A Wolak

AA Mahabadi

AJ Taylor

B Tamarappoo

Damini Dey

Daniel S. Berman

DS Berman

FY Lin

K Nasir

LJ Shaw

M Galli

M Janik

MD Cerqueira

MJ Budoff

MJ LaMonte

P Raggi

P Stolzmann

R Brunken

R Detrano

R Haberl

R Nakazato

R Vliegenthart

RC Brunken

Ronak Rajani

S Mao

TF Jakobs

VY Cheng

Y Arad

English

PubMed

Springer - Publisher Connector

Non-enhanced cardiac computed tomography—still an open book

Crossref

EDITORIALNon-enhanced cardiac computed tomography—still an open bookRonak Rajani, MD, MRCP, BM, Damini Dey, PhD,and Daniel S. Berman, MD, FACCSee related article, pp. 96–103The assessment of coronary artery calcium (CAC) byECG-gated non-contrast enhanced computed tomogra-phy (NCCT) has achieved widespread clinical acceptanceas a measure of coronary atherosclerosis and future car-diac risk. A CAC score of 0 is associated with an excellentprognosis1,2 while elevated levels provide incrementalprognostic information above and beyond that of con-ventional cardiovascular risk factors in both Caucasian3-5and multiethnic populations.6 Specifically, the CAC scorehas been consistently shown to be more predictive ofcardiac outcomes as well as all-cause mortality than theFramingham risk score.7,8 Guidelines have beenincreasingly favorable regarding the use of CAC scanningand currently the test is commonly used in asymptomaticpatients for predicting future coronary events and inguiding the intensity of preventive therapies.In this issue of JNC, Gupta et al report a novelapplication of gated NCCT obtained with the same studyused for CAC assessment. They demonstrate a rela-tionship between areas of hypo-attenuation on NCCTand irreversible defects on SPECT myocardial perfusionimaging. Using a cut-off of value of 27.2 HU, theyreport a sensitivity and specificity of 97.4% and 98.7%for the detection of non-reversible perfusion defectson post-stress and rest imaging with technetium-99msestamibi.Assessing the presence of prior myocardial infarc-tion (MI) by NCCT could add significantly to theclinical value of NCCT. While the CAC score isstrongly predictive of patient outcome, it is not highlypredictive of coronary stenosis.9 Knowing that a patientwith coronary calcification had prior MI could help inthe prediction of significant coronary artery diseasefrom the NCCT. Further, since NCCT is increasinglyperformed as part of SPECT or PET–MPI studies,knowledge of prior MI could add to the informationprovided by the combined scans.There are, however, several issues with the reportby Gupta et al that suggest that the observations shouldbe taken as preliminary. For example, they used stan-dard rest sestamibi scanning to define non-reversibilityof perfusion defects, and throughout the manuscriptrefer to the non-reversible defects as chronic MI. Asmentioned by the authors, it is well known that hiber-nating myocardium could show non-reversible defects inpatients without prior MI,10,11 and that the prediction ofprior MI is enhanced by the use of nitroglycerin prior tothe rest injection with sestamibi imaging. Given thislimitation, it would have been preferable for them touse the term ‘‘non-reversible defect’’ rather than MIthroughout the manuscript. Further, as pointed out by theauthors, a primary limitation of their study was that onstandard rest sestamibi was used as the reference stan-dard for non-reversible perfusion defects. It would beexpected that hibernating regions would have beenincorrectly classified as infarct by their approach. Inaddition, ‘‘visual assessment of perfusion abnormalitiesby the referring physicians’’ was used to define thepresence and location of the non-reversible defects.Given the known high variability of visual assessmentof SPECT–MPI by experts,12,13 significant inaccuracyamong the various readers in the detection and locationof the perfusion defects must have been present, suchthat repeat expert visual reading or quantitative analysisof the data would have been preferred.Thus, while this provisional data are interesting anddemonstrate an additional potential use of NCCT, fur-ther validation is required. It would be important toexamine the findings with more specific infarct imagingmodalities such as cardiac magnetic resonance imaging(CMR), FDG-PET, or possibly nitroglycerin-augmentedTc-99m agent SPECT14 or Tl-201 rest-redistributionSPECT prior to clinical use.From the Department of Imaging, Cedars-Sinai Medical Center,Los Angeles, CA.Reprint requests: Daniel S. Berman, MD, FACC, Department ofImaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd.,Los Angeles, CA 90048; bermand@cshs.org.J Nucl Cardiol 2011;18:21–3.1071-3581/$34.00Copyright  2010 The Author(s). This article is published with openaccess at Springerlink.comdoi:10.1007/s12350-010-9325-021If validated in additional studies, informationregarding MI using NCCT would likely be of