Dual energy imaging and intracycle motion correction for CT coronary angiography in patients with intermediate to high likelihood of coronary artery disease

We explored whether intracycle motion correction algorithms (MCAs) might be applicable to dual energy computed tomography coronary angiography in patients with intermediate to high likelihood of coronary artery disease. MCA reconstructions were associated with higher interpretability rates (96.7% vs 87.9%, P < .001), image quality scores (4.12±0.9 vs. 3.76±1.0; P < .0001), and diagnostic performance [area under the curve of 0.95 (95% confidence interval [CI] 0.92-0.97) vs 0.89 (95% CI 0.86-0.92); P < .0001] compared to conventional reconstructions. In conclusion, application of intracycle MCA reconstructions to dual energy computed tomography acquisitions was feasible and resulted in significantly higher image quality scores, interpretability, and diagnostic performance.Fil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena C.. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentin

Effect of Intracycle Motion Correction Algorithm on Image Quality and Diagnostic Performance of Computed Tomography Coronary Angiography in Patients with Suspected Coronary Artery Disease

Rationale and objectives: We sought to explore the impact of intracycle motion correction algorithms (MCA) in the interpretability and diagnostic accuracy of computed tomography coronary angiography (CTCA) performed in patients suspected of coronary artery disease (CAD) referred to invasive coronary angiography. Materials and Methods: Patients with suspected CAD referred to invasive coronary angiography previously underwent CTCA. Patients under rate-control medications were advised to withhold for the previous 24hours. The primary end point of the study was to evaluate image interpretability and diagnostic performance of MCA compared to conventional reconstructions in patients referred to invasive angiography because of suspected CAD. Results: Thirty-five patients were prospectively included in the study protocol. The mean age was 61.4±9.4years. Twenty-seven (77%) patients were men. A total of 533 coronary segments were evaluated using conventional and MCA reconstructions. MCA reconstructions were associated to higher interpretability rates (525 of 533, 98.5% vs. 515 of 533, 96.6 %; P<.001) and image quality scores (3.88±0.54 vs. 3.78±0.76; P<.0001) compared to conventional reconstructions. Although only mild, a significant difference was observed regarding the diagnostic performance between reconstruction modes, with an area under the curve of 0.90 (0.87-0.92) versus 0.89 (0.86-0.92), respectively, for MCA and conventional reconstructions (. P=.0447). Conclusions: In this pilot investigation, MCA reconstructions performed in patients with suspected CAD were associated to higher interpretability rates and image quality scores compared to conventional reconstructions, although only mild differences were observed regarding the diagnostic performance between reconstruction modes.Fil: Carrascosa, Patricia. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena C.. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Sanatorio Güemes; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Invasive coronary angiography findings across the CAD-RADS classification spectrum

The recently introduced coronary artery disease reporting and data system (CAD-RADS) evaluated by computed tomography and based on stenosis severity, might not adequately reflect the complexity of CAD. We explored the relationship between CAD-RADS and the spatial distribution, burden, and complexity of lesions by invasive coronary angiography (ICA). Stable patients who underwent coronary computed tomography angiography (CCTA) and ICA comprised the study population. Patients were classified according to the CAD-RADS: 0, No plaque; 1, 1–24% stenosis; 2, 25–49%; 3, 50–69%; 4A, 70–99%; 4B, left main stenosis or 3-vessel obstructive disease; and 5, total occlusion. Based on ICA findings, we calculated the SYNTAX score and the CAD extension index. Ninety-one patients were included, with a mean age of 61.4 ± 10.5 years (74% male). We found significant relationships between CAD-RADS and both the SYNTAX score (p 5. Of the 30 patients with CAD-RADS 5, 9 (30%) affected distal segments or secondary branches, and 9 (30%) had concomitant severe non-extensive disease at ICA. Regarding the spatial distribution of the non-occluded most severe lesions, 27 (44%) comprised distal segments or secondary branches. In the present study including a high-risk population, we identified diverse coronary anatomy complexity scenarios and relevant differences in spatial distribution sharing the same CAD-RADS classification.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina. Diagnóstico Maipú; ArgentinaFil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Guemes Sociedad Anonima.; ArgentinaFil: Arbab Zadeh, Armin. University Johns Hopkins; Estados Unido

