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ABSTRACT: Computed tomography coronary angiography (CTCA) has reached very high standards both in terms of diagnostic performance and radiation dose reduction. This commentary follows a report on CTCA using less than 0.1 mSv in selected patients. This is an extraordinary accomplishment, both for technology and for medicine. The difficult task is now to implement this tool in clinical practice so it can play the best possible role. CTCA can improve diagnostic pathways, can save money for healthcare systems and could even improve pharmacological therapy. All of this may happen, but it will require the combined effort of all the experienced operators in this field, including the referring clinicians. In times of financial constraint, CTCA may also help to restrict ineffective medical expenses. Key Points • CT coronary angiography provides high diagnostic standards in non-invasive cardiovascular medicine. • It should therefore replace other less effective diagnostic tools. • Inappropriate catheter angiography is costly to healthcare systems. • CTCA could help reduce costs of cardiac investigations by around 33 %. • Low radiation doses in CTCA lead to risk-free individualised pharmacological treatment.
European Radiology 01/2013; · 3.22 Impact Factor
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Erica Maffei,
Chiara Martini, Teresa Arcadi,
Alberto Clemente,
Sara Seitun,
Alessandra Zuccarelli,
Tito Torri,
Nico R Mollet,
Alexia Rossi,
Onofrio Catalano,
Giancarlo Messalli,
Filippo Cademartiri
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ABSTRACT: To assess the attenuation of non-calcified atherosclerotic coronary artery plaques with computed tomography coronary angiography (CTCA).
Four hundred consecutive patients underwent CTCA (Group 1: 200 patients, Sensation 64 Cardiac, Siemens; Group 2: 200 patients, VCT GE Healthcare, with either Iomeprol 400 or Iodixanol 320, respectively) for suspected coronary artery disease (CAD). CTCA was performed using standard protocols. Image quality (score 0-3), plaque (within the accessible non-calcified component of each non-calcified/mixed plaque) and coronary lumen attenuation were measured. Data were compared on a per-segment/per-plaque basis. Plaques were classified as fibrous vs lipid rich based on different attenuation thresholds. A P < 0.05 was considered significant.
In 468 atherosclerotic plaques in Group 1 and 644 in Group 2, average image quality was 2.96 ± 0.19 in Group 1 and 2.93 ± 0.25 in Group 2 (P ≥ 0.05). Coronary lumen attenuation was 367 ± 85 Hounsfield units (HU) in Group 1 and 327 ± 73 HU in Group 2 (P < 0.05); non-calcified plaque attenuation was 48 ± 23 HU in Group 1 and 39 ± 21 HU in Group 2 (P < 0.05). Overall signal to noise ratio was 15.6 ± 4.7 in Group 1 and 21.2 ± 7.7 in Group 2 (P < 0.01).
Higher intra-vascular attenuation modifies significantly the attenuation of non-calcified coronary plaques. This results in a more difficult characterization between lipid rich vs fibrous type.
World journal of radiology. 06/2012; 4(6):265-72.
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Filippo Cademartiri,
Erica Maffei,
Alessandro Palumbo,
Chiara Martini,
Sara Seitun,
Carlo Tedeschi,
Roberto De Rosa, Teresa Arcadi,
Ignazio Salamone,
Alfredo Blandino,
Annick C Weustink,
Nico R Mollet,
Pim J De Feyter,
Gabriel P Krestin
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ABSTRACT: To evaluate the diagnostic accuracy of 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in patients with zero on the Agatston Calcium Score (CACS). We enrolled 279 consecutive patients (96 male, mean age 48 +/- 12 years) with suspected coronary artery disease. Patients were symptomatic (n = 208) or asymptomatic (n = 71), and underwent conventional coronary angiography (CAG). For CT-CA we administered an IV bolus of 100 ml of iodinated contrast material. CT-CA was compared to CAG using a threshold for significant stenosis of >or=50%. The prevalence of disease demonstrated at CAG was 15% (1.4% in asymptomatic). The population at CAG showed no or non-significant disease in 85% (238/279), single vessel disease in 9% (25/279), and multi-vessel disease in 6% (16/279). Sensitivity, specificity, and positive and negative predictive values of CT-CA vs. CAG on the patient level were 100%, 95%, 76%, and 100% in the overall population and 100%, 100%, 100%, and 100% in asymptomatic patients, respectively. CT-CA proves high diagnostic performance in patients with or without symptoms and with zero CACS. The prevalence of significant disease detected by CT-CA was not negligible in asymptomatic patients. The role of CT-CA in asymptomatic patients remains uncertain.
European Radiology 08/2009; 20(1):81-7. · 3.22 Impact Factor
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Erica Maffei,
Sara Seitun,
Matteo Romano,
Alessandro A Palumbo,
Chiara Martini,
Giuseppe Tarantini,
Carlo Tedeschi,
Annick C Weustink,
Nico R Mollet, Teresa Arcadi,
Ignazio Salamone,
Alfredo Blandino,
Ludovico La Grutta,
Massimo Midiri,
Filippo Cademartiri
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ABSTRACT: To determine the relationship between established cardiovascular risk factors, clinical presentation and the extent of coronary artery disease (CAD), as described with computed tomography coronary angiography.
In this cross-sectional study, we included 567 symptomatic individuals without a history of CAD who consecutively underwent 64-slice computed tomography coronary angiography for evaluation of suspected CAD. We analyzed the prevalence of CAD depending on sex, age, symptoms and risk factors.
A total of 8542 segments were analyzed. No evidence of CAD was observed in 225 patients (40%), nonsignificant CAD in 221 patients (39%) and significant CAD (luminal narrowing >50%) in the remaining 121 patients (21%). CAD increased with advancing age, significantly above 50 years (P < 0.05). Female patients had a higher prevalence of normal coronary arteries and males of significant CAD (P < 0.01). With the increase of risk factors, there was a significant increase of the significant disease (P < 0.01). Typical pain with respect to atypical pain had the strongest association with significant CAD (16 vs. 38%; P < 0.05). In multivariate analysis, the number of risk factors, age, male sex and typical pain remained strong predictors of significant CAD (P < 0.0001).
Computed tomography coronary angiography may play an important role in risk stratification of patients with suspected CAD.
Journal of Cardiovascular Medicine 06/2009; 10(12):913-20. · 1.51 Impact Factor
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ABSTRACT: We report a case of young male with a penetrating chest trauma due to a gunshot. The bullet was detected by conventional X-ray and localized within the lateral wall of the left ventricle by CT. During surgery the bullet was not found. Thereafter conventional X-ray showed migration of the bullet within the lung parenchyma.
Journal of cardiovascular computed tomography 4(2):144-6.
