Annick C Weustink

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (122)394.74 Total impact

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    ABSTRACT: PURPOSE To investigate the value of calcium score (CaSc) in addition to clinical evaluation to restrict referral to CTCA by reducing the number of patients with intermediate probability of CAD. METHOD AND MATERIALS We retrospectively included 2042 symptomatic stable patients who underwent clinical evaluation, unenhanced CT-scan for the calculation of CaSc and CTCA. Obstructive CAD (≥50% lumen diameter narrowing) assessed by CTCA was the outcome. We investigated 2 models, first, clinical evaluation consisting of chest pain typicality, female sex, age, risk factors and ECG) and second model consisting of clinical evaluation with CaSc. The model discrimination of CAD was compared by using area under the receiver operating characteristic curves. We assessed the net reclassification improvement (NRI) that allows both models to reclassify patients into low (<10%), intermediate (10-90%) and high risk (≥90%) of CAD groups, as well as clinical NRI that allows only the reclassification by model 2 of those patients first classified having intermediate risk by model 1. RESULTS Discriminiation of CAD was significantly improved by addition of CaSc to clinical evaluation (AUC: 0.80 vs. 0.90, p < 0.001). The NRI using both model to reclassify all patients was 56%. The clinical net reclassification improvement by model 2 of patients first classified by model 1 having intermediate risk was 66%. Unenhanced CT-scan and CTCA could be avoided in 12% using model 1 and an additional 32% of CTCA’s could be avoided using model 2 subsequently. CONCLUSION Calcium score provides incremental discrimination of CAD compared to clinical evaluation. Implementation of calcium score model can reduce referral to CT coronary angiography by 44%. CLINICAL RELEVANCE/APPLICATION Risk stratification of stable angina patients can be improved by using the calcium score model.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE To determine whether 2 millimeter slice thickness on knee MRI has additional value for evaluating menisci and cruciate ligaments in symptomatic patients. METHOD AND MATERIALS 74 consecutive patients undergoing knee arthroscopy following MRI of the knee from January 1, 2011 until November 1, 2012 were included retrospectively. A routine clinical MRI protocol was acquired with 3 millimeter (mm) slice thickness followed by additional sagittal and axial 2 mm proton density (PD) weighted sequences. 2 sets of MR sequences per patient were created: routine protocol with 3 mm only and the extended protocol with additional 2 mm sequences. All MR imaging studies were reviewed independently by two musculoskeletal radiologists for presence of ligament and meniscal tears. Sensitivity and specificity of the routine and extended MRI protocol in the detection of meniscal tears and cruciate ligament tears were calculated with arthroscopy used as the reference standard. Logistic regression analysis was used to assess the additional value of the 2 mm PD-slices. RESULTS The extended MR imaging protocol with 2 mm slices had higher sensitivity than the routine MR imaging protocol for the detection of meniscal tears (94% versus 90%) and similar specificity (94% and 95% respectively). Sensitivity for detection of medial meniscal tears was 98% with the extended protocol versus 93% with the routine protocol with no difference in specificity (88%). For detection of lateral meniscal tears, both sensitivity and specificity were higher for the extended MR imaging protocol (89 versus 85% and 100 versus 98% respectively). Sensitivity for anterior cruciate ligament tears was 90% for the extended MR imaging protocol versus 92% for the routine imaging protocol, whereas the specificity was 83% for the extended imaging protocol versus 75%. Logistic regression analysis showed statistically significant additional value for the extended versus the routine MR imaging protocol in the detection of meniscal and anterior cruciate ligament tears (P<0.01). CONCLUSION An extended knee MRI protocol with 2 mm slice thickness has additional value in the detection of meniscal and anterior cruciate ligament tears. CLINICAL RELEVANCE/APPLICATION Routine knee MRI protocols are often based on sequences with 3-4 millimeter slices. Two millimeter sequences improve diagnostic performance and may be an alternative to 3D isotropic scanning.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: To determine the diagnostic performance of CT coronary angiography (CTCA) in detecting and excluding left main (LM) and/or three-vessel CAD ("high-risk" CAD) in symptomatic patients and to compare its discriminatory value with the Duke risk score and calcium score. Between 2004 and 2011, a total of 1,159 symptomatic patients (61 ± 11 years, 31 % women) with stable angina, without prior revascularisation underwent both invasive coronary angiography (ICA) and CTCA. All patients gave written informed consent for the additional CTCA. High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50 % diameter stenosis). A total of 197 (17 %) patients had high-risk CAD as determined by ICA. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of CTCA were 95 % (95 % CI 91-97 %), 83 % (80-85 %), 53 % (48-58 %), 99 % (98-99 %), 5.47 and 0.06, respectively. CTCA provided incremental value (AUC 0.90, P < 0.001) in the discrimination of high-risk CAD compared with the Duke risk score and calcium score. CTCA accurately excludes high-risk CAD in symptomatic patients. The detection of high-risk CAD is suboptimal owing to the high percentage (47 %) of overestimation of high-risk CAD. CTCA provides incremental value in the discrimination of high-risk CAD compared with the Duke risk score and calcium score. • Computed tomography coronary angiography (CTCA) accurately excludes high-risk coronary artery disease. • CTCA overestimates high-risk coronary artery disease in 47 %. • CTCA discriminates high-risk CAD better than clinical evaluation and coronary calcification.
    European Radiology 06/2013; · 4.34 Impact Factor
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    ABSTRACT: OBJECTIVE: To investigate the value of the calcium score (CaSc) plus clinical evaluation to restrict referral for CT coronary angiography (CTCA) by reducing the number of patients with an intermediate probability of coronary artery disease (CAD). METHODS: We retrospectively included 1,975 symptomatic stable patients who underwent clinical evaluation and CaSc calculation and CTCA or invasive coronary coronary angiography (ICA). The outcome was obstructive CAD (≥50 % diameter narrowing) assessed by ICA or CTCA in the absence of ICA. We investigated two models: (1) clinical evaluation consisting of chest pain typicality, gender, age, risk factors and ECG and (2) clinical evaluation with CaSc. Discrimination of the two models was compared. The stepwise reclassification of patients with an intermediate probability of CAD (10-90 %) after clinical evaluation followed by clinical evaluation with CaSc was assessed by clinical net reclassification improvement (NRI). RESULTS: Discrimination of CAD was significantly improved by adding CaSc to the clinical evaluation (AUC: 0.80 vs. 0.89, P < 0.001). CaSc and CTCA could be avoided in 9 % using model 1 and an additional 29 % of CTCAs could be avoided using model 2. Clinical NRI was 57 %. CONCLUSION: CaSc plus clinical evaluation may be useful in restricting further referral for CTCA by 38 % in symptomatic stable patients with suspected CAD. KEY POINTS: • CT calcium scores (CaSc) could proiritise referrals for CT coronary angiography (CTCA) • CaSc provides an incremental discriminatory value of CAD compared with clinical evaluation • Risk stratification is better when clinical evaluation is combined with CaSc • Appropriate use of clinical evaluation and CaSc helps avoid unnecessary CTCA referrals.
    European Radiology 06/2013; · 4.34 Impact Factor
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    ABSTRACT: OBJECTIVES: To compare the diagnostic performance and radiation exposure of 128-slice dual-source CT coronary angiography (CTCA) protocols to detect coronary stenosis with more than 50 % lumen obstruction. METHODS: We prospectively included 459 symptomatic patients referred for CTCA. Patients were randomized between high-pitch spiral vs. narrow-window sequential CTCA protocols (heart rate below 65 bpm, group A), or between wide-window sequential vs. retrospective spiral protocols (heart rate above 65 bpm, group B). Diagnostic performance of CTCA was compared with quantitative coronary angiography in 267 patients. RESULTS: In group A (231 patients, 146 men, mean heart rate 58 ± 7 bpm), high-pitch spiral CTCA yielded a lower per-segment sensitivity compared to sequential CTCA (89 % vs. 97 %, P = 0.01). Specificity, PPV and NPV were comparable (95 %, 62 %, 99 % vs. 96 %, 73 %, 100 %, P > 0.05) but radiation dose was lower (1.16 ± 0.60 vs. 3.82 ± 1.65 mSv, P < 0.001). In group B (228 patients, 132 men, mean heart rate 75 ± 11 bpm), per-segment sensitivity, specificity, PPV and NPV were comparable (94 %, 95 %, 67 %, 99 % vs. 92 %, 95 %, 66 %, 99 %, P > 0.05). Radiation dose of sequential CTCA was lower compared to retrospective CTCA (6.12 ± 2.58 vs. 8.13 ± 4.52 mSv, P < 0.001). Diagnostic performance was comparable in both groups. CONCLUSION: Sequential CTCA should be used in patients with regular heart rates using 128-slice dual-source CT, providing optimal diagnostic accuracy with as low as reasonably achievable (ALARA) radiation dose. KEY POINTS : • 128-slice dual-source CT coronary angiography offers several different acquisition protocols. • Randomized comparison of protocols reveals an optimal protocol selection strategy. • Appropriate CTCA protocol selection lowers radiation dose, while maintaining high quality. • CTCA protocol selection should be based on individual patient characteristics. • A prospective sequential protocol is preferred for CTCA.
    European Radiology 10/2012; · 4.34 Impact Factor
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    ABSTRACT: RATIONALE AND OBJECTIVES: The aim of this study was to automatically detect and quantify calcium lesions for the whole heart as well as per coronary artery on non-contrast-enhanced cardiac computed tomographic images. MATERIALS AND METHODS: Imaging data from 366 patients were randomly selected from patients who underwent computed tomographic calcium scoring assessments between July 2004 and May 2009 at Erasmum MC, Rotterdam. These data included data sets with 1.5-mm and 3.0-mm slice spacing reconstructions and were acquired using four different scanners. The scores of manual observers, who annotated the data using commercially available software, served as ground truth. An automatic method for detecting and quantifying calcifications for each of the four main coronary arteries and the whole heart was trained on 209 data sets and tested on 157 data sets. Statistical testing included determining Pearson's correlation coefficients and Bland-Altman analysis to compare performance between the system and ground truth. Wilcoxon's signed-rank test was used to compare the interobserver variability to the system's performance. RESULTS: Automatic detection of calcified objects was achieved with sensitivity of 81.2% per calcified object in the 1.5-mm data set and sensitivity of 86.6% per calcified object in the 3.0-mm data set. The system made an average of 2.5 errors per patient in the 1.5-mm data set and 2.2 errors in the 3.0-mm data set. Pearson's correlation coefficients of 0.97 (P < .001) for both 1.5-mm and 3.0-mm scans with respect to the calcium volume score of the whole heart were found. The average R values over Agatston, mass, and volume scores for each of the arteries (left circumflex coronary artery, right coronary artery, and left main and left anterior descending coronary arteries) were 0.93, 0.96, and 0.99, respectively, for the 1.5-mm scans. Similarly, for 3.0-mm scans, R values were 0.94, 0.94, and 0.99, respectively. Risk category assignment was correct in 95% and 89% of the data sets in the 1.5-mm and 3-mm scans. CONCLUSIONS: An automatic vessel-specific coronary artery calcium scoring system was developed, and its feasibility for calcium scoring in individual vessels and risk category classification has been demonstrated.
    Academic radiology 09/2012; · 2.09 Impact Factor
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    ABSTRACT: To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men. In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30 % and 30-90 % were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50 % lumen diameter narrowing) was calculated on patient level. P < 0.05 was considered significant. A total of 570 patients (46 % women [262/570]) were included and stratified as low (women 73 % [80/109]) and intermediate risk (women 39 % [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97 % vs. 100 %, 79 % vs. 90 %, 80 % vs. 80 % and 97 % vs. 100 %, respectively. For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively. CTCA has similar diagnostic accuracy in women and men at low and intermediate risk. KEY POINTS : • Coronary artery disease (CAD) is increasingly investigated by computed tomography angiography (CTCA). • CAD detection or exclusion by CTCA is not different between sexes. • CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups. • CTCA rarely misses obstructive CAD in low-intermediate risk women and men. • CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups.
    European Radiology 06/2012; 22(11):2415-23. · 4.34 Impact Factor
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    ABSTRACT: We determined the extent, severity, distribution and type of coronary plaques in cardiac asymptomatic patients with familial hypercholesterolemia (FH) using computed tomography (CT). FH patients have accelerated progression of coronary artery disease (CAD) with earlier major adverse cardiac events. Non-invasive CT coronary angiography (CTCA) allows assessing the coronary plaque burden in asymptomatic patients with FH. A total of 140 asymptomatic statin treated FH patients (90 men; mean age 52 ± 8 years) underwent CT calcium scoring (Agatston) and CTCA using a Dual Source CT scanner with a clinical follow-up of 29 ± 8 months. The extent, severity (obstructive or non-obstructive plaque based on >50% or <50% lumen diameter reduction), distribution and type (calcified, non-calcified, or mixed) of coronary plaque were evaluated. The calcium score was 0 in 28 (21%) of the patients. In 16% of the patients there was no CT-evidence of any CAD while 24% had obstructive disease. In total 775 plaques were detected with CT coronary angiography, of which 11% were obstructive. Fifty four percent of all plaques were calcified, 25% non-calcified and 21% mixed. The CAD extent was related to gender, treated HDL-cholesterol and treated LDL-cholesterol levels. There was a low incidence of cardiac events and no cardiac death occurred during follow-up. Development of CAD is accelerated in intensively treated male and female FH patients. The extent of CAD is related to gender and cholesterol levels and ranges from absence of plaque in one out of 6 patients to extensive CAD with plaque causing >50% lumen obstruction in almost a quarter of patients with FH.
    Atherosclerosis 12/2011; 219(2):721-7. · 3.71 Impact Factor
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    ABSTRACT: To compare image quality, radiation dose, and their relationship with heart rate of computed tomographic (CT) coronary angiographic scan protocols by using a 128-section dual-source CT scanner. Institutional review board approved the study; all patients gave informed consent. Two hundred seventy-two patients (175 men, 97 women; mean ages, 58 and 59 years, respectively) referred for CT coronary angiography were categorized according to heart rate: less than 65 beats per minute (group A) and 65 beats per minute or greater (group B). Patients were randomized to undergo prospective high-pitch spiral scanning and narrow-window prospective sequential scanning in group A (n = 160) or wide-window prospective sequential scanning and retrospective spiral scanning in group B (n = 112). Image quality was graded (1 = nondiagnostic; 2 = artifacts present, diagnostic; 3 = no artifacts) and compared (Mann-Whitney and Student t tests). In group A, mean image quality grade was significantly lower with high-pitch spiral versus sequential scanning (2.67 ± 0.38 [standard deviation] vs 2.86 ± 0.21; P < .001). In a subpopulation (heart rate, <55 beats per minute), mean image quality grade was similar (2.81 ± 0.30 vs 2.94 ± 0.08; P = .35). In group B, image quality grade was comparable between sequential and retrospective spiral scanning (2.81 ± 0.28 vs 2.80 ± 0.38; P = .54). Mean estimated radiation dose was significantly lower (high-pitch spiral vs sequential scanning) in group A (for 100 kV, 0.81 mSv ± 0.30 vs 2.74 mSv ± 1.14 [P < .001]; for 120 kV, 1.65 mSv ± 0.69 vs 4.21 mSv ± 1.20 [P < .001]) and in group B (sequential vs retrospective spiral scanning) (for 100 kV, 4.07 mSv ± 1.07 vs 5.54 mSv ± 1.76 [P = .02]; for 120 kV, 7.50 mSv ± 1.79 vs 9.83 mSv ± 3.49 [P = .1]). A high-pitch spiral CT coronary angiographic protocol should be applied in patients with regular and low (<55 beats per minute) heart rates; a sequential protocol is preferred in all others.
