HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vogl, T. J. Articles by Herzog, C. Search for Related Content PubMed PubMed Citation Articles by Vogl, T. J. Articles by Herzog, C.

Techniques for the Detection of Coronary Atherosclerosis: Multi–detector Row CT Coronary Angiography¹

¹ From the Institute for Diagnostic and Interventional Radiology (T.J.V., N.D.A., T.D., K.E., M.A., C.H.) and Department of Thoracic and Cardiovascular Surgery (S.D., G.W.G., A.M.), J. W. Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Received February 28, 2001; revision requested April 2; revision received July 2; accepted September 7. Address correspondence to C.H. (e-mail: c.herzog@em.uni-frankfurt.de).

View larger version (28K): [in a new window]   Figure 1. Coronary segments according to AHA classification (7), and subdivision of coronary arteries into 15 segments. Segments 1-4 correspond to RCA; segment 5, to the left main branch, segments 6-10, to the LCA; and segments 11-15, to the LCX. 1. = first, 2. = second.

View larger version (23K): [in a new window]   Figure 2. Graph shows visibility of coronary arteries, depending on heart rate and imaging technique ( = 3D reformation, = VE reformation, = MPR; and = transverse scanning). The best visibility was obtained at heart rates below approximately 60 bpm. Transverse scans proved least irritable against cardiac motion, since, even at heart rates higher than 70 bpm, overall visibility still amounted to 66.2%.

View larger version (45K): [in a new window]   Figure 3. Bar graph shows sensitivity of CT coronary angiography in detecting atherosclerotic plaques, as well as differentiation between coronary arteries as a whole, RCA, LCA, and LCX. Three-dimensional and VE reformation, MPR, and transverse scanning (AX) are compared. By using a combination (COMBI) of all four visualization techniques, achieved sensitivity is displayed. The most sensitive results were obtained at transverse scanning (65.6%) and technique combination (71.6%). Single-vessel analysis revealed highest sensitivities for the LCA with transverse scanning (87.8%).

View larger version (45K): [in a new window]   Figure 4. Bar graph shows sensitivity of CT coronary angiography in identifying HRS (>50%) and differentiating between coronary arteries as a whole, RCA, LCA, and LCX. Comparison between 3D and VE reformation, MPR, and transverse scanning (AX) and sensitivities achieved by combining all four visualization techniques (COMBI) is also displayed. The most sensitive results were obtained for transverse scanning (73.4%) and technique combination (74.7%). Single-vessel analysis revealed the highest sensitivities for the LCA with transverse scanning (85.1%).

View larger version (158K): [in a new window]   Figure 5a. Three-dimensional reformations obtained after ECG-gated multi-detector row CT. Comparison between (a) excellent and (b) poor imaging techniques. (a) Nearly artifact-free image of left ventricle and LCAs in patient with heart rate of 56.5 bpm. Structures labeled are segment 9 (diagonal branch 1 [D1]), segment 10 (diagonal branch 2 [D2]), segment 12 (marginal branch 1 [M1]), and segment 14 (marginal branch 2 [M2]). (b) Distinct motion artifacts in patient with elevated heart rate (70.4 bpm), in same view as a. Structures labeled are segment 9 (diagonal branch 1 [D1]), segment 10 (diagonal branch 2 [D2]), segment 12 (marginal branch 1 [M1], and segment 14 (marginal branch 2 [M2]). Arrows = marked motion artifacts consