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F Cademartiri,
L La Grutta,
R Malagò, F Alberghina,
A Palumbo,
M Belgrano,
E Maffei,
A Aldrovandi,
F Pugliese,
G Runza,
A Weustink,
W Bob Meeijboom,
N R Mollet,
M Midiri
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ABSTRACT: The aim of this study was to correlate left main (LM) coronary artery dimensions with the presence of atherosclerosis by multidetector-row computed tomography (MDCT) coronary angiography (CA) and to assess coronary atherosclerotic plaques with a semiquantitative method.
Sixty-two consecutive patients (41 men, mean age 60+/-11) with suspected coronary artery disease underwent 64-MDCT coronary angiography. LM dimensions (length, ostial and bifurcation diameters), quantitative [location, Hounsfield unit (HU) attenuation] and qualitative (composition, shape) analysis of plaques within the LM were performed. All patients underwent conventional CA.
Thirty patients (mean age 55+/-10) without plaques in the LM presented the following average dimensions: length 10.6+/-6.1 mm, ostial diameter 5.5+/-0.7 mm, bifurcation diameter 4.9+/-0.9 mm. LM plaques (n=36) were detected in 32 patients (mean age 64+/-10) with the following LM average dimensions: length 11.3+/-4.0 mm, ostial diameter 6.0+/-1.2 mm and bifurcation diameter 6.0+/-1.2 mm. Plaques were calcified (40%, mean attenuation 742+/-191 HU), mixed (43%, mean attenuation 387+/-94 HU) or noncalcified (17%, mean attenuation 56+/-14 HU) and were frequently eccentric (77%). Age was significantly different in the two groups (p<0.05). LM diameters of patients with plaques were improved (p<0.05). A moderate correlation was found between the LM bifurcation diameter and the corresponding plaque area (r=0.56). Significant conventional CA lesions of the LM were present in just three patients (5%).
Increased LM diameters are associated with the presence of atherosclerosis. MDCT CA indicates relevant features of LM atherosclerotic burden, as rupture and subsequent thrombosis of vulnerable plaques may develop from lesions characterised as nonsignificant at conventional CA.
La radiologia medica 05/2009; 114(3):358-69. · 1.44 Impact Factor
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G Runza,
L La Grutta,
V Alaimo,
L Damiani,
A La Fata, F Alberghina,
M Galia,
G Lo Re,
G Luccichenti,
T Bartolotta,
F Cademartiri,
M Midiri,
M De Maria,
R Lagalla
[show abstract]
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ABSTRACT: The aim of our study was to assess the influence of heart rate on the selection of the optimal reconstruction window with 40-slice multidetector-row computed tomography (40-MDCT) coronary angiography.
We studied 170 patients (114 men, age 60+/-11.3 years) with suspected or known coronary artery disease with 40-MDCT coronary angiography. Patients [mean heart rate (HR) 62.9+/-9.3 bpm, range 42-94 bpm] were clustered in two groups (group A: HR <or=65 bpm; group B: HR >65 bpm). Multiphase reconstruction data sets were obtained with a retrospective electrocardiogram (ECG)-gated 40-MDCT coronary angiography scan from 0% to 95% every 5% of the R-R interval. Two radiologists in consensus evaluated the best data sets for diagnostic purposes.
In group A, the optimal reconstruction windows were at 70% (55/110, 71/110 and 69/110 for the right coronary artery, left anterior descending and the left circumflex, respectively) and 75% (26/110, 28/110 and 28/110, respectively) of the R-R interval. In group B, a wide range of reconstruction windows were employed, both in the end-systolic phase at 40% (32/60, 18/60 and 17/60, for the right coronary artery, left anterior descending and circumflex, respectively) and diastolic phases at 70% (12/60, 22/60 and 19/60, respectively). Six scans were excluded due to severe respiratory artefacts.
Optimal position of the image reconstruction window relative to the cardiac cycle is significantly influenced by the heart rate during scanning. Diastolic reconstruction phases often allowed an optimal assessment in group A. Reconstruction phases from 30% to 45% are advisable for higher heart rates.