    Radiology 12/2011; 261(3):779-86. · 6.34 Impact Factor
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    ABSTRACT: PURPOSE To compare radiation dose and diagnostic performance to detect significant coronary stenosis of 3 CT coronary angiography protocols using a 128-slice Dual Source CT scanner (Siemens): a prospective high pitch spiral (HPS), a prospective step-and-shoot (SAS), and a retrospective (RS) scan protocol. METHOD AND MATERIALS We prospectively included 459 symptomatic patients with a regular heart rate (HR). Patients were categorized into 2 groups: pre-scan HR <65 bpm (group A) or ≥ 65 bpm (group B). Patients in group A (231 patients, 146 men, mean HR 58±7 bpm) were randomized to have a HPS or SAS (scan window 62-74% of the RR-interval) scan. Patients in group B (228 patients, 132 men, mean HR 75±11 bpm) were randomized to have a SAS (scan window 31-75%) or RS scan (pulsing window 31-75%). The presence of a significant stenosis (>50% lumen reduction) was assessed on a per segment level and compared with quantitative coronary angiography. The estimated radiation exposure was calculated. RESULTS Group A: Sensitivity and negative predictive value (NPV) of CT coronary angiography using HPS were significantly lower than by using the SAS protocol (89% vs. 97%, p<0.05, and 99% vs. 100%, p<0.05). Specificity and positive predictive value (PPV) were similar (95% vs. 97%, NS, and 62% vs. 73%, NS). The estimated radiation dose was significantly lower with the HPS protocol than with the SAS protocol (tube voltage 100 kV: 0.74±0.15 vs. 2.65±1.0 mSv, p<0.001 and 120 kV: 1.60±0.57 vs. 4.65±1.51 mSv, p<0.001). Group B: Sensitivity, specificity, PPV and NPV of CT coronary angiography were not significantly different using a SAS (93%, 95%, 67% and 99%, respectively) or RS scan protocol (92%, 95%, 65% and 99%, respectively, NS) . The estimated radiation dose was significantly lower with the SAS protocol than with the RS protocol (tube voltage 100 kV: 4.05±1.46 vs. 5.66±2.30 mSv, p<0.001 and 120 kV: 7.53±2.18 vs. 10.21±4.98 mSv, p<0.001). CONCLUSION A prospectively triggered step and shoot scan protocol using a narrow (≤65 bpm) or wide (>65 bpm) scan window is the preferred CT coronary angiography scan protocol in patients with regular heart rates using 128-slice Dual Source CT, providing optimal diagnostic quality with an “as low as reasonably achievable” radiation dose. CLINICAL RELEVANCE/APPLICATION Careful selection of the CT coronary angiography scan protocol is mandatory to obtain diagnostic quality with an “as low as reasonably achievable” radiation dose.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: PURPOSE The aim of this study was to determine the diagnostic accuracy of CT coronary angiography (CTCA) in women with low, intermediate and high risk of having significant coronary artery disease (CAD). METHOD AND MATERIALS A total of 275 symptomatic women without prior history of coronary revascularization who underwent both CTCA and invasive coronary angiography between 2004 and 2009 were retrospectively included. The pre-test probability for significant CAD was estimated using the Duke Clinical Score and were grouped in low (≤20% probability), intermediate (21% to 80% probability), and high risk (≥81% probability). The diagnostic accuracy of CTCA to detect significant CAD (≥50% lumen diameter narrowing) was assessed in the different risk groups on a per patient level. RESULTS Two-hundred-and-seventy-five women were stratified, of which 50 in low risk group, 183 in intermediate risk group and 42 in high risk group. The estimated pre-test probability in the low, intermediate and high risk groups were 12%, 49% and 89%, resp. The prevalence of at least one obstructive lesion on patient level in the low, intermediate and high risk groups were 38%, 66%, and 83%, resp. The median calcium score in the low, intermediate and high risk group was, 4 (25th and 75th percentile: 0–174), 154 (20–482) and 416 (216–891) resp. In the low risk group the sensitivity, specificity, PPV and NPV was 100% (95 % CI: 83–100%), 74% (57–86%), 70% (52–84%) and 100% (85–100%). In the intermediate risk group the sensitivity, specificity, PPV and NPV was 98% (94–100%), 78% (66–86%), 89% (83–94%) and 