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      Dual-source computed tomography for evaluating coronary stenosis and left ventricular function

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          Abstract

          This study aimed to evaluate the correlation between coronary stenosis and left ventricular function using dual-source computed tomography (DSCT). DSCT coronary angiography (CAG) was performed on 66 patients with coronary disease and 36 healthy volunteers. The degree of coronary stenosis, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and myocardial mass (MM) were measured for the left ventricle. These values were compared with the results obtained by echocardiography (ECHO) and selective CAG, which were both adopted as controls. The diagnoses of coronary stenosis based on DSCT CAG and those based on selective CAG were not significantly different (P>0.05). Similarly, the values of EDV, ESV, SV or EV measured by DSCT CAG were not significantly different from thoses obtained by ECHO (P>0.05). However, significant differences were observed in the ESV, EF and SV of the severe stenosis group compared with the moderate and mild stenosis groups (both P<0.05). The values of EDV and MM significantly varied between the mild, moderate and severe stenosis groups (P<0.05). DSCT CAG is a highly accurate and highly reproducible method for evaluating the preliminary changes in cardiac function based on the variations of coronary stenosis. Significant changes were detected in the EDV and MM of the moderate stenosis group and in all parameters of the severe stenosis group.

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          Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound.

          The aim of the present study was to determine the diagnostic accuracy of 64-slice computed tomography (CT) to identify and quantify atherosclerotic coronary lesions in comparison with catheter-based angiography and intravascular ultrasound (IVUS). Currently, the ability of multislice CT to quantify the degree of coronary artery stenosis and dimensions of coronary plaques has not been evaluated. We included 59 patients scheduled for coronary angiography due to stable angina pectoris. A contrast-enhanced 64-slice CT (Senation 64, Siemens Medical Solutions, Forchheim, Germany) was performed before the invasive angiogram. In a subset of 18 patients, IVUS of 32 vessels was part of the catheterization procedure. In 55 of 59 patients, 64-slice CT enabled the visualization of the entire coronary tree with diagnostic image quality (American Heart Association 15-segment model). The overall correlation between the degree of stenosis detected by quantitative coronary angiography compared with 64-slice CT was r = 0.54. Sensitivity for the detection of stenosis 50%, and stenosis >75% was 79%, 73%, and 80%, respectively, and specificity was 97%. In comparison with IVUS, 46 of 55 (84%) lesions were identified correctly. The mean plaque areas and the percentage of vessel obstruction measured by IVUS and 64-slice CT were 8.1 mm2 versus 7.3 mm2 (p < 0.03, r = 0.73) and 50.4% versus 41.1% (p < 0.001, r = 0.61), respectively. Contrast-enhanced 64-slice CT is a clinically robust modality that allows the identification of proximal coronary lesions with excellent accuracy. Measurements of plaque and lumen areas derived by CT correlated well with IVUS. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis.
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            Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose.

            To retrospectively compare image quality, radiation dose, and blood vessel assessability for coronary artery computed tomographic (CT) angiograms obtained with a prospectively gated transverse (PGT) CT technique and a retrospectively gated helical (RGH) CT technique. This HIPAA-compliant study received a waiver for approval from the institutional review board, including one for informed consent. Coronary CT angiograms obtained with 64-detector row CT were retrospectively evaluated in 203 clinical patients. A routine RGH technique was evaluated in 82 consecutive patients (44 males, 38 females; mean age, 55.6 years). The PGT technique was then evaluated in 121 additional patients (71 males, 50 females; mean age, 56.7 years). All images were evaluated for image quality, estimated radiation dose, and coronary artery segment assessability. Differences in image quality score were evaluated by using a proportional odds logistic regression model, with main effects for three readers, two techniques, and four arteries. The mean effective dose for the group with the PGT technique was 2.8 mSv; this represents an 83% reduction as compared with that for the group with the RGH technique (mean, 18.4 mSv; P < .001). The image quality score for each of the arteries, as well as the overall combined score, was significantly greater for images obtained with PGT technique than for images obtained with RGH technique. The combined mean image quality score was 4.791 for images obtained with PGT technique versus 4.514 for images obtained with RGH technique (proportional odds model odds ratio, 2.8; 95% confidence interval: 1.7, 4.8). The percentage of assessable coronary artery segments was 98.6% (1196 of 1213) for images obtained with PGT technique versus 97.9% (1741 of 1778) for images obtained with RGH technique (P = .83). PGT coronary CT angiography offers improved image quality and substantially reduced effective radiation dose compared with traditional RGH coronary CT angiography. (c) RSNA, 2008.
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              Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control

              The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14±9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3±3.9 kg/m2 (range 22.4–36.3 kg/m2), mean heart rate during CT was 70.3±14.2 bpm (range 47–102 bpm), and mean Agatston score was 821±904 (range 0–3,110). Image quality was diagnostic (scores 1–3) in 98.6% (414/420) of segments (mean image quality score 1.68±0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control.
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                Author and article information

                Journal
                Exp Ther Med
                Exp Ther Med
                ETM
                Experimental and Therapeutic Medicine
                D.A. Spandidos
                1792-0981
                1792-1015
                October 2013
                06 August 2013
                06 August 2013
                : 6
                : 4
                : 961-966
                Affiliations
                [1 ]Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029;
                [2 ]Department of Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
                Author notes
                Correspondence to: Professor Jie Wang, Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, P.R. China, E-mail: jiewangcn@ 123456163.com
                Article
                etm-06-04-0961
                10.3892/etm.2013.1253
                3797288
                24137298
                650f6c49-96fc-4adf-86b4-14d664027bf0
                Copyright © 2013, Spandidos Publications

                This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.

                History
                : 05 April 2013
                : 18 July 2013
                Categories
                Articles

                Medicine
                dual-source computed tomography,left ventricular function,echocardiography,coronary stenosis

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