Abstract 4210: Evaluation of Coronary Stenoses and their Functional Significance in Patients with Known and Suspected Coronary Artery Disease using MRI and CTA

Objectives: Non-invasive computed tomography coronary angiography (CTA) is an accurate anatomic imaging technique, but cannot assess the hemodynamic severity of the detected atherosclerotic lesions. In patients with abnormal CTA, optimal treatment strategy may therefore remain uncertain. The purpose of the current study was to compare anatomic observations with CTA to functional assessment with MRI in patients with known and suspected CAD. Methods: In this prospective study, 55 patients (62% male, average age 57±9 years, pre-test likelihood low to intermediate 62%) underwent 64-slice CTA and 1.5 Tesla MRI within 40 days. The presence of CAD (normal <30% stenosis, non-significant 30%–50% stenosis, and significant >50% stenosis) was determined on CTA and first pass perfusion during adenosine stress was assessed on MRI. Results: CTA was normal in 15 (27%), non-significant in 24 (44%) and significant in 16 (29%) patients. MRI revealed a perfusion defect in 21 (38%) patients, and was normal in 34 (62%). Table 1 shows the CTA results for patients with normal and abnormal perfusion on MRI. CTA was abnormal in almost all patients with an abnormal perfusion. However, a normal perfusion MRI study was associated with abnormal CTA in a large proportion of patients, as non-significant and significant CAD was noted in 15 (44%) and 5 (15%) patients respectively. Conclusion: Although abnormal perfusion on MRI correlated well with abnormal CTA, underlying CAD is present in the majority of patients with a normal MRI perfusion study. The combination of both techniques may allow more refined characterization of CAD. Table 1

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Stress-induced Myocardial Ischaemia – Perfusion Contrast Echocardiography to Evaluate Presence and Severity of Coronary Artery Disease

European Cardiology Review ◽

10.15420/ecr.2011.7.3.172 ◽

2011 ◽

Vol 7 (3) ◽

pp. 172

Author(s):

Benoy Nalin Shah ◽

Roxy Senior ◽

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Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Perfusion ◽

Contrast Echocardiography ◽

Evidence Base ◽

Suspected Coronary Artery Disease ◽

Ultrasound Contrast Agents ◽

Prognostic Information ◽

Non Invasive ◽

Artery Disease

The development of stable transpulmonary ultrasound contrast agents (UCAs) has allowed the echocardiographic assessment of myocardial perfusion, a technique known as myocardial contrast echocardiography (MCE). MCE exploits the ultrasonic properties of UCAs, which consist of acoustically active gas-filled microspheres. These are intravascular agents that have a rheology similar to red blood cells and thus allow analysis of myocardial blood flow both at rest and after stress. The combined assessment of wall motion and myocardial perfusion provides significant diagnostic and prognostic information during stress echocardiography. Functional imaging tests, such as myocardial perfusion scintigraphy and stress cardiac magnetic resonance imaging, are also used for non-invasive assessment of coronary disease. The principal advantages of MCE are that it does not expose the patient to ionising radiation or radioactive pharmaceuticals, is not contraindicated in patients with an implanted metallic device or who suffer from claustrophobia and it can be performed at the bedside. The purpose of this article is to outline the physiological principles underpinning ischaemia testing with MCE before proceeding to review the evidence base for MCE in patients with known or suspected coronary artery disease.

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Cardiac Computed Tomography Radiomics for the Non-Invasive Assessment of Coronary Inflammation

Cells ◽

10.3390/cells10040879 ◽

2021 ◽

Vol 10 (4) ◽

pp. 879

Author(s):

Kevin Cheng ◽

Andrew Lin ◽

Jeremy Yuvaraj ◽

Stephen J. Nicholls ◽

Dennis T.L. Wong

Keyword(s):

Cardiac Computed Tomography ◽

Quantitative Information ◽

Imaging Biomarkers ◽

Great Promise ◽

Non Invasive ◽

Quantitative Image ◽

Artery Disease ◽

Therapeutic Decision Making ◽

Underlying Pathophysiology

Radiomics, via the extraction of quantitative information from conventional radiologic images, can identify imperceptible imaging biomarkers that can advance the characterization of coronary plaques and the surrounding adipose tissue. Such an approach can unravel the underlying pathophysiology of atherosclerosis which has the potential to aid diagnostic, prognostic and, therapeutic decision making. Several studies have demonstrated that radiomic analysis can characterize coronary atherosclerotic plaques with a level of accuracy comparable, if not superior, to current conventional qualitative and quantitative image analysis. While there are many milestones still to be reached before radiomics can be integrated into current clinical practice, such techniques hold great promise for improving the imaging phenotyping of coronary artery disease.

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