96% (87–99%). In the high risk group the sensitivity, specificity, PPV and NPV was 100% (90–100%), 57% (25–84%), 92% (81–97%) and 100% (51–100%). CONCLUSION The prevalence of CAD in women is underestimated in low and intermediate risk groups. CTCA can accurately rule out significant CAD in women with all risk groups. The post-test probability for detecting significant CAD is not depended on the pre-test probability of disease and is similar in the various risk groups. CLINICAL RELEVANCE/APPLICATION Women with significant coronary artery disease are generally under-diagnosed. CT coronary angiography has the potential to improve the detection of significant CAD in women.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: Our aim was to determine the prognostic value of computed tomography coronary angiography (CTCA), coronary artery calcium scoring (CACS) and Morise clinical score in patients with known or suspected coronary artery disease (CAD). A total of 722 patients (480 men; 62.7±10.9 years) who were referred for further cardiac evaluation underwent CACS and contrast-enhanced CTCA to evaluate the presence and severity of CAD. Of these, 511 (71%) patients were without previous history of CAD. Patients were stratified according to the Morise clinical score (low, intermediate, high), to CACS (0-10, 11-100, 101-400, 401-1,000, >1,000) and to CTCA (absence of CAD, nonsignificant CAD, obstructive CAD). Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation. Significant CAD (>50% luminal narrowing) was detected in 260 (36%) patients; nonsignificant CAD (<50% luminal narrowing) in 250 (35%) and absence of CAD in 212 (29%). During a mean follow-up of 20±4 months, 116 events (21 hard) occurred. In patients with normal coronary arteries on CTCA, the major event rate was 0% vs. 1.7% in patients with nonsignificant CAD and 7.3% in patients with significant CAD (p<0.0001). Three hard events (14%) occurred in patients with CACS≤100 and two (9.5%) in patients with intermediate Morise score; one revascularisation was observed in a patient with low Morise score. At multivariate analysis, diabetes, obstructive CAD and CACS >1,000 were significant predictors of events (p<0.05). An excellent prognosis was noted in patients with a normal CTCA (0% event rate). CACS ≤100 and low-intermediate Morise score did not exclude the possibility of events at follow-up.
    La radiologia medica 09/2011; 116(8):1188-202. · 1.46 Impact Factor
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    ABSTRACT: This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; ≥50% lumen reduction) in intermediate/high-risk asymptomatic patients. A total of 183 consecutive asymptomatic individuals (92 men; mean age 54±11 years) with more than one major risk factor (obesity, hypertension, diabetes, hypercholesterolaemia, family history, smoking) and an inconclusive or nonfeasible noninvasive stress test result (stress electrocardiography, stress echocardiography, nuclear stress scintigraphy) underwent CT-CA in an outpatient setting. All patients underwent conventional coronary angiography (CAG) within 4 weeks. Data from CT-CA were compared with CAG regarding the presence of significant CAD (≥50% lumen reduction). Mean calcium score was 177±432, mean heart rate during the CT-CA scan was 58±8 bpm and the prevalence (per-patient) of obstructive CAD was 19%. CT-CA showed single-vessel CAD in 9% of patients, two-vessel CAD in 9% and three-vessel CAD in 0%. Per-patient sensitivity, specificity, positive predictive value and negative predictive value of CT-CA were 100% (90-100), 98% (96-99), 97% (85-99), 100% (97-100), respectively. Positive and negative likelihood ratios were 151 and 0, respectively. CT-CA is an excellent noninvasive imaging modality for excluding significant CAD in intermediate/ high-risk asymptomatic patients with inconclusive or nonfeasible noninvasive stress test.
    La radiologia medica 09/2011; 116(8):1161-73. · 1.46 Impact Factor
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    ABSTRACT: We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris. Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS). Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05). MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.