La radiologia medica 08/2008; 113(5):644-57. · 1.44 Impact Factor
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F Pugliese,
A C Weustink,
C Van Mieghem, F Alberghina,
M Otsuka,
W B Meijboom,
N van Pelt,
N R Mollet,
F Cademartiri,
G P Krestin,
M G M Hunink,
P J de Feyter
[show abstract]
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ABSTRACT: To evaluate the performance of dual source CT coronary angiography (DSCT-CA) in the detection of in-stent restenosis (>or=50% luminal narrowing) in symptomatic patients referred for conventional angiography (CA). DESIGN/ PATIENTS: 100 patients (78 males, age 62 (SD 10)) with chest pain were prospectively evaluated after coronary stenting. DSCT-CA was performed before CA.
Many patients undergo coronary artery stenting; availability of a non-invasive modality to detect in-stent restenosis would be desirable.
Average heart rate (HR) was 67 (SD 12) (range 46-106) bpm. There were 178 stented lesions. The interval between stenting and inclusion in the study was 35 (SD 41) (range 3-140) months. 39/100 (39%) patients had angiographically proven restenosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DSCT-CA, calculated in all stents, were 94%, 92%, 77% and 98%, respectively. Diagnostic performance at HR <70 bpm (n = 69; mean 58 bpm) was similar to that at HR >or=70 bpm (n = 31; mean 78 bpm); diagnostic performance in single stents (n = 95) was similar to that in overlapping stents and bifurcations (n = 83). In stents >or=3.5 mm (n = 78), sensitivity, specificity, PPV, NPV were 100%; in 3 mm stents (n = 59), sensitivity and NPV were 100%, specificity 97%, PPV 91%; in stents <or=2.75 mm (n = 41), sensitivity was 84%, specificity 64%, PPV 52%, NPV 90%. Nine stents <or=2.75 mm were uninterpretable. Specificity of DSCT-CA in stents >or=3.5 mm was significantly higher than in stents <or=2.75 mm (OR = 6.14; 99%CI: 1.52 to 9.79).
DSCT-CA performs well in the detection of in-stent restenosis. Although DSCT-CA leads to frequent false positive findings in smaller stents (<or=2.75 mm), it reliably rules out in-stent restenosis irrespective of stent size.
Heart (British Cardiac Society) 07/2008; 94(7):848-54. · 4.22 Impact Factor
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F Cademartiri,
R Malagò,
L La Grutta, F Alberghina,
A Palumbo,
E Maffei,
V Brambilla,
F Pugliese,
G Runza,
M Midiri,
N R Mollet,
G P Krestin
[show abstract]
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ABSTRACT: This paper aims to provide the tools for a complete anatomical evaluation of the coronary tree using 64-slice computed tomography (CT) and evaluate the prevalence of anatomical variants and anomalies in a population of 202 consecutive patients.
Two hundred and two patients with suspected coronary artery disease underwent 64-slice CT with a standard protocol. Two observers working in consensus evaluated and collected the data regarding anatomical variants and anomalies of the coronary vessels.
In the 202 consecutive patients, the prevalence of anatomical variants was: left dominant circulation (7%), absent left main (5%), presence of intermediate branch (17%), aortic origin of conus branch (13%) and circumflex origin of sinus node branch (15%). Coronary anomalies (origin and course, intrinsic and termination) showed an overall prevalence of 25%.
CT is the ideal method for the three-dimensional evaluation of the coronary tree. Anatomical variants and anomalies of the coronary arteries are quite common and should be known and recognised promptly by the operators.
La radiologia medica 01/2008; 112(8):1117-31. · 1.44 Impact Factor
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F Cademartiri,
R Malagò,
M Belgrano, F Alberghina,
E Maffei,
L La Grutta,
A A Palumbo,
G Runza,
N R Mollet,
M Midiri,
G P Krestin,
R Pozzi Mucelli
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ABSTRACT: The aim of the study was to investigate the prevalence of the noncardiac collateral findings during multislice computed tomography coronary angiography (MSCT-CA).
