Gianluca Marrone ◽

Giuseppe Mamone ◽

Mariapina Milazzo ◽

Settimo Caruso ◽

Cesar Hernandez Baravoglia ◽

...

Keyword(s):

Coronary Angiography ◽

Coronary Arteries ◽

Multidetector Ct ◽

Ct Coronary Angiography ◽

Cirsoid Aneurysm

Download Full-text

Noninvasive Detection of Coronary Atherosclerotic Plaques and Assessment of Stenosis Degree at Multidetector CT Coronary Angiography

Journal of Korean Medical Association ◽

10.5124/jkma.2007.50.2.109 ◽

2007 ◽

Vol 50 (2) ◽

pp. 109

Author(s):

Yeon Hyeon Choe

Keyword(s):

Coronary Angiography ◽

Multidetector Ct ◽

Ct Coronary Angiography ◽

Noninvasive Detection ◽

Atherosclerotic Plaques

Download Full-text

The central role of CT coronary angiography in postcardiac arrest care in the young adult

BMJ Case Reports ◽

10.1136/bcr-2019-232104 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232104

Author(s):

Ayisha Mehtab Khan-Kheil ◽

Alexandra Sophie Moss ◽

Leanne Stephens ◽

Jamal Nasir Khan

Keyword(s):

Coronary Angiography ◽

Invasive Coronary Angiography ◽

Young Patients ◽

Population Group ◽

Ct Coronary Angiography ◽

Successful Resuscitation ◽

Cardioverter Defibrillator ◽

Non Invasive ◽

Tertiary Centre ◽

Artery Disease

A 32-year-old man with no medical history went into ventricular fibrillation while running at the gym. He was transferred to our tertiary centre post successful resuscitation where admission electrocardiography and echocardiography were unremarkable. The initial cause of cardiac arrest was suspected arrhythmogenic and he was admitted for further investigations including exercise testing, ajmaline challenge, CT coronary angiography (CTCA) and cardiovascular MRI, with the likely outcome of cardioverter-defibrillator implantation. CTCA, however, revealed significant stenosis in the proximal left anterior descending artery as the likely cause for his arrest. Invasive coronary angiography confirmed this and facilitated successful stent implantation, avoiding the need for implantable cardioverter-defibrillator implantation. This case highlights the importance of CTCA, a non-invasive and readily-available test in the investigation of young patients postcardiac arrest, who require active exclusion of coronary artery disease and anomalous coronary anatomy, though they represent a low-risk population group.

Download Full-text

P1436 Diagnostic yield and accuracy of CT coronary angiography compared to invasive coronary angiography: real world data from a district general hospital in the United Kingdom

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.865 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Cited By ~ 1

Author(s):

A M Masoud ◽

W T Topping ◽

M L Lynch

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Predictive Value ◽

Invasive Coronary Angiography ◽

District General Hospital ◽

Ct Coronary Angiography ◽

Non Invasive ◽

Epicardial Coronary Artery ◽

Luminal Stenosis ◽

Clinically Significant

Abstract Background Cost-effectiveness is imperative for a sustainable healthcare service. Non-invasive testing is used to risk stratify patients and reduce the need for invasive investigations in cardiology. The National Institute for Health and Care Excellence (NICE) Clinical Guideline for evaluation of chest pain was updated in 2016 when NICE recommended CT coronary angiography (CTCA) as the first-line investigation for patients with suspected stable coronary artery disease (CAD). Purpose To evaluate the accuracy of CTCA in real life daily practice in a district general hospital outside the strict environment of clinical trials. Methods A retrospective analysis of all CTCA studies carried out between June and December 2017 was performed. Graft studies were excluded. Potentially obstructive CAD on CTCA was defined as any luminal stenosis ≥50% of a major epicardial coronary artery. On invasive coronary angiography (ICA), clinically significant CAD was defined as a luminal stenosis of ≥50% in the left main stem or a stenosis of ≥70% of any other major epicardial coronary artery. Results Out of a total of 528 CTCA studies, 109 patients (mean age 64.2 ± 10.4; 67.9% male) showed potentially significant CAD in at least one major epicardial coronary artery. The median calcium score was 379.7 (IQR = 86-929). 61 (56%) patients had ICA, 20 (18.3%) patients had non-invasive functional coronary assessment (19 stress echocardiogram and 1 stress perfusion cardiac magnetic resonance) and 3 (2.8%) patients had both. The remaining patients were managed medically without further investigation. Correlation between potentially obstructive CAD on CTCA and clinically significant CAD on ICA showed a sensitivity of 95.8% (95% CI: 85.8%-99.5%), specificity of 68.0% (95% CI: 61.0%-74.5%), positive predictive value of 42.2% (95% CI: 37.1%-47.4%), negative predictive value of 98.5% (95% CI: 94.5%-99.6%) and overall accuracy of 73.5% (95% CI: 67.5%-78.9%). Among patients who had ICA, 21 patients (34.4%) required coronary revascularization (16 percutaneous coronary intervention and 5 coronary artery bypass grafting) and 40 (65.6%) patients were treated medically. Only 1 patient (4.3% of 23 patients) showed evidence of inducible ischemia on non-invasive functional testing. Conclusion CTCA in a real world practice has high sensitivity and high negative predictive value compared to the gold standard ICA. CTCA improved patient selection for ICA to those most likely to have significant CAD.

Download Full-text