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      In vitro Evaluation of Metallic Coronary Artery Stents with Sub-Millimeter Multi-Slice Computed Tomography Using an ECG-Gated Cardiac Phantom: Relationship between In-Stent Visualization and Stent Type

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          Abstract

          The aim of this experimental study was to investigate visualization of various coronary artery stents with sub-millimeter multi-slice spiral computed tomography (MSCT) using a cardiac physical phantom. Four 3-mm stents of various designs were implanted in tubes with an inner diameter of 3 mm to simulate coronary artery. Stents were placed on a cardiac phantom and scanned at different heart rates. Retrospective ECG-gated adaptive segmental reconstruction technique was employed. Profile curves across longitudinal curved planar reconstruction images of the stents were generated. From the profile curve, the full width at half maximum was defined as the stent lumen index. The effect of heart rate and stent type on the stent lumen index was evaluated. Visual evaluation for each stent at various heart rates was also performed. The heart rate had no significant effect on in-stent visualization. However, in-stent visualization differed significantly for the various stent types for both profile curve analysis and visual evaluation (the Tukey-Kramer multiple comparisons test). Multiple regression analysis indicated that strut thickness, especially minimal strut thickness, was the significant influencing factor for the in-stent visualization. On the basis of four stent models examined it would appear that visualization of the coronary stent lumen varies depending on the stent type, but not on the heart rate. Stents with slim struts are preferable for in-stent evaluation with multi-slice spiral computed tomography.

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          Most cited references 15

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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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            Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography.

            Multislice spiral computed tomography (MSCT) is a promising technique for noninvasive coronary angiography, although clinical application has remained limited because of frequently incomplete interpretability, caused by motion artifacts and calcifications. In 59 patients (53 male, aged 58+/-12 years) with suspected obstructive coronary artery disease, ECG-gated MSCT angiography was performed with a 16-slice MSCT scanner (0.42-s rotation time, 12x0.75-mm detector collimation). Thirty-four patients were given additional beta-blockers (average heart rate: 56+/-6 min(-1)). After contrast injection, all data were acquired during an approximately 20-s breath hold. The left main (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), including > or =2.0-mm side branches, were independently evaluated by two blinded observers and screened for > or =50% stenoses. The consensus reading was compared with quantitative coronary angiography. MSCT was successful in 58 patients. Eighty-six of the 231 evaluated branches were significantly diseased. Without exclusion of branches, the sensitivity, specificity and positive and negative predictive value to identify > or =50% obstructed branches was 95% (82/86), 86% (125/145), 80% (82/102), and 97% (125/129), respectively. The overall accuracy for the LM, LAD, RCA, and LCX was 100%, 91%, 86%, and 81%, respectively. No obstructed LM, LAD, or RCA branches remained undetected. Classification of patients as having no, single, or multivessel disease was accurate in 78% (45/58) of patients and no patients with significant obstructions were incorrectly excluded. Improvements in MSCT technology, combined with heart rate control, allow reliable noninvasive detection of obstructive coronary artery disease.
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              Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter.

              To compare the effect of different reconstruction kernels and a noise-reducing postprocessing filter on the delineation of coronary artery stents in 16-slice CT-angiography. Ten patients with coronary stents (seven LAD, five RCX and three RCA) were examined with a 16-slice MDCT using standard acquisition parameters. Images were reconstructed using a medium soft (B30f) and a dedicated, edge-enhancing kernel (B46f). Additional postprocessing with an edge-preserving filter was performed on B46f images to reduce the image noise. In multiplanar reformations (MPRs) along and perpendicular to the stent axis, intraluminal attenuation values and the visible lumen diameter were measured. Image noise was measured in the subcutaneous fat using a region of interest (ROI) technique. Arterial enhancement in the aorta was 275.1 HU. Attenuation in the stent lumen was 390.4, 340.0 and 346.8 HU in MPRs derived from B30f, original B46 and postprocessed B46f images. The mean noise level was 20.4, 35.0 and 24.9 HU respectively. The visible lumen diameter was significantly greater in B46f and postprocessed B46f images (2.17 and 2.16 mm), compared to 1.93 mm in B30f images (p<0.01). Edge-enhancing reconstruction kernels increase the visible stent lumen, but also increase image noise. Dedicated postprocessing filters can reduce the introduced noise without a loss of spatial resolution.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2007
                May 2007
                01 September 2006
                : 107
                : 4
                : 254-260
                Affiliations
                aDiagnostic Imaging Center, Saiseikai Kumamoto Hospital, Departments of bDiagnostic Image Analysis, and cDiagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
                Article
                95502 Cardiology 2007;107:254–260
                10.1159/000095502
                16953111
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 5, References: 21, Pages: 7
                Categories
                Original Research

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