    La radiologia medica 09/2011; 116(8):1174-87. · 1.46 Impact Factor
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    A C Weustink, P J de Feyter
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    ABSTRACT: Contrast-enhanced CT coronary angiography (CTCA) has evolved as a reliable alternative imaging modality technique and may be the preferred initial diagnostic test in patients with stable angina with intermediate pre-test probability of CAD. However, because CTCA is moderately predictive for indicating the functional significance of a lesion, the combination of anatomic and functional imaging will become increasingly important. The technology will continue to improve with better spatial and temporal resolution at low radiation exposure, and CTCA may eventually replace invasive coronary angiography. The establishment of the precise role of CTCA in the diagnosis and management of patients with stable angina requires high-quality randomised study designs with clinical outcomes as a primary outcome.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 08/2011; 19(7-8):336-43. · 1.41 Impact Factor
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    ABSTRACT: To determine the calcium score and coronary plaque burden in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH) compared with a control group of patients with low probability of coronary artery disease, having non-anginal chest pain, using CT. 101 asymptomatic patients with FH (mean age 53 ± 7 years; 62 men) and 126 patients with non-anginal chest pain (mean age 56 ± 7 years; 80 men) underwent CT calcium scoring and CT coronary angiography. All patients with FH were treated with statins during a period of 10 ± 8 years before CT. The coronary calcium score and plaque burden were determined and compared between the two patient groups. The median total calcium score was significantly higher in patients with FH (Agatston score = 87, IQR 5-367) than in patients with non-anginal chest pain (Agatston score = 7, IQR 0-125; p < 0.001). The overall coronary plaque burden was significantly higher in patients with FH (p < 0.01). Male patients with FH, whose low-density lipoprotein cholesterol levels were reduced by statins below 3.0 mmol/l, had significantly less coronary calcium (p < 0.01) and plaque burden (p = 0.02). The coronary plaque burden is high in asymptomatic middle-aged patients with FH despite intense statin treatment.
    Heart (British Cardiac Society) 07/2011; 97(14):1151-7. · 5.01 Impact Factor
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    ABSTRACT: To evaluate additional adenosine magnetic resonance perfusion (MRP) imaging in the diagnostic workup of patients with suspected stable angina with computed tomography coronary angiography (CTCA) as first-line diagnostic modality. Two hundred and thirty symptomatic patients (male, 52%; age, 56 year) with suspected stable angina underwent CTCA. In patients with a stenosis of >50% as visually assessed, MRP was performed and the quantitative myocardial perfusion reserve index (MPRI) was calculated. Coronary flow reserve (CFR) using invasive coronary flow measurements served as the standard of reference. CTCA showed non-significant CAD in 151/230 (66%) patients and significant CAD in 79/230 patients (34%), of whom 50 subsequently underwent MRP and CFR. MRP showed reduced perfusion in 32 patients (64%), which was confirmed by CFR in 27 (84%). All 18 cases of normal MRP (36%) were confirmed by CFR. The positive likelihood ratio of MRP for the presence of functional significant disease in patients with a lesion on CTCA was 4.49 (95% confidence interval [CI] 2.12-9.99). The negative likelihood ratio was 0.05 (95%CI 0.01-0.34). CTCA as first-line diagnostic modality excluded coronary artery disease in a high percentage of patients referred for diagnostic workup of suspected stable angina. MRP made a significant contribution to the detection of functional significant lesions in patients with a positive CTCA.
    Circulation Journal 06/2011; 75(7):1678-84. · 3.58 Impact Factor
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    ABSTRACT: This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in a male and female population. A total of 1,372 patients (882 men, 490 women; mean age 59.3 ± 11.9 years) in sinus rhythm imaged with CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR+ and LR-) of CTCA were assessed against CAG for the male and female populations. The prevalence of obstructive disease was 53% (men 58%; women 43%). CAG demonstrated the absence of significant coronary artery disease (CAD) in 47% (men 42%; women 56%), single-vessel disease in 25% (men 36%; women 22%) and multivessel disease in 29% (men 32%; women 23%) of patients. In the per-patient analysis, sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of CTCA were 99% (men 98%; women 100%), 92% (men 92%; women 92%), 94% (men 95%; women 90%) and 99% (men 98%; women 100%), respectively. The per-patient likelihood ratios (LR) in the total population (LR+=12.4 and LR-=0.011), the male (LR+=12.9 and LR-=0.016) and female (LR =11.9 and LR-=0) populations were very good. We observed no significant differences in diagnostic accuracy between male and female populations. CTCA is a reliable diagnostic modality with high sensitivity and NPV in the female population.