Abstract 2941: Combined Assessment of Coronary Artery Stenosis and Myocardial Ischemia by Rest-Dipyridamole Stress Multidetector Computed Tomography

Introduction: MDCT coronary angiography has been evolving as a noninvasive method for the assessment of coronary artery disease (CAD). More recently, It has been demonstrated that MDCT identifies reduced contrast enhancement in ischemic and/or scarred myocardial segments. Objective: to determine the ability of rest-stress multidetector computed tomography (RS-MDCT) to detect myocardial ischemia and to assess the relationship between MDCT myocardial perfusion abnormalities and coronary artery stenosis. Methods: Forty seven patients underwent stress/rest 99mTc sestamibi SPECT and RS-MDCT, using a 16-row detector scanner (Philips Brilliance-16). Myocardial segments were classified by SPECT as normal, ischemic or scarred. SPECT results were then compared with MDCT regional myocardial contrast enhancement. The results of MDCT coronary angiography were also analyzed in 20 patients who underwent invasive catheterization. Results: The presence of a reduction in contrast enhancement at rest by MDCT identified scar by SPECT with 96% sensitivity and 98% specificity. A stress-induced reduction in contrast enhancement by MDCT identified ischemia by SPECT with 77% sensitivity and 99% specificity. The segment-based sensitivity and specificity for the detection of significant stenosis by MDCT were 92% and 98%, respectively. Conclusion: Our results showed that a rest-dipyridamole stress MDCT protocol can identify the presence of myocardial ischemia as well as the severity of coronary artery stenosis in patients with suspected coronary artery disease.</jats:p

Monochromatic image reconstruction by dual energy imaging allows half iodine load computed tomography coronary angiography

Purpose: To compare image interpretability and diagnostic performance of dual-energy CT coronary angiography (DE-CTCA) performed with 50% iodine load reduction versus single energy acquisitions (SE-CTCA) with full iodine load. Materials and methods: The present prospective study involved patients with suspected coronary artery disease (CAD) clinically referred for CTCA. DE-CTCA with 50% iodine volume load was performed first, and after heart rate returned to baseline SE-CTCA was performed using full iodine volume load. The primary endpoint was to compare image interpretability between groups. DE-CTCA was performed by rapid switching between low and high tube potentials (80–140 kV) from a single source, allowing the generation of monochromatic image reconstructions ranging from 40 to 140 keV. Image quality assessment was performed using a 5-point Likert scale. Results: Thirty-six patients constituted the study population. The mean heart rate before the CT scan (DE-CTCA 57.3 ± 10.7 bpm vs. SE-CTCA 58.5 ± 11.2 bpm, p = 0.29) and the mean effective radiation dose (3.5 ± 1.9 mSv vs. 3.8 ± 0.9 mSv, p = 0.48) did not differ between groups. Likert image quality scores were similar between groups (DE-CTCA 4.42 ± 0.98 vs. SE-CTCA 4.43 ± 0.84, p = 0.67). Signal-to-noise and contrast-to-noise ratios were significantly lower with DE-CTCA, driven by lower signal density levels at 60 keV compared to SE-CTCA. The sensitivity and specificity for the detection of stenosis >50% was indistinguishable between groups (DE-CTCA 84.4% (69.9–93.0%), 87.1% (81.6–91.2%); SE-CTCA 84.4% (69.9–93.0%), 87.1% (81.6–91.2%). Conclusions: In this pilot, prospective study, dual energy CTCA imaging with half iodine load achieved comparable interpretability than full iodine load with single energy CTCA.Fil: Carrascosa, Patricia. Diagnostico Maipu; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Capunay, Carlos. Diagnostico Maipu; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipu; ArgentinaFil: Vallejos, Javier. Diagnostico Maipu; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnostico Maipu; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Extensión y distribución espacial de la carga ateroesclerótica mediante imágenes monocromáticas virtuales derivadas de tomografía computarizada de doble energía

