State-of-the-Art CT Imaging Techniques for Congenital Heart Disease

CT is increasingly being used for evaluating the cardiovascular structures and airways in the patients with congenital heart disease. Multi-slice CT has traditionally been used for the evaluation of the extracardiac vascular and airway abnormalities because of its inherent high spatial resolution and excellent air-tissue contrast. Recent developments in CT technology primarily by reducing the cardiac motion and the radiation dose usage in congenital heart disease evaluation have helped expand the indications for CT usage. Tracheobronchomalacia associated with congenital heart disease can be evaluated with cine CT. Intravenous contrast injection should be tailored to unequivocally demonstrate cardiovascular abnormalities. Knowledge of the state-of-the-art CT imaging techniques that are used for evaluating congenital heart disease is helpful not only for planning and performing CT examinations, but also for interpreting and presenting the CT image findings that consequently guide the proper medical and surgical management

Computed Tomography of the Coronary Arteries

MSCT Coronary Angiography is a fast developing non-invasive diagnostic technique that can detect a coronary stenosis. The detection of a coronary stenosis is hampered by limited image quality and by motion artefacts and extensive calcifications. However, MSCT-coronary angiography is highly reliable to rule out coronary stenosis. The role of MSCT-coronary angiography in the diagnostic work-up of coronary artery disease needs further research

Accuracy of MSCT coronary angiography with 64-slice technology: first experience

Aims The aim of our study was to investigate the accuracy of 64-slice computed tomography (CT) for assessing haemodynamically significant stenoses of coronary arteries. Methods and results CT angiography was performed in 67 patients (50 male, 17 female; mean age 60.1±10.5 years) with suspected coronary artery disease and compared with invasive coronary angiography. All vessels ≥1.5 mm were considered for the assessment of significant coronary artery stenosis (diameter reduction >50%). Forty-seven patients were identified as having significant coronary stenoses on invasive angiography with 18% (176/1005) affected segments. None of the coronary segments needed to be excluded from analysis. CT correctly identified all 20 patients having no significant stenosis on invasive angiography. Overall sensitivity for classifying stenoses was 94%, specificity was 97%, positive predictive value was 87%, and negative predictive value was 99%. Conclusion Sixty-four-slice CT provides a high diagnostic accuracy in assessing coronary artery stenose

Detectability of motions in AAA with ECG-gated CTA: A quantitative study

Purpose: ECG-gated CT enables the visualization of motions caused by the beating of the heart. Although ECG gating is frequently used in cardiac CT imaging, this technique is also very promising for evaluating vessel wall motion of the aortic artery and the motions of (stent grafts inside) abdominal aortic aneurysms (AAA). Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion characteristics of stent grafts will be beneficial for designing future devices. In addition, these data can be valuable in predicting stent graft failure in patients. To be able to reliably quantify the motion, however, it is of importance to know the performance and limitations of ECG gating, especially when the motions are small, as is the case in AAA. Since the details of the reconstruction algorithms are proprietary information on the CT manufacturers and not in the public domain, empirical experiments are required. The goal of this study is to investigate as to what extent the motions in AAA can be measured using ECG-gated CT. The authors quantitatively investigate four aspects of motion in ECG-gated CT: The detectability of the motion of objects at different amplitudes and different periodic motions, the temporal resolution, and the volume gaps that occur as a function of heart rate.\ud \ud Methods: They designed an experiment on a standard static phantom to empirically determine temporal resolution. To investigate motion amplitude and frequency, as well as patient heart rate, they designed dynamic experiments in which a home-made phantom driven by a motion unit moves in a predetermined pattern.\ud \ud Results: The duration of each ECG-gated phase was found to be 185 ms, which corresponds to half of the rotation time and is thus in accordance with half scan reconstruction applied by the scanner. By using subpixel localization, motions become detectable from amplitudes of as small as 0.4 mm in the x direction and 0.7 mm in the z direction. With the rotation time used in this study, motions up to 2.7 Hz can be reliably detected. The reconstruction algorithm fills volume gaps with noisy data using interpolation, but objects within these gaps remain hidden.\ud \ud Conclusions: This study gives insight into the possibilities and limitations for measuring small motions using ECG-gated CT. Application of the experimental method is not restricted to the CT scanner of a single manufacturer. From the results, they conclude that ECG-gated CTA is a suitable technique for studying the expected motions of the stent graft and vessel wall in AAA.\u