clinical usein patients undergoing stress imaging studies. In patientsundergoing PET/CT or SPECT/CT, gated NCCT is fre-quently performed. The finding of hypo-attenuation onNCCT could provide complementary information to theperfusion study, aiding in distinguishing MI from atten-uation artifact. Further, hypo-attenuation on NCCT,along with the coronary calcium score, may add pre-dictive value in estimating the likelihood of coronarydisease and, thus, improve the overall accuracy of per-fusion imaging. Finally, as noted above, the informationregarding prior MI could aid in predicting significantCAD in patients undergoing CAC scanning alone.There has recently been renewed interest in theadditional anatomic measurements, aside from the coro-nary arteries, that can be obtained from NCCT in order tobest predict the likelihood of developing cardiac disease.Nasir et al15 demonstrated that, by applying a validatedalgorithm,16 measurements of left ventricular volume onNCCT correlated with end-diastolic volume obtained byCMR. Lin et al17 reported a relationship between aorticroot dimensions on NCCT and comparative measure-ments from transthoracic echocardiography and Wolaket al18 have established normal ranges of thoracic aorticmeasurements for age, gender, and body surface area.Another application of NCCT that is gainingmomentum is the measurement of epicardial fat volume(EFV). Epicardial and thoracic fat are routinely imagedon NCCT and there is now emerging evidence that EFVis an important parameter in cardiovascular risk strati-fication and appears to provide incremental prognosticinformation regarding future cardiac events over thatprovided by CAC scanning alone.19,20 In contrast tocoronary calcium that provides a snapshot of the his-torical lifetime build up of atherosclerotic plaque, EFVmay represent the current state of atherogenesis activitywithin the coronary arteries.8 Recent data also suggestan intriguing relationship between EFV and myocardialischemia.21,22 Although the mechanism of the relation-ship of coronary atherosclerosis and epicardial fatremains unclear, initial studies indicate that peri-coro-nary epicardial fat is associated with atherosclerosis inthe coronary arteries.23The study of Gupta et al provides further evidencethat the gated NCCT scan should not simply be considereda coronary calcium scan. As additional substantiatingstudies emerge, it is plausible that measurements such asLV size, thoracic aortic measurements, epicardial fat, andpossibly assessment of prior MI may well become a rou-tine part of the NCCT. The radiation dose associated withNCCT is falling24-26 and the additional clinical imagingparameters that can be extracted from this data areincreasing. The chapter on coronary calcium may soon beconsidered written, but the pages on NCCT keep turning.The story is far from complete.AcknowledgmentsThis study was supported in part by ACC/BCS, the EisnerFoundation, and Diane and Guilford Glazer.Dr Ronak Rajani is currently an advanced cardiacimaging fellow funded by the American College ofCardiology and the British Cardiovascular Society.The authors have indicated that they have no financialconflicts of interest.Open AccessThis article is distributed under the terms of the CreativeCommons Attribution Noncommercial License which permitsany noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and source arecredited.References1. Raggi P, Callister TQ, Cooil B, He ZX, Lippolis NJ, Russo DJ,et al. Identification of patients at increased risk of first unheraldedacute myocardial infarction by electron-beam computed tomog-raphy. Circulation 2000;101:850-5.2. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronarycalcification, coronary disease risk factors, C-reactive protein, andatherosclerotic cardiovascular disease events: The St. FrancisHeart Study. J Am Coll Cardiol 2005;46:158-65.3. LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB,Levine BD, et al. Coronary artery calcium score and coronaryheart disease events in a large cohort of asymptomatic men andwomen. Am J Epidemiol 2005;162:421-9.4. Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M,O’Malley PG. Coronary calcium independently predicts incidentpremature coronary heart disease over measured cardiovascularrisk factors: Mean three-year outcomes in the Prospective ArmyCoronary Calcium (PACC) project. J Am Coll Cardiol 2005;46:807-14.5. Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W,van Rooij FJ, et al. Coronary calcification improves cardiovascularrisk prediction in the elderly. Circulation 2005;112:572-7.6. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR,et al. Coronary calcium as a predictor of coronary events in fourracial or ethnic groups. N Engl J Med 2008;358:1336-45.7. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ.Prognostic value of cardiac risk factors and coronary artery cal-cium screening for all-cause mortality. Radiology 2003;228:826-33.8. Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, TsengPH, et al. Long-term prognosis associated with coronary calcifi-cation: Observations from a registry of 25,253 patients. J Am CollCardiol 2007;49:1860-70.9. Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, et al.Correlation of coronary calcification and angiographically docu-mented stenoses in patients with suspected coronary arterydisease: Results of 1,764 patients. J Am Coll Cardiol 2001;37:451-7.22 Rajani et al Journal of Nuclear CardiologyNCCT—still an open book January/February 201110. Brunken R, Schwaiger M, Grover-McKay M, Phelps ME, TillischJ, Schelbert HR. Positron emission tomography detects tissuemetabolic activity in myocardial segments with persistent thalliumperfusion defects. J Am Coll Cardiol 1987;10:557-67.11. Brunken RC, Kottou S, Nienaber CA, Schwaiger M, Ratib OM,Phelps ME, et al. PET detection of viable tissue in myocardialsegments with persistent defects at T1-201 SPECT. Radiology1989;172:65-73.12. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, IskandrianAE. Effects of age, gender, obesity, and diabetes on the efficacyand safety of the selective A2A agonist regadenoson versus aden-osine in myocardial perfusion imaging integrated ADVANCE-MPItrial results. JACC Cardiovasc Imaging 2008;1:307-16.13. Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, HayesSW, et al. Quantitative assessment of myocardial perfusionabnormality on SPECT myocardial perfusion imaging is morereproducible than expert visual analysis. J Nucl Cardiol 2009;16:45-53.14. Galli M, Marcassa C, Imparato A, Campini R, Orrego PS, Gian-nuzzi P. Effects of nitroglycerin by technetium-99m sestamibitomoscintigraphy on resting regional myocardial hypoperfusion instable patients with healed myocardial infarction. Am J Cardiol1994;74:843-8.15. Nasir K, Katz R, Mao S, Takasu J, Bomma C, Lima JA, et al.Comparison of left ventricular size by computed tomography withmagnetic resonance imaging measures of left ventricle mass andvolumes: The multi-ethnic study of atherosclerosis. J CardiovascComput Tomogr 2008;2:141-8.16. Mao S, Budoff MJ, Oudiz RJ, Bakhsheshi H, Wang S, BrundageBH. A simple single slice method for measurement of left andright ventricular enlargement by electron beam tomography. Int JCard Imaging 2000;16:383-90.17. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A,et al. Assessment of the thoracic aorta by multidetector computedtomography: Age- and sex-specific reference values in adultswithout evident cardiovascular disease. J Cardiovasc ComputTomogr 2008;2:298-308.18. Wolak A, Gransar H, Thomson LE, Friedman JD, HachamovitchR, Gutstein A, et al. Aortic size assessment by noncontrast cardiaccomputed tomography: Normal limits by age, gender, and bodysurface area. JACC Cardiovasc Imaging 2008;1:200-9.19. Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM,Wolf PA, et al. Association of pericardial fat, intrathoracic fat, andvisceral abdominal fat with cardiovascular disease burden: TheFramingham Heart Study. Eur Heart J 2009;30:850-6.20. Cheng VY, Dey D, Tamarappoo B, Nakazato R, Gransar H,Miranda-Peats R, et al. Pericardial fat burden on ECG-gatednoncontrast CT in asymptomatic patients who subsequentlyexperience adverse cardiovascular events. JACC CardiovascImaging 2010;3:352-60.21. Janik M, Hartlage G, Alexopoulos N, Mirzoyev Z, McLean DS,Arepalli CD, et al. Epicardial adipose tissue volume and coronaryartery calcium to predict myocardial ischemia on positron emis-sion tomography-computed tomography studies. J Nucl Cardiol2010;17:841-7.22. Tamarappoo B, Dey D, Shmilovich H, Nakazato R, Gransar H,Cheng V et al. Increased pericardial fat volume measured fromnoncontrast CT predicts myocardial ischemia by SPECT. JACCCardiovasc Imaging 2010;3:1104-12.23. Mahabadi AA, Reinsch N, Lehmann N, Altenbernd J, Kalsch H,Seibel RM, et al. Association of pericoronary fat volume withatherosclerotic plaque burden in the underlying coronary artery: Asegment analysis. Atherosclerosis 2010;211:195-9.24. Nakazato R, Dey D, Gutstein A, Le Meunier L, Cheng VY, Pi-mentel R, et al. Coronary artery calcium scoring using a reducedtube voltage and radiation dose protocol with dual-source com-puted tomography. J Cardiovasc Comput Tomogr 2009;3:394-400.25. Jakobs TF, Wintersperger BJ, Herzog P, Flohr T, Suess C, Knez A,et al. Ultra-low-dose coronary artery calcium screening using multi-slice CT with retrospective ECG gating. Eur Radiol 2003;13:1923-30.26. Stolzmann P, Leschka S, Betschart T, Desbiolles L, Flohr TG,Marincek B, et al. Radiation dose values for various coronarycalcium scoring protocols in dual-source CT. Int J CardiovascImaging 2009;25:443-51.Journal of Nuclear Cardiology Rajani et al 23Volume 18, Number 1;21–3 NCCT—still an open book

