Impact of Several Factors on the Diagnostic Interpretability of Coronary Computed Tomographic Angiography Using a 256-Detector Row CT Scanner

2021 ◽  
Vol 17 ◽  
Author(s):  
Lixue Xu ◽  
Nan Luo ◽  
Yi He ◽  
Zhenghan Yang
Keyword(s):  
Predictive Value ◽  
Signal To Noise Ratio ◽  
Invasive Coronary Angiography ◽  
Computed Tomographic Angiography ◽  
Ct Scanner ◽  
Logistic Regression Models ◽  
Computed Tomographic ◽  
Stenosis Severity ◽  
Calcium Load ◽  
The Impact

Purpose: To explore the impact of patient-related, vessel-related, image quality-related and cardiovascular risk factors on CCTA interpretability using 256-detector row Computed Tomography (CT). Methods: One hundred ten patients who underwent CCTA and Invasive Coronary Angiography (ICA) were consecutively retrospectively enrolled from January 2018 to October 2018. Using ICA as the reference standard, ≥50% diameter stenosis was defined as the cut-off criterion to detect the diagnostic performance of CCTA. Diagnostic reproducibility was investigated by calculating the interrater reproducibility of CCTA. Multiple logistic regression models were performed to evaluate the impact of 14 objective factors. Results: A total of 1019 segments were evaluated. The per-segment sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CCTA were 76.8%, 93.7%, 91.2%, 67.8% and 95.9%, respectively. The per-segment diagnostic reproducibility was 0.44 for CCTA. Regarding accuracy, a negative association was found for stenosis severity, calcium load and hyperlipidaemia. Regarding sensitivity, calcium load and diabetes mellitus (DM) were positively related. Regarding specificity, a negative correlation was observed between stenosis severity and calcium load. Regarding interrater reproducibility, stenosis severity and calcium load were negatively associated, whereas male sex and the signal-to-noise ratio (SNR) were positively related (all p<0.05). Conclusion: Per-segment 256-detector row CCTA performance was optimal in stenosis-free or occluded segments. Heavier calcium load was associated with poorer CCTA interpretability. On the one hand, our findings confirmed the rule-out value of CCTA; on the other hand, they suggested improvements in calcium subtractions and deep learning-based tools to improve CCTA diagnostic interpretability.

scholarly journals Cardiac Computed Tomographic Angiography after Abnormal Ischemia Test as a Gatekeeper to Invasive Coronary Angiography.

2021 ◽  
Author(s):  
João Reis ◽  
Ruben Ramos ◽  
Hugo Marques ◽  
Pedro Modas Daniel ◽  
Silvia A ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Computed Tomographic Angiography ◽  
Major Adverse Cardiovascular Events ◽  
Selection Strategy ◽  
Diagnostic Strategy ◽  
Computed Tomographic ◽  
Tertiary Center ◽  
Tomographic Angiography ◽  
The Impact

Abstract ObjectivesThis study aimed to determine the impact of systematic coronary computed tomographic angiography (CCTA) use following an abnormal non-invasive ischemia test (NIST) on patient selection strategy for invasive coronary angiography (ICA).BackgroundIn patients with suspected stable coronary artery disease (CAD), NIST use frequently results in sub-optimal diagnostic and revascularization yields of ICA.MethodsThis randomized clinical trial, conducted at a single academic tertiary center, selected 220 symptomatic patients with mild-to-moderately abnormal NIST results who were referred for ICA. Patients received either the originally intended ICA (n = 105) or CCTA (n = 115). The primary endpoint was the diagnostic yield of ICA in each group. Revascularization yield and major adverse cardiovascular events at 12 months were also assessed.ResultsThe patients were 69 ± 9 years old, 60% were men, and 31% had typical angina. Mean pre-test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 37.7% on the index angiographic procedure. In the CCTA group, ICA was cancelled by referring physicians in 83 patients (72.2%) after receiving CCTA results. For those undergoing ICA, diagnostic (84.4% vs 41.7%, p < 0.001) and revascularization (71.9% vs 38.8%, p = 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs 16 ± 10 mSv, respectively, p = 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (p = 0.439).ConclusionsIn patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.

Additional value of deep learning computed tomographic angiography-based fractional flow reserve in detecting coronary stenosis and predicting outcomes

2021 ◽  
pp. 028418512098397
Author(s):  
Yang Li ◽  
Hong Qiu ◽  
Zhihui Hou ◽  
Jianfeng Zheng ◽  
Jianan Li ◽  
...  
Keyword(s):  
Deep Learning ◽  
Unstable Angina ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Computed Tomographic Angiography ◽  
Fractional Flow ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
Sensitivity Specificity ◽  
Tomographic Angiography

Background Deep learning (DL) has achieved great success in medical imaging and could be utilized for the non-invasive calculation of fractional flow reserve (FFR) from coronary computed tomographic angiography (CCTA) (CT-FFR). Purpose To examine the ability of a DL-based CT-FFR in detecting hemodynamic changes of stenosis. Material and Methods This study included 73 patients (85 vessels) who were suspected of coronary artery disease (CAD) and received CCTA followed by invasive FFR measurements within 90 days. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristics curve (AUC) were compared between CT-FFR and CCTA. Thirty-nine patients who received drug therapy instead of revascularization were followed for up to 31 months. Major adverse cardiac events (MACE), unstable angina, and rehospitalization were evaluated and compared between the study groups. Results At the patient level, CT-FFR achieved 90.4%, 93.6%, 88.1%, 85.3%, and 94.9% in accuracy, sensitivity, specificity, PPV, and NPV, respectively. At the vessel level, CT-FFR achieved 91.8%, 93.9%, 90.4%, 86.1%, and 95.9%, respectively. CT-FFR exceeded CCTA in these measurements at both levels. The vessel-level AUC for CT-FFR also outperformed that for CCTA (0.957 vs. 0.599, P < 0.0001). Patients with CT-FFR ≤0.8 had higher rates of rehospitalization (hazard ratio [HR] 4.51, 95% confidence interval [CI] 1.08–18.9) and MACE (HR 7.26, 95% CI 0.88–59.8), as well as a lower rate of unstable angina (HR 0.46, 95% CI 0.07–2.91). Conclusion CT-FFR is superior to conventional CCTA in differentiating functional myocardial ischemia. In addition, it has the potential to differentiate prognoses of patients with CAD.

Abstract 6101: Cost Effectiveness of Cardiac Computed Tomography Compared to Myocardial Perfusion Imaging (MPI) as an Effective Gatekeeper to Cardiac Catheterization in the Evaluation of Asymptomatic Firefighters with an Abnormal Treadmill Test

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthew Budoff ◽  
Robert Karwasky ◽  
Naser Ahmadi MD Ahmadi ◽  
Cyrus A Nasserian ◽  
William W Chang ◽  
...  
Keyword(s):  
Los Angeles ◽  
Care Pathway ◽  
Cardiac Computed Tomography ◽  
Clinical Care ◽  
Invasive Coronary Angiography ◽  
Calcium Score ◽  
Computed Tomographic Angiography ◽  
Sensitivity Analyses ◽  
Computed Tomographic ◽  
Clinical Care Pathway

To identify CAD among patients who fail treadmill tests, the traditional clinical care pathway is MPI, then invasive coronary angiography (ICA). In a retrospective cohort study, we compared the direct costs for detecting CAD using the traditional clinical care pathway and an alternative that incorporates MDCT, with coronary calcium score (CCS) followed by computed tomographic angiography (CTA) and ICA. Over a 2-year period, 3,950 Los Angeles, CA Firefighters underwent wellness/fitness exams at 6 contracted medical facilities. A total of 495 cases had abnormal treadmill tests and were referred for follow-up cardiology evaluation. All cases received CCS, followed by CTA for calcium scores >10, and ICA for abnormal CTA (>50% obstruction in at least one vessel). MPI results were estimated based on the prior year’s experience, with abnormal MPI receiving ICA. Costs to detect CAD were calculated for both the MPI and MDCT pathways based on results for the cohort and current Medicare reimbursement costs. Sensitivity analyses were performed by varying each of the clinical and cost components of the model to “low” and “high” levels and computing net costs. Most model inputs were varied by ±50% of baseline values to gauge the robustness of the results. Among 495 cases with abnormal treadmill tests, 146 (29.5%) would have required ICA due to abnormal MPI tests; 131 (26.9%) had abnormal CCS (>10) and went to CTA; 40 (8.1%) had abnormal CTA (>50% stenosis) and went to ICA. ICA showed 38 (7.7%) cases of CAD. The computed cost to detect CAD was $1,376 per case for the traditional route with MPI as gatekeeper and $503 per case for CCS as gatekeeper. All sensitivity analyses showed lower costs for the MDCT compared to MPI pathways. The net cost to ICA-confirmed diagnosis of CAD is substantially lower with MDCT compared to MPI as gatekeeper to ICA.