Application of Dual-Energy Computed Tomography to the Evalution of Coronary Atherosclerotic Plaque

Atherosclerotic coronary artery disease is responsible for around 50 of cardiovascular deaths in USA. Early detection and characterization of coronary artery atherosclerotic plaque could help prevent cardiac events. Computed tomography (CT) is an excellent modality for imaging calcifications and has higher spatial resolution than other common non-invasive modalities (e.g MRI), making it more suitable for coronary plaque detection. However, attenuation-based classification of non-calcified plaques as fibrous or lipid is difficult with conventional CT, which relies on a single x-ray energy. Dual-energy CT (DECT) may provide additional attenuation data for the identification and discrimination of plaque components. The purpose of this research was to evaluate the feasibility of DECT imaging for coronary plaque characterization and further, to explore the limits of CT for non-invasive plaque analysis. DECT techniques were applied to plaque classification using a clinical CT system. Saline perfused coronary arteries from autopsies were scanned at 80 and 140 kVp, prior to and during injection of iodinated contrast. Plaque attenuation was measured from CT images and matched to histology. Measurements were compared to assess differences among plaque types. Although calcified and non-calcified plaques could be identified and differentiated with DECT, further characterization of non-calcified plaques was not possible. The results also demonstrated that calcified plaque and iodine could be discriminated. The limits of x-ray based non-calcified plaque discrimination were assessed using microCT, a pre-clinical x-ray based high spatial resolution modality. Phantoms and tissues of different composition were scanned using different tube voltages (i.e., different energies) and resulting attenuation values were compared. Better vessel wall visualization and increase in tissue contrast resolution was observed with decrease in x-ray energy. Feasibility of calcium quantification from contrast-enhanced scans by creating virtual n

Application of Dual-Energy Computed Tomography to the Evalution of Coronary Atherosclerotic Plaque

Atherosclerotic coronary artery disease is responsible for around 50 of cardiovascular deaths in USA. Early detection and characterization of coronary artery atherosclerotic plaque could help prevent cardiac events. Computed tomography (CT) is an excellent modality for imaging calcifications and has higher spatial resolution than other common non-invasive modalities (e.g MRI), making it more suitable for coronary plaque detection. However, attenuation-based classification of non-calcified plaques as fibrous or lipid is difficult with conventional CT, which relies on a single x-ray energy. Dual-energy CT (DECT) may provide additional attenuation data for the identification and discrimination of plaque components. The purpose of this research was to evaluate the feasibility of DECT imaging for coronary plaque characterization and further, to explore the limits of CT for non-invasive plaque analysis. DECT techniques were applied to plaque classification using a clinical CT system. Saline perfused coronary arteries from autopsies were scanned at 80 and 140 kVp, prior to and during injection of iodinated contrast. Plaque attenuation was measured from CT images and matched to histology. Measurements were compared to assess differences among plaque types. Although calcified and non-calcified plaques could be identified and differentiated with DECT, further characterization of non-calcified plaques was not possible. The results also demonstrated that calcified plaque and iodine could be discriminated. The limits of x-ray based non-calcified plaque discrimination were assessed using microCT, a pre-clinical x-ray based high spatial resolution modality. Phantoms and tissues of different composition were scanned using different tube voltages (i.e., different energies) and resulting attenuation values were compared. Better vessel wall visualization and increase in tissue contrast resolution was observed with decrease in x-ray energy. Feasibility of calcium quantification from contrast-enhanced scans by creating virtual n

Coronary spiral CT

This dissertation describes the use and clinical potential of ECG gated multislice spiral computed tomography in patients with coronary artery disease. First the use of other non invasive cardiac imaging, i.e. the previously mentioned electron beam CT and magnetic resonance imaging is reviewed (chapter 2.1). Part 3 contains studies related to the characteristics of multislice spiral CT for the imaging of the heart and coronary arteries, and the diagnostic potential of ECG gated spiral CT coronary angiography to detect and visualize obstructive coronary artery disease in symptomatic patients, using conventional coronary angiography as the standard of reference. Part 4 is focussed on the feasibility and characteristics of coronary wall imaging by CT, including the assessment of non calcified atherosclerotic plaque material. The usefulness of contrast enhanced multislice spiral CT in symptomatic patients who previously underwent coronary artery bypass grafting and percutaneous coronary intervention with stent implantation is discussed in part 5. Finally, the first results with the latest generation 16 slice computed tomography scanners and patient preparation with ~ receptor blockers are described in part 6, including a review and future outlook on the continuing development and clinical use of non invasive coronary angiography with spiral computed tomography

Bioresorbable coronary stents : non-invasive quantitative assessment of edge and intrastent plaque – a 256-slice computed tomography longitudinal study

Les bioresorbable stents (BRS), en français intitulés tuteurs coronariens biorésorbables, sont constitués d’un polymère biorésorbable, plutôt que de métal, et ne créent pas d’artéfacts métalliques significatifs en tomodensitométrie (TDM). Cela permet une meilleure évaluation de la plaque coronarienne sous ces tuteurs en TDM qu’avec les anciens tuteurs qui sont en métal. OBJECTIF: Évaluer l’évolution de la composition de la plaque, sa fraction lipidique (FL)— marqueur de vulnérabilité de la plaque, dans les 3 zones pré-tuteur (bord proximal), intra-tuteur et post-tuteur (bord distal), et le volume de la plaque entre 1 et 12 mois post-implantation de BRS. MÉTHODOLOGIE: Il s’agit d’une étude observationnelle longitudinale réalisée chez 27 patients consécutifs (âge moyen 59,7 +/- 8,6 ans) et recrutés prospectivement pour une imagerie par TDM 256-coupes à 1 et 12 mois post-implantation de BRS (35 tuteurs total). Les objectifs primaires sont: volume de plaque totale et de FL (mm3) comparés entre 1 et 12 mois. Afin de tenir compte de la corrélation intra-patient, des analyses de variance des modèles linéaires mixtes avec ou sans spline sont utilisés avec deux facteurs répétés temps et zone/bloc (1 bloc= 5 mm en axe longitudinal). La valeur % FL= volume absolu du FL/ volume total de la plaque. RÉSULTATS: Notre analyse par bloc ou par spline n’a pas démontré une différence significative dans les volumes de plaque ou des FL dans les zones pre- intra- and post-tuteur entre 1 et 12 mois. CONCLUSION: Notre étude a réussi à démontrer la faisabilité d’une analyse non-invasive quantitative répétée de la plaque coronarienne et de la lumière intra-tuteur avec l’utilisation de TDM 256 coupes. Cette étude pilote n’a pas démontré de différence significative dans les volumes des plaques et atténuation entre 1- et 12- mois de follow-up post-implantation de BRS. Notre méthode pourrait être appliquée à l’évaluation des différents structures ou profils pharmacologiques de ces tuteurs.Coronary bioresorbable stents (BRS) are made of a bioresorbable polymer rather than metal. Unlike metallic stents, BRS do not produce significant artifacts in computed tomography (CT) and are radiolucent in CT, making it possible to evaluate coronary plaque beneath an implanted stent. PURPOSE: The purpose of our study was to evaluate the volumes of plaque and low attenuation plaque components (LAP —a marker of plaque vulnerability) of pre-, intra- and post-stent plaque location between 1 and 12 months post-implantation. METHODS: In our prospective longitudinal study, we recruited 27 consecutive patients (mean age 59.7 +/- 8.6 years) with bioresorbable stents (n=35) for a 256-slice ECG-synchronized CT evaluation at 1 month and at 12 months post stent implantation. Total plaque volume (mm3) as well as absolute and relative (%) LAP volume per block in the pre-, intra- and post-stent zones were analyzed; comparison of 1 and 12 months post BRS implantation. Changes in these variables were assessed using mixed effects models with and without spline, which also accounted for correlation between repeated measurements with factors such as time and zone/block (1 block = 5 mm in longitudinal axis). The value % LAP= LAP absolute volume/ total plaque volume. RESULTS: Our block or spline model analysis showed no significant difference in plaque or LAP volumes in pre-, intra- and post-stent zones measured at 1 month and at 12 months. CONCLUSION: Our study demonstrates the feasibility of repeated non-invasive quantitative analysis of intrastent coronary plaque and in-stent lumen using a 256-channel CT scan. This pilot study did not show significant differences in plaque volume and attenuation between 1- and 12-month follow-up from stent implantation. The method we used could be applied to the evaluation of different stent structures or different pharmacological profiles of bioresorbable stents