Journal of Nuclear Cardiology

EDITORIAL
Non-enhanced cardiac computed tomography—
still an open book
Ronak Rajani, MD, MRCP, BM, Damini Dey, PhD,
and Daniel S. Berman, MD, FACC
See related article, pp. 96–103
The assessment of coronary artery calcium (CAC) by
ECG-gated non-contrast enhanced computed tomogra-
phy (NCCT) has achieved widespread clinical acceptance
as a measure of coronary atherosclerosis and future car-
diac risk. A CAC score of 0 is associated with an excellent
prognosis1,2 while elevated levels provide incremental
prognostic information above and beyond that of con-
ventional cardiovascular risk factors in both Caucasian3-5
and multiethnic populations.6 Specifically, the CAC score
has been consistently shown to be more predictive of
cardiac outcomes as well as all-cause mortality than the
Framingham risk score.7,8 Guidelines have been
increasingly favorable regarding the use of CAC scanning
and currently the test is commonly used in asymptomatic
patients for predicting future coronary events and in
guiding the intensity of preventive therapies.
In this issue of JNC, Gupta et al report a novel
application of gated NCCT obtained with the same study
used for CAC assessment. They demonstrate a rela-
tionship between areas of hypo-attenuation on NCCT
and irreversible defects on SPECT myocardial perfusion
imaging. Using a cut-off of value of 27.2 HU, they
report a sensitivity and specificity of 97.4% and 98.7%
for the detection of non-reversible perfusion defects
on post-stress and rest imaging with technetium-99m
sestamibi.
Assessing the presence of prior myocardial infarc-
tion (MI) by NCCT could add significantly to the
clinical value of NCCT. While the CAC score is
strongly predictive of patient outcome, it is not highly
predictive of coronary stenosis.9 Knowing that a patient
with coronary calcification had prior MI could help in
the prediction of significant coronary artery disease
from the NCCT. Further, since NCCT is increasingly
performed as part of SPECT or PET–MPI studies,
knowledge of prior MI could add to the information
provided by the combined scans.
There are, however, several issues with the report
by Gupta et al that suggest that the observations should
be taken as preliminary. For example, they used stan-
dard rest sestamibi scanning to define non-reversibility
of perfusion defects, and throughout the manuscript
refer to the non-reversible defects as chronic MI. As
mentioned by the authors, it is well known that hiber-
nating myocardium could show non-reversible defects in
patients without prior MI,10,11 and that the prediction of
prior MI is enhanced by the use of nitroglycerin prior to
the rest injection with sestamibi imaging. Given this
limitation, it would have been preferable for them to
use the term ‘‘non-reversible defect’’ rather than MI
throughout the manuscript. Further, as pointed out by the
authors, a primary limitation of their study was that on
standard rest sestamibi was used as the reference stan-
dard for non-reversible perfusion defects. It would be
expected that hibernating regions would have been
incorrectly classified as infarct by their approach. In
addition, ‘‘visual assessment of perfusion abnormalities
by the referring physicians’’ was used to define the
presence and location of the non-reversible defects.
Given the known high variability of visual assessment
of SPECT–MPI by experts,12,13 significant inaccuracy
among the various readers in the detection and location
of the perfusion defects must have been present, such
that repeat expert visual reading or quantitative analysis
of the data would have been preferred.
Thus, while this provisional data are interesting and
demonstrate an additional potential use of NCCT, fur-
ther validation is required. It would be important to
examine the findings with more specific infarct imaging
modalities such as cardiac magnetic resonance imaging
(CMR), FDG-PET, or possibly nitroglycerin-augmented
Tc-99m agent SPECT14 or Tl-201 rest-redistribution
SPECT prior to clinical use.
From the Department of Imaging, Cedars-Sinai Medical Center,
Los Angeles, CA.
Reprint requests: Daniel S. Berman, MD, FACC, Department of
Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd.,
Los Angeles, CA 90048; bermand@cshs.org.
J Nucl Cardiol 2011;18:21–3.
1071-3581/$34.00
Copyright  2010 The Author(s). This article is published with open
access at Springerlink.com
doi:10.1007/s12350-010-9325-0
21
If validated in additional studies, information
regarding MI using NCCT would likely be of clinical use
in patients undergoing stress imaging studies. In patients
undergoing PET/CT or SPECT/CT, gated NCCT is fre-
quently performed. The finding of hypo-attenuation on
NCCT could provide complementary information to the
perfusion study, aiding in distinguishing MI from atten-