Six hundred and seventy patients undergoing MSCT-CA with 16-slice and 64-slice CT scanners for suspected atherosclerotic disease of the coronary arteries were retrospectively reviewed. All data sets obtained with a large field of view (FOV) were analysed by two radiologists using standard mediastinal and lung window settings. Collateral findings were divided according to clinical importance into nonsignificant, remarkable and compulsory to be investigated.
Eighty-five percent of patients revealed coronary artery disease (CAD). Only 138/670 (20.6%) were without any additional finding. An additional 1,234 findings were recorded: nonsignificant 332 (26.9%), mild 821 (66.53%), compulsory for study 81 (6.56%). A total of 81 patients (12.08%) had significant noncardiac pathology requiring clinical or radiological follow-up. Among these, newly discovered pathologies were revealed in two patients (2.46%).
A significant number of noncardiac findings might have been missed in MSCT-CA scans; the appropriate approach should be as a team trained in cardiology and radiology.
La radiologia medica 11/2007; 112(7):937-48. · 1.44 Impact Factor
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F Cademartiri,
E Maffei,
A Palumbo,
R Malagò, F Alberghina,
A Aldrovandi,
V Brambilla,
G Runza,
L La Grutta,
A Menozzi,
L Vignali,
G Casolo,
M Midiri,
N R Mollet
[show abstract]
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ABSTRACT: Our aim was to evaluate the diagnostic accuracy of 64-slice computed tomography coronary angiography (MSCT-CA) for detecting significant stenosis (>or=50% lumen reduction) in a population of patients at low to intermediate risk.
We studied 72 patients (38 men, 34 women, mean age 53.9+/-8.0 years) with atypical or typical chest pain and stratified in the low-to intermediate risk category. MSCT-CA (Sensation 64 Cardiac, Siemens, Germany) was performed after IV administration of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). Two observers, blinded to the results of conventional coronary angiography (CAG), assessed the MSCT-CA scans in consensus. Diagnostic accuracy for detecting significant stenosis was calculated.
CAG demonstrated the absence of significant disease in 70.1% of patients (51/72). No patient was excluded from MSCT-CA. There were 37 significant lesions on 1,098 available coronary segments. Sensitivity, specificity and positive and negative predictive value of MSCT-CA for detecting significant coronary artery on a per-segment basis were 100%, 98.6%, 71.2% and 100%, respectively. All patients with at least one significant lesion were correctly identified by MSCT-CA. MSCT-CA scored 15 false positives on a per-segment base, which affected only marginally the per-patient performance (only one false positive).
We concluded that 64-slice CT-CA is a diagnostic modality with high sensitivity and negative predictive value in patients at low to intermediate risk.
La radiologia medica 10/2007; 112(7):969-81. · 1.44 Impact Factor
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F Cademartiri,
L La Grutta,
A Palumbo,
E Maffei,
A Aldrovandi,
R Malagò, F Alberghina,
F Pugliese,
G Runza,
M Belgrano,
M Midiri,
M A Cova,
G P Krestin
[show abstract]
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ABSTRACT: The goal of this article is to illustrate the main invasive and noninvasive diagnostic modalities to image the vulnerable coronary plaque, which is responsible for acute coronary syndrome. The main epidemiologic and histological issues are briefly discussed in order to provide an adequate background. Comprehensive coronary atherosclerosis imaging should involve visualization of the entire coronary artery tree and plaque characterization, including three-dimensional morphology, relationship with the lumen, composition, vascular remodelling and presence of inflammation. No single technique provides such a comprehensive description, and no available modality extensively identifies the vulnerable plaque. In particular, we describe multislice computed tomography, which at present seems to be the most promising noninvasive tool for an exhaustive image-based quantification of coronary atherosclerosis.
La radiologia medica 09/2007; 112(5):637-59. · 1.44 Impact Factor
