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ABSTRACT: PURPOSE: The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. MATERIALS AND METHODS: A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). RESULTS: The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. CONCLUSIONS: MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
La radiologia medica 06/2012; 117(6):939-952. · 1.44 Impact Factor
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ABSTRACT: PurposeMultidetector-row computed tomography coronary angiography (MDCT-CA) produces high-level radiation dose because of submillimetre
slice thickness and short scan time. As a result, manufacturers have produced different dose-saving protocols that may, however,
reduce image quality and thus diagnostic accuracy. The aim of our study was to assess the diagnostic quality of MDCT-CA using
different dose-saving protocols.
Materials and methodsBetween April and August 2008, we examined 65 patients with 64-slice MDCT-CA: 6/65 using the step-and-shoot dose-saving protocol,
45/65 the cardiac dose right protocol and 14/65 using a standard protocol. Image quality was evaluated on a per-patient and
per-segment basis, and the effective dose of each protocol was recorded.
ResultsIn the per-patient analysis, image quality was excellent in 100% of the step-and-shoot protocols, in 91.1% of the cardiac
dose right protocols and in 85.8% of the standard protocols. Effective dose to the patient considering the whole study (i.e.
scout, calcium score, triggering and MDCT-CA) was 20.49 mSv in the standard protocol, 14.8 mSv in the cardiac dose right protocol
and 6.63 mSv in the step-and-shoot protocol.
ConclusionsThe radiologist should apply the appropriate protocol in relation to the clinical indications, type of patient and information
required in order to spare as much dose as possible while maintaining high image quality.
IntroduzioneL’angiografia coronarica con tomografia computerizzata multistrato (AC-TCMS) comporta una dose elevata a causa di spessori
submillimetrici e ridotti tempi di acquisizione; le case costruttrici quindi hanno prodotto protocolli di risparmio di dose
che però possono ridurre la qualità delle immagini e l’accuratezza diagnostica. Lo scopo di questo lavoro è valutare la qualità
diagnostica nello studio delle arterie coronarie con i differenti protocolli di risparmio di dose.
Materiali e metodiTra aprile e agosto 2008, 65 pazienti sono stati sottoposti ad AC-TCMS a 64 detettori; 6/65 mediante protocollo step and shoot,
45/65 con protocollo cardiac dose right, 14/65 con protocollo standard. È stata valutata la qualità delle immagini con analisi
per paziente e per segmento ed è stata calcolata la dose effettiva per ciascun protocollo di acquisizione.
RisultatiNelle analisi per paziente la qualità delle immagini è risultata ottimale nel 100% dei casi per il protocollo step and shoot,
nel 91,1% dei casi per il protocollo cardiac dose right e nell’85,8% dei casi per il protocollo standard. La dose effettiva
al paziente dell’intero esame (calcium score e AC-TCMS) è risultata pari a 20,49 mSv nel protocollo standard, 14,8 mSv nel
protocollo cardiac dose right e 6,63 mSv per il protocollo step and shoot.
ConclusioniIl radiologo deve utilizzare il protocollo di scansione più adatto a seconda dell’indicazione clinica, del paziente e del
tipo di informazioni necessarie per l’iter diagnostico.
La radiologia medica 04/2012; 114(8):1196-1213. · 1.44 Impact Factor
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ABSTRACT: Anomalies of the coronary arteries are congenital and in most of the cases asymptomatic, although they may present with severe
symptoms such as angina pectoris or cardiac arrest. Multidetector CT coronary angiography (MDCT-CA) permits, through curved
multiplanar reconstructions and three-dimensional reformatting, noninvasive visualisation of the coronary tree and its variants
and anomalies, providing a more accurate alternative to conventional coronary angiography (CCA). The purpose of this pictorial
essay is to describe the main variants and anomalies of the coronary arteries using MDCT imaging with multiplanar and three-dimensional
reconstructions.