uation artifact. Further, hypo-attenuation on NCCT,
along with the coronary calcium score, may add pre-
dictive value in estimating the likelihood of coronary
disease and, thus, improve the overall accuracy of per-
fusion imaging. Finally, as noted above, the information
regarding prior MI could aid in predicting significant
CAD in patients undergoing CAC scanning alone.
There has recently been renewed interest in the
additional anatomic measurements, aside from the coro-
nary arteries, that can be obtained from NCCT in order to
best predict the likelihood of developing cardiac disease.
Nasir et al15 demonstrated that, by applying a validated
algorithm,16 measurements of left ventricular volume on
NCCT correlated with end-diastolic volume obtained by
CMR. Lin et al17 reported a relationship between aortic
root dimensions on NCCT and comparative measure-
ments from transthoracic echocardiography and Wolak
et al18 have established normal ranges of thoracic aortic
measurements for age, gender, and body surface area.
Another application of NCCT that is gaining
momentum is the measurement of epicardial fat volume
(EFV). Epicardial and thoracic fat are routinely imaged
on NCCT and there is now emerging evidence that EFV
is an important parameter in cardiovascular risk strati-
fication and appears to provide incremental prognostic
information regarding future cardiac events over that
provided by CAC scanning alone.19,20 In contrast to
coronary calcium that provides a snapshot of the his-
torical lifetime build up of atherosclerotic plaque, EFV
may represent the current state of atherogenesis activity
within the coronary arteries.8 Recent data also suggest
an intriguing relationship between EFV and myocardial
ischemia.21,22 Although the mechanism of the relation-
ship of coronary atherosclerosis and epicardial fat
remains unclear, initial studies indicate that peri-coro-
nary epicardial fat is associated with atherosclerosis in
the coronary arteries.23
The study of Gupta et al provides further evidence
that the gated NCCT scan should not simply be considered
a coronary calcium scan. As additional substantiating
studies emerge, it is plausible that measurements such as
LV size, thoracic aortic measurements, epicardial fat, and
possibly assessment of prior MI may well become a rou-
tine part of the NCCT. The radiation dose associated with
NCCT is falling24-26 and the additional clinical imaging
parameters that can be extracted from this data are
increasing. The chapter on coronary calcium may soon be
considered written, but the pages on NCCT keep turning.
The story is far from complete.
Acknowledgments
This study was supported in part by ACC/BCS, the Eisner
Foundation, and Diane and Guilford Glazer.
Dr Ronak Rajani is currently an advanced cardiac
imaging fellow funded by the American College of
Cardiology and the British Cardiovascular Society.
The authors have indicated that they have no financial
conflicts of interest.
Open Access
This article is distributed under the terms of the Creative
Commons Attribution Noncommercial License which permits
any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are
credited.
References
1. Raggi P, Callister TQ, Cooil B, He ZX, Lippolis NJ, Russo DJ,
et al. Identification of patients at increased risk of first unheralded
acute myocardial infarction by electron-beam computed tomog-
raphy. Circulation 2000;101:850-5.
2. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronary
calcification, coronary disease risk factors, C-reactive protein, and
atherosclerotic cardiovascular disease events: The St. Francis
Heart Study. J Am Coll Cardiol 2005;46:158-65.
3. LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB,
Levine BD, et al. Coronary artery calcium score and coronary
heart disease events in a large cohort of asymptomatic men and
women. Am J Epidemiol 2005;162:421-9.
4. Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M,
O’Malley PG. Coronary calcium independently predicts incident
premature coronary heart disease over measured cardiovascular
risk factors: Mean three-year outcomes in the Prospective Army
Coronary Calcium (PACC) project. J Am Coll Cardiol 2005;46:
807-14.
5. Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W,
van Rooij FJ, et al. Coronary calcification improves cardiovascular
risk prediction in the elderly. Circulation 2005;112:572-7.
6. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR,
et al. Coronary calcium as a predictor of coronary events in four
racial or ethnic groups. N Engl J Med 2008;358:1336-45.
7. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ.
Prognostic value of cardiac risk factors and coronary artery cal-
cium screening for all-cause mortality. Radiology 2003;228:826-
33.
8. Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng
PH, et al. Long-term prognosis associated with coronary calcifi-
cation: Observations from a registry of 25,253 patients. J Am Coll
Cardiol 2007;49:1860-70.
9. Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, et al.
Correlation of coronary calcification and angiographically docu-
mented stenoses in patients with suspected coronary artery
disease: Results of 1,764 patients. J Am Coll Cardiol 2001;37:
451-7.
22 Rajani et al Journal of Nuclear Cardiology
NCCT—still an open book January/February 2011
10. Brunken R, Schwaiger M, Grover-McKay M, Phelps ME, Tillisch
J, Schelbert HR. Positron emission tomography detects tissue
metabolic activity in myocardial segments with persistent thallium
perfusion defects. J Am Coll Cardiol 1987;10:557-67.
11. Brunken RC, Kottou S, Nienaber CA, Schwaiger M, Ratib OM,
Phelps ME, et al. PET detection of viable tissue in myocardial
segments with persistent defects at T1-201 SPECT. Radiology
1989;172:65-73.
12. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian
AE. Effects of age, gender, obesity, and diabetes on the efficacy
and safety of the selective A2A agonist regadenoson versus aden-
osine in myocardial perfusion imaging integrated ADVANCE-MPI
trial results. JACC Cardiovasc Imaging 2008;1:307-16.
13. Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes
SW, et al. Quantitative assessment of myocardial perfusion
abnormality on SPECT myocardial perfusion imaging is more
reproducible than expert visual analysis. J Nucl Cardiol 2009;16:
45-53.
14. Galli M, Marcassa C, Imparato A, Campini R, Orrego PS, Gian-
nuzzi P. Effects of nitroglycerin by technetium-99m sestamibi
tomoscintigraphy on resting regional myocardial hypoperfusion in
stable patients with healed myocardial infarction. Am J Cardiol
1994;74:843-8.
15. Nasir K, Katz R, Mao S, Takasu J, Bomma C, Lima JA, et al.
Comparison of left ventricular size by computed tomography with
magnetic resonance imaging measures of left ventricle mass and
volumes: The multi-ethnic study of atherosclerosis. J Cardiovasc
Comput Tomogr 2008;2:141-8.
16. Mao S, Budoff MJ, Oudiz RJ, Bakhsheshi H, Wang S, Brundage
BH. A simple single slice method for measurement of left and
right ventricular enlargement by electron beam tomography. Int J
Card Imaging 2000;16:383-90.
17. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A,
et al. Assessment of the thoracic aorta by multidetector computed
tomography: Age- and sex-specific reference values in adults
without evident cardiovascular disease. J Cardiovasc Comput
Tomogr 2008;2:298-308.
18. Wolak A, Gransar H, Thomson LE, Friedman JD, Hachamovitch
R, Gutstein A, et al. Aortic size assessment by noncontrast cardiac
computed tomography: Normal limits by age, gender, and body
surface area. JACC Cardiovasc Imaging 2008;1:200-9.
19. Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM,
Wolf PA, et al. Association of pericardial fat, intrathoracic fat, and
visceral abdominal fat with cardiovascular disease burden: The
Framingham Heart Study. Eur Heart J 2009;30:850-6.
20. Cheng VY, Dey D, Tamarappoo B, Nakazato R, Gransar H,
Miranda-Peats R, et al. Pericardial fat burden on ECG-gated
noncontrast CT in asymptomatic patients who subsequently
experience adverse cardiovascular events. JACC Cardiovasc
Imaging 2010;3:352-60.
21. Janik M, Hartlage G, Alexopoulos N, Mirzoyev Z, McLean DS,
Arepalli CD, et al. Epicardial adipose tissue volume and coronary
artery calcium to predict myocardial ischemia on positron emis-
sion tomography-computed tomography studies. J Nucl Cardiol
2010;17:841-7.
22. Tamarappoo B, Dey D, Shmilovich H, Nakazato R, Gransar H,
Cheng V et al. Increased pericardial fat volume measured from
noncontrast CT predicts myocardial ischemia by SPECT. JACC
Cardiovasc Imaging 2010;3:1104-12.
23. Mahabadi AA, Reinsch N, Lehmann N, Altenbernd J, Kalsch H,
Seibel RM, et al. Association of pericoronary fat volume with
atherosclerotic plaque burden in the underlying coronary artery: A
segment analysis. Atherosclerosis 2010;211:195-9.
24. Nakazato R, Dey D, Gutstein A, Le Meunier L, Cheng VY, Pi-
mentel R, et al. Coronary artery calcium scoring using a reduced
tube voltage and radiation dose protocol with dual-source com-
puted tomography. J Cardiovasc Comput Tomogr 2009;3:394-400.
25. Jakobs TF, Wintersperger BJ, Herzog P, Flohr T, Suess C, Knez A,
et al. Ultra-low-dose coronary artery calcium screening using multi-
slice CT with retrospective ECG gating. Eur Radiol 2003;13:1923-30.
26. Stolzmann P, Leschka S, Betschart T, Desbiolles L, Flohr TG,
Marincek B, et al. Radiation dose values for various coronary
calcium scoring protocols in dual-source CT. Int J Cardiovasc
Imaging 2009;25:443-51.
Journal of Nuclear Cardiology Rajani et al 23
Volume 18, Number 1;21–3 NCCT—still an open book


