Use of MDCT coronary angiography for detection of coronary artery disease in the setting of multiple-discipline hospital e-Poster: 126 Congress: ESCR 2008 Type: Poster Topic: ESCR 2008 Authors: N. Silchenko, V. Sinitsyn, S. Morozov, V. Likov; Moscow/RU MeSH:
Cardiovascular System [A07] Tomography, X-Ray Computed [E01.370.350.825.810.810]
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1. Purpose To assess the diagnostic value of coronary MDCT-angiography as a first-line coronary patients triage method in the setting of large multiple-discipline hospital.
2. Methods and Materials The study sample included 63 patients (male/female=2.5/1) at the age of 37-75 years. Twelve patients had complaints of first onset of chest pain, 51 patients have had history of coronary heart disease. Coronary bypass surgery was performed previously in 7 patients, in 6 cases coronary stents were implanted. The study was performed in terms of routine clinical practice. MDCT coronary angiography was performed with 64-slice scanner and retrospective ECG-gating. Results of coronary MDCT were compared with those of catheter coronary angiography.
3. Results For MDCT accuracy calculations only proximal and middle segments of 3 main coronary arteries were used. Coronary stenosis >70% of proximal and middle LAD segments were found in 13% and 18% of patients, resp. Significant stenosis of left circumflex artery were found in 17% of patients. Proximal and middle RCA stenosis >70% were detected in 10% and 8% of patients, resp. The Pearson correlation coefficient for MDCT and coronary angiography was 0.83. ROC curve analysis demonstrated 100% sensitivity of MDCT for the diagnosis of any coronary atherosclerotic lesions at the specificity of 55.6%. MDCT detected significant (>70%) coronary stenosis with the specificity of 92.6%.
4. Conclusion Our data suggest that coronary MDCT at multiple-discipline hospital allows non-invasive triage of patients with suspected or existing coronary stenosis. MDCT results allow direct referral of patients with significant stenosis to coronary stenting or bypass grafting. Coronary MDCT is the alternative to coronary angiography as first-line method of significant coronary stenosis exclusion. 5. References 1. Hoffmann MH, Shi H. Manzke R. el al. Noninvasive coronary angiography with 16-detector row CT: Effect ot heart rate. Radiology. 2005;234:86-97. 2. Hoffmann U, Moelewski F, Cury RC,Ferencik M, Jang I, Diaz LJ,et al. (2004) Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease. Patient- versus segment-based analysis. Circulation 110:2638-2643 3. Kuettner A, Trabold T, Schroeder S, Feyer A, Beck T, Brueckner A,et al. (2004) Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology. Initial clinical results. J Am Coll Cardiol 44:1230-1237 4. Nieman K, Cademartiri F, Lemos PA,Raaijmakers R,Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051-2054
5. Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, et al. (2003) Detection of coronary artery stenosis with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 107:664-666 6. Personal Information Dr. Natalia Silchenko email:
[email protected] Radiologist Central clinical hospital, Moscow, Russia
7. Mediafiles
Fig. 1
Slab MIP projection and surface-rendering volumetric image demonstrate focal stenosis in the proximal left anterior descending (LAD) artery related to noncalcified plaque.
Fig.2
Conventional arteriography confirms the CTA findings, again demonstrating focal stenosis in the LAD.
Fig. 3
Slab MIP projection demonstrate stenosis to 50% in the proximal portions left anterior descending (LAD) artery and high-grade stenosis middle portions of the vessel. The same patient after installation stent in the mid left anterior descending artery.
Fig. 4
The findings of the CT angiogram are corfirmed by conventional arteriography, demonstrating a severe narrowing in the midportion of the LAD.
Fig. 5
Slab MIP projection and surface-rendering volumetric image demonstrate occlusion of the proximal and middle portions in right coronary artery.
Fig. 6
Conventional arteriography confirms the CTA findings, again demonstrating extended occlusion in right coronary artery. Distal segment of the vessel fill due to collateral vessel
Fig. 7
Slab MIP projection and surface-rendering volumetric image demonstrate calcified and noncalcified plaque in the proximal to mid left anterior descending artery with less than 50% luminal narrowing. Conventional arteriography confirms the CTA findings, again demonstrating with less than 50% luminal narrowing in the proximal to mid LAD.
Fig. 8
Slab MIP projection demonstrate focal stenosis in the proximal right coronary artery related to noncalcified plaque. Conventional arteriography confirms the CTA findings, again demonstrating in the proximal right coronary artery.