Le anomalie delle arterie coronariche sono presenti alla nascita nella maggior parte dei casi asintomatiche ma possono manifestarsi
con sintomatologia severa quale angina pectoris o addirittura l’arresto cardiaco. L’angiografia coronarica mediante tomografia
computerizzata multistrato (TCMS) permette, tramite ricostruzioni multiplanari secondo piani curvilinei e riformattazioni
3D, la visualizzazione dell’albero coronarico e delle sue varianti ed anomalie in maniera non invasiva, fornendo migliore
e più accurata alternativa alla angiografia coronarica (AC). Lo scopo di questo pictorial consiste nella descrizione mediante
immagini TCMS con ricostruzioni multiplanari e 3D delle principali varianti e anomalie delle arterie coronarie.
KeywordsMDCT-coronary angiography-Coronary anomalies-Coronary variants-Miocardial bridging-Fistula
Parole chiaveAngiografia coronarica-TCMS-Anomalie coronariche-Varianti coronariche-Ponte miocardico-Fistola
La radiologia medica 04/2012; 115(5):679-692. · 1.44 Impact Factor
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ABSTRACT: PurposeThis study was done to compare the parameters of left ventricular (LV) function obtained by multidetector computed tomography
coronary angiography (MDCT-CA) using 64-slice equipment with those obtained using twodimensional echocardiography (2D-SE)
considered as reference standard.
Materials and methodsBetween April 2008 and September 2009, 116 consecutive patients were studied with both techniques. We analysed the parameters
commonly sampled in echocardiography and related them with those retrieved with MDCT-CA: septal thickness, posterior wall
thickness, diameter of ascending aorta, diameter and volumes in end-systolic and end-diastolic phase, ejection fraction, stroke
volume, cardiac output and heart mass.
ResultsGood correlation was found measuring septal thickness (r=0.470; p=0.001), and diameters of the ascending aorta. Correlation between systolic and diastolic diameters obtained with the two
techniques was good. Poor correlation was attained measuring thickness of the posterior wall (r=0.243; p=0.104). MDCT-CA consistently overestimated the average volumes; diastolic and systolic volumes showed significant correlation
(r=0.0456; p= 0.002; r=0.640; p<0.001). Ejection fraction agreement showed a significant correlation (r=0.626; p<0.001).
ConclusionsMDCT-CA provides parameters of cardiac function comparable to those found in echocardiography. MDCT-CA although used primarily
for coronary noninvasive imaging can provide additional information on ventricular function useful to the diagnostic workup
of cardiac patients.
ObiettivoScopo del nostro studio è stato comparare i parametri della funzione ventricolare ottenuti mediante angiografia coronarica
mediante tomografia computerizzata multistrato (AC-TCMS) a 64 strati con quelli ottenuti mediante ecocardiografia bidimensionale
(2DSE), considerata come standard di riferimento.
Materiali e metodiTra aprile 2008 e settembre 2009, 116 pazienti consecutivi sono stati studiati con entrambe le tecniche. Sono stati analizzati
per entrambe le metodiche i seguenti parametri comunemente campionati in ecocardiografia e correlati con quelli ottenuti in
ACTCMS: spessore del setto, spessore della parete posteriore, diametro dell’aorta ascendente, diametro e volume tele sistolico
e tele diastolico, frazione di eiezione, stroke volume, gittata cardiaca e massa cardiaca.
RisultatiÈ stata riscontrata una buona correlazione tra le misure dello spessore del setto (r=0,470 e p=0,001) e del diametro dell’aorta
ascendente (r=0,777 e p<0,001) in ecografia e in TC, mentre una scarsa correlazione tra le misure dello spessore della parete
posteriore (r=0,243 e p=0,104). La correlazione tra i diametri tele diastolico (r=0,375 e p=0,054) e tele sistolico (r=0,703
e p<0,001) ottenuti con le due tecniche è risultata buona. La TCMS ha sovrastimato in modo consistente i valori medi dei volumi
rispetto all’ecocardiografia ma i volumi tele diastolico e tele sistolico derivati dalla 2DSE e dalla ACTCMS hanno mostrato
una correlazione significativa (rispettivamente r=0,456 e p=0,002; r=0,640 e p<0,001). Come indicatore di funzione sistolica
globale del ventricolo sinistro (VS), la frazione di eiezione (FE) misurata tramite TCMS o ecocardiografia ha mostrato un’eccellente
correlazione (r=0,626 e p<0,001).