A simple single slice method for measurement of left and right ventricular enlargement by electron beam tomography.

Aortic size assessment by noncontrast cardiac computed tomography: Normal limits by age, gender, and body surface area.

Assessment of the thoracic aorta by multidetector computed tomography: Age- and sex-speciﬁc reference values in adults without evident cardiovascular disease.

Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: The Framingham Heart Study.

Association of pericoronary fat volume with atherosclerotic plaque burden in the underlying coronary artery: A segment analysis.

Comparison of left ventricular size by computed tomography with magnetic resonance imaging measures of left ventricle mass and volumes: The multi-ethnic study of atherosclerosis.

Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women.

Coronary artery calcium scoring using a reduced tube voltage and radiation dose protocol with dual-source computed tomography.

Coronary calciﬁcation improves cardiovascular risk prediction in the elderly.

Coronary calciﬁcation, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: The St. Francis Heart Study.

Coronary calcium as a predictor of coronary events in four racial or ethnic groups.

Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: Mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project.

Correlation of coronary calciﬁcation and angiographically documented stenoses in patients with suspected coronary artery disease: Results of 1,764 patients.

Effects of age, gender, obesity, and diabetes on the efﬁcacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results.

Effects of nitroglycerin by technetium-99m sestamibi tomoscintigraphy on resting regional myocardial hypoperfusion in stable patients with healed myocardial infarction.

Epicardial adipose tissue volume and coronary artery calcium to predict myocardial ischemia on positron emission tomography-computed tomography studies.

Identiﬁcation of patients at increased risk of ﬁrst unheralded acute myocardial infarction by electron-beam computed tomography.

Increased pericardial fat volume measured from noncontrast CT predicts myocardial ischemia by SPECT.

Long-term prognosis associated with coronary calciﬁ-cation: Observations from a registry of 25,253 patients.

Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events.

PET detection of viable tissue in myocardial segments with persistent defects at T1-201 SPECT.

Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003;228:826-

Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis.

Radiation dose values for various coronary calcium scoring protocols in dual-source CT.

Ultra-low-dose coronary artery calcium screening using multisliceCTwithretrospectiveECGgating.EurRadiol2003;13:1923-30.

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Non-enhanced cardiac computed tomography—still an open book

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