P6149Coronary computed tomographic angiography (CTA) for risk stratification in the diagnostic triage of patients undergoing liver transplantation (LT): A long-term outcome study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Strobl ◽  
T Senoner ◽  
A Finkenstedt ◽  
G Widmann ◽  
F Plank ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Calcium Score ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Computed Tomographic ◽  
All Cause Mortality ◽  
Stenosis Severity ◽  
Tomographic Angiography

Abstract Background Cardiovascular (CV) risk stratification in patients with end-stage liver disease (ESLD) prior to liver transplantation (LT) is crucial: CV-disease poses a major threat for posttransplant survival. Therefore, our purpose was to assess safety of coronary computed tomographic angiography (CTA) in patients prior to orthotopic LT over a long-term follow up period, and its value for CV risk stratification. Methods In this single center, retrospective observational study 458 patients underwent coronary calcium score (CCS) and coronary CTA for pre-LT risk stratification between 2005 and 2016. CTA was evaluated for 1) stenosis severity (CADRADS: 4-severe>70%/3-intermediate50–70%/2-mild<50%/1-minimal<25%/0=no CAD) 2) plaque burden (SIS, G-score), 3) high–risk plaque features (Napkin Ring Sign, low attenuation plaque, positive remodelling) and 4) Coronary Calcium Score. Primary endpoint was mortality (all-cause and cardiovascular), secondary endpoint major cardiovascular events (MACE). Results Finally 270 patients (79.3% males, age 61±8.5 years) who underwent orthotopic LT were included (mean follow-up 7.5 years±3.1, range 2–13). 87 (32.2%) had CCS zero and 60 (22.2%) CCS >300 Agatston Units (CCS 335.6 AU± 868.9). 248 patients underwent CTA after CCS. The majority had CAD (n=173, 72.3%) by CTA while only 75 (27.7%) had no CAD. 102 patients (38.8%) had minimal-or-mild stenosis<50% (CADRADS 1–2), 34 (12.9%) intermediate and 17 (6.5%) severe stenosis.Out of CCS 0 patients, 13 had non-calcified plaque. All-cause mortality rate was 46 (17.0%), with the majority of patients (43 (93.5%) experiencing non-cardiac death and 3 (6.5%) cardiovascular death due to 1 myocardial infarction and 2 cardiopulmonary failure. CADRADS predicted mortality (Kaplan Meir, p<0.001). On multivariate Cox Regression modell, SIS and G-score predicted all-cause mortality (HR 1.1:p=0.034; 95% CI: 0.649–0.983 and HR 1.1, p=0.029; 95% CI: 1.0–1.6), while Calcium Score did not. There were 6 MACE (3 STEMI, 3 NSTEMI). MACE rate was 0% in CADRADS 0 or 1, 1 in CADRADS-2 and increasing to 5 in CADRADS 3 and 4 groups. Coronary CTA for LT risk stratification Conclusion Cardiac CT is a reliable non-invasive modality for pre-LT assessment of CV-risk over a long-term period, with 0% MACE in patients with no CAD or minimal CAD. CTA allows for an improved CV-risk stratification by stenosis severity (CADRADS) and plaque burden as compared to calcium scoring.

P2722Optimizing diagnosis of obstrutive coronary artery disease by CT angiography and ischemia test: a randomized clinical trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J P Dias Ferreira Reis ◽  
R Ramos ◽  
P Modas Daniel ◽  
S Rosa Aguiar ◽  
L Almeida Morais ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trial ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Computed Tomographic Angiography ◽  
Functional Test ◽  
Computed Tomographic ◽  
Artery Disease ◽  
Tomographic Angiography

Abstract Aim In patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve patient selection for invasive coronary angiography (ICA) as alternative to functional testing. However, the role of CTA in symptomatic patients after abnormal functional test is incompletely defined. Methods and results This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic patients (pts) with mild to moderately abnormal functional test referred to invasive coronary to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Patients with high risk features on functional tests, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR <60 ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic and revascularization yields of ICA in either group were also assessed. Subjects averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA angiography was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, nonobstructive CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (P<0.001). Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, P=0.152), but a greater cumulative contrast dose in the CTA-guided group (87.5±21 vs 77±40, p=0.026) was observed. Both diagnostic (84.4% vs 41.7, p<0.001) and revascularization (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard functional test-guided ICA. Conclusions In patients with suspected CAD and mild to moderately abnormal functional test, a diagnostic strategy including computed tomographic angiography as gatekeeper is effective and significantly improves diagnostic and revascularization yields of invasive coronary angiography.

scholarly journals Comparison of CTA to DSA in Determining the Etiology of Spontaneous ICH

2009 ◽  
Vol 36 (2) ◽  
pp. 176-180 ◽  
Author(s):  
Robert Yeung ◽  
Tabassum Ahmad ◽  
Richard I. Aviv ◽  
Lyne Noel de Tilly ◽  
Allan J. Fox ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Predictive Value ◽  
Computed Tomographic Angiography ◽  
Lower Sensitivity ◽  
Study Cohort ◽  
Computed Tomographic ◽  
Arteriovenous Fistulas ◽  
Kappa Value ◽  
Sensitivity Specificity ◽  
Tomographic Angiography

Background and Purpose:To compare the efficacy of computed tomographic angiography (CTA) to that of digital subtraction angiography (DSA) in the detection of secondary causes of intracerebral hemorrhage (ICH).Methods:Between January 2001 and February 2007 there were 286 patients that had both CTA and DSA for intracranial hemorrhage of all types. Those with primarily subarachnoid hemorrhage or recent trauma were excluded. Fifty-five patients formed the study cohort. Three reviewers independently analyzed the CTAs in a blinded protocol and classified them based on presence or absence of a secondary etiology. Results were compared with the reference standard DSA and kappa values determined for interobserver variability.Results:The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA were 89%, 92%, 91%, 91% and 91%, respectively. Kappa value for interobserver agreement ranged from 0.78 to 0.89. Two of four dural arteriovenous fistulas (dAVF) were missed on CTA by all three reviewers.Conclusion:CTA is nearly as effective as DSA at determining the cause of secondary intracerebral hemorrhage, but with a lower sensitivity for dAVFs. This supports the use of CTA as the first screening test in patients presenting with spontaneous ICH.

Preoperative Sizing of Grafts for Transfemoral Endovascular Aneurysm Management: A Prospective Comparative Study of Spiral CT Angiography, Arteriography, and Conventional CT Imaging

1997 ◽  
Vol 4 (3) ◽  
pp. 252-261 ◽  
Author(s):  
Ivo A.M.J. Broeders ◽  
Jan D. Blankensteijn ◽  
Marco Olree ◽  
Willem Mali ◽  
Bert C. Eikelboom
Keyword(s):  
Imaging Techniques ◽  
Ct Scanning ◽  
Spiral Ct ◽  
Computed Tomographic Angiography ◽  
Radiological Investigation ◽  
Computed Tomographic ◽  
First Choice ◽  
Conventional Ct ◽  
The Impact ◽  
Graft Selection

Purpose: To define the impact of spiral computed tomographic angiography (CTA) with image reconstruction on graft selection for Transfemoral Endovascular Aneurysm Management (TEAM) by comparing it to conventional computed tomography (CT) and contrast arteriography. Methods: Twenty-one candidates for TEAM were included. The diameters of the superior and inferior aneurysm necks and lengths between the graft attachment sites were measured using the three imaging techniques. These measurements and their consequences on graft selection were studied. Results: The difference in length sizing between spiral CTA and arteriography never exceeded 1 cm; however, lengths measured by conventional CT scanning resulted in underestimation of graft length in 91% of patients. Graft diameters were chosen too small in 62% of the patients when based on arteriographic diameter measurements. A graft of similar diameter was selected by spiral CTA and conventional CT scanning in 81% of the patients, while minor oversizing by conventional CT scanning was found in 14%. Conclusions: Neither conventional CT scanning nor arteriography is adequate as a sole preoperative radiological investigation for TEAM graft sizing. Spiral CTA with image processing produces all information required for selection of tho-optimal graft size and should be regarded the method of first choice for this purpose.

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