ConclusioniLa AC-TCMS fornisce parametri della funzione cardiaca comparabili a quelli riscontrati in ecocardiografia. La AC-TCMS sebbene
utilizzata prevalentemente per l’imaging non invasivo delle arterie coronarie, può fornire informazioni aggiuntive allo studio
delle coronarie utili al work up diagnostico dei pazienti con patologie coronariche e cardiache.
KeywordsMDCT coronary angiography–Ventricular function–Left ventricle parameters–Ejection fraction–Cardiac failure
Parole chiaveAngiografia coronarica TCMS–Funzione ventricolare–Parametri ventricolari sinistri–Frazione di eiezione–Scompenso cardiaco
La radiologia medica 04/2012; 116(4):505-520. · 1.44 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: This study was done to compare the parameters of left ventricular (LV) function obtained by multidetector computed tomography coronary angiography (MDCT-CA) using 64-slice equipment with those obtained using twodimensional echocardiography (2D-SE) considered as reference standard.
Between April 2008 and September 2009, 116 consecutive patients were studied with both techniques. We analysed the parameters commonly sampled in echocardiography and related them with those retrieved with MDCT-CA: septal thickness, posterior wall thickness, diameter of ascending aorta, diameter and volumes in end-systolic and end-diastolic phase, ejection fraction, stroke volume, cardiac output and heart mass.
Good correlation was found measuring septal thickness (r=0.470; p=0.001), and diameters of the ascending aorta. Correlation between systolic and diastolic diameters obtained with the two techniques was good. Poor correlation was attained measuring thickness of the posterior wall (r=0.243; p=0.104). MDCT-CA consistently overestimated the average volumes; diastolic and systolic volumes showed significant correlation (r=0.0456; p= 0.002; r=0.640; p<0.001). Ejection fraction agreement showed a significant correlation (r=0.626; p<0.001).
MDCT-CA provides parameters of cardiac function comparable to those found in echocardiography. MDCT-CA although used primarily for coronary noninvasive imaging can provide additional information on ventricular function useful to the diagnostic workup of cardiac patients.
La radiologia medica 01/2011; 116(4):505-20. · 1.44 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Anomalies of the coronary arteries are congenital and in most of the cases asymptomatic, although they may present with severe symptoms such as angina pectoris or cardiac arrest. Multidetector CT coronary angiography (MDCT-CA) permits, through curved multiplanar reconstructions and three-dimensional reformatting, noninvasive visualisation of the coronary tree and its variants and anomalies, providing a more accurate alternative to conventional coronary angiography (CCA). The purpose of this pictorial essay is to describe the main variants and anomalies of the coronary arteries using MDCT imaging with multiplanar and three-dimensional reconstructions.
La radiologia medica 02/2010; 115(5):679-92. · 1.44 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Multidetector-row computed tomography coronary angiography (MDCT-CA) produces high-level radiation dose because of submillimetre slice thickness and short scan time. As a result, manufacturers have produced different dose-saving protocols that may, however, reduce image quality and thus diagnostic accuracy. The aim of our study was to assess the diagnostic quality of MDCT-CA using different dose-saving protocols.
Between April and August 2008, we examined 65 patients with 64-slice MDCT-CA: 6/65 using the step-and-shoot dose-saving protocol, 45/65 the cardiac dose right protocol and 14/65 using a standard protocol. Image quality was evaluated on a per-patient and per-segment basis, and the effective dose of each protocol was recorded.
In the per-patient analysis, image quality was excellent in 100% of the step-and-shoot protocols, in 91.1% of the cardiac dose right protocols and in 85.8% of the standard protocols. Effective dose to the patient considering the whole study (i.e. scout, calcium score, triggering and MDCT-CA) was 20.49 mSv in the standard protocol, 14.8 mSv in the cardiac dose right protocol and 6.63 mSv in the step-and-shoot protocol.
The radiologist should apply the appropriate protocol in relation to the clinical indications, type of patient and information required in order to spare as much dose as possible while maintaining high image quality.
La radiologia medica 09/2009; 114(8):1196-213. · 1.44 Impact Factor