Introduction and objectives We explored the differences between atherosclerotic burden with invasive coronary angiography and virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography. Methods Eighty consecutive patients referred for invasive coronary angiography underwent dual-energy computed tomography coronary angiography and were categorized according to the atherosclerotic burden extent using the modified Duke prognostic coronary artery disease index, coronary artery disease extension score, segment involvement score, and the segment stenosis score. Results The mean segment involvement score (8.2 ± 3.9 vs 6.0 ± 3.7; P < .0001), modified Duke index (4.33 ± 1.6 vs 4.0 ± 1.7; P = .003), coronary artery disease extension score (4.84 ± 1.8 vs 4.43 ± 2.1; P = .005), and the median segment stenosis score (13.5 [9.0-18.0] vs 9.5 [5.0-15.0]; P < .0001) were significantly higher on dual-energy computed tomography compared with invasive angiography. Dual-energy computed tomography showed a significantly higher number of patients with any left main coronary artery lesion (46 [58%] vs 18 [23%]; P < .0001) and with severe proximal lesions (0.28 ± 0.03 vs 0.26 ± 0.03; P < .0001) than invasive angiography. Levels of coronary artery calcification below and above the median showed a sensitivity, specificity, positive predictive value, and negative predictive value of 100% and 97%; 86% and 50%; 93% and 95%; 100% and 67% for the identification of ≥ 50% stenosis. Conclusions Dual-energy computed tomography coronary angiography identified a significantly larger atherosclerotic burden compared with invasive coronary angiography, particularly involving the proximal segments.Introducción y objetivos Se analizaron las diferencias de carga ateroesclerótica observadas entre la coronariografía invasiva y las imágenes monocromáticas virtuales obtenidas con la tomografía computarizada de doble energía. Métodos Se examinó con tomografía computarizada de doble energía y se clasificó a 80 pacientes consecutivos remitidos a una coronariografía invasiva según el grado de carga ateroesclerótica utilizando el índice pronóstico de enfermedad coronaria de Duke modificado, la puntuación de extensión de la enfermedad coronaria, la puntuación de afección de segmentos y la puntuación de estenosis de segmentos. Resultados La media de la puntuación de afección de segmento (8,2 ± 3,9 frente a 6,0 ± 3,7; p < 0,0001), el índice de Duke modificado (4,33 ± 1,6 frente a 4,0 ± 1,7; p = 0,003), la puntuación de extensión de la enfermedad coronaria (4,84 ± 1,8 frente a 4,43 ± 2,1; p = 0,005) y la mediana de la puntuación de estenosis de segmento (13,5 [9,0-18,0] frente a 9,5 [5,0-15,0]; p < 0,0001) fueron significativamente superiores con la tomografía computarizada de doble energía que con la coronariografía invasiva. La tomografía computarizada de doble energía mostró un número de pacientes con alguna lesión del tronco coronario izquierdo significativamente mayor (46 [58%] frente a 18 [23%]; p < 0,0001) y con lesiones proximales graves (0,28 ± 0,03 frente a 0,26 ± 0,03; p < 0,0001) en comparación con lo observado en la coronariografía invasiva. Los grados de calcificación arterial coronaria por debajo y por encima de la mediana mostraron sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del 100 y el 97%; el 86 y el 50%; el 93 y el 95% y el 100 y el 67% para la identificación de estenosis ≥ 50%. Conclusiones La angiografía coronaria con tomografía computarizada de energía dual identificó una carga ateroesclerótica significativamente mayor que la observada con la coronariografía invasiva, en especial por lo que respecta a la afección de los segmentos proximales.Fil: Rodriguez Granillo, Gaston Alfredo. Diagnostico Maipú; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; ArgentinaFil: Carrascosa, Patricia. Diagnostico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipú; ArgentinaFil: Capunay, Carlos. Diagnostico Maipú; ArgentinaFil: De Zan, Macarena C.. Diagnostico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; Argentin