    La radiologia medica 06/2011; 117(1):6-18. · 1.46 Impact Factor
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    ABSTRACT: This study sought to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in non-ST-elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) and in subgroups selected by gender and number of risk factors (RF). We selected from a population of 1,500 patients in a multicentre registry with NSTEMI-ACS who had undergone CTCA and CAG, (n=237; 187 men, mean age 63±10 years). Diagnostic accuracy and likelihood ratios (LR) of CTCA were assessed against CAG in the total population and subgroups (men, women: 0 RF = absence of RF, 1-2 RF = presence of one or two RF, >2 RF = presence of more than two RF). The prevalence of obstructive disease was 53%. In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 100% (men 100%; women 100%; 0 RF 100%; 1-2 RF 100%; >2 RF 100%), 95% (men 98%; women 50%; 0 RF NA% (NA, not assessable); 1-2 RF 96%; >2 RF 96%), 95% (men 98%; women 91%; 0 RF 91%; 1-2 RF 96%; >2 RF 96%), 100% (men 100%; women 100%; 0 RF NV%; 1-2 RF 100%; >2 RF 100%), respectively. The per-segment analysis showed a reduction in PPV (ranging between 56% and 67%). The per-patient LR+ ranged between 18 and 27, whereas LR-were always 0. We observed no significant differences in diagnostic accuracy between subgroups. CTCA is a reliable diagnostic modality with high sensitivity and NPV in NSTEMI-ACS patients who are not candidates for early revascularisation, regardless of gender and number of risk factors.
    La radiologia medica 06/2011; 116(7):1014-26. · 1.46 Impact Factor
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    ABSTRACT: To assess the influence of sex on the diagnostic performance of computed tomography coronary angiography (CTCA). A total of 916 symptomatic patients (30.5% women) without earlier history of coronary artery intervention underwent both CTCA and invasive coronary angiography. Descriptive diagnostic parameters, to detect obstructive coronary artery disease (CAD; ≥ 50% lumen diameter narrowing) on CTCA, were compared between women and men on a per-patient, per-vessel, and per-segment level. Adjusted values were calculated for clustered segments and differences in sex variables using logistic multivariate regression models in general estimated equations. Women were older, had less typical chest complaints, and had a lower prevalence, extent, and severity of CAD compared with men. Multivariate analysis on a per-patient level revealed no difference in sensitivity (98 vs. 99%, P=0.15), specificity (78 vs. 82%, P=0.65), positive predictive value (PPV; 87 vs. 95%, P=0.10), negative predictive value (NPV; 97 vs. 98%, P=0.63), and diagnostic odds ratio (DOR; 198 vs. 721, P=0.07). No difference was found on per-vessel level analysis (sensitivity 95 vs. 97%, P=0.14; specificity 89 vs. 87%, P=0.93; PPV 73 vs. 79%, P=0.06; NPV 98 vs. 98%, P=0.72; and DOR 143 vs. 240, P=0.08). Per-segment analysis revealed a lower sensitivity (88 vs. 94%, P<0.001) and DOR (163 vs. 302, P=0.002) in women compared with men, without a difference in specificity (96 vs. 95%, P=0.19), PPV (64 vs. 69%, P=0.07), and NPV (99 vs. 99%, P=0.08). CTCA can accurately rule out obstructive CAD in both women and men. CTCA is less accurate in women to detect individual obstructive disease.
    Coronary artery disease 05/2011; 22(6):421-7. · 1.56 Impact Factor

Publication Stats

2k Citations
394.74 Total Impact Points

Institutions

  • 2006–2013
    • Erasmus MC
      • • Department of Cardiology
      • • Department of Radiology
      Rotterdam, South Holland, Netherlands
  • 2012
    • Delft University Of Technology
      • Faculty of Applied Sciences (AS)
      Delft, South Holland, Netherlands
  • 2009–2011
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy
  • 2006–2011
    • Erasmus Universiteit Rotterdam
      • • Department of Cardiology
      • • Department of Radiology
      Rotterdam, South Holland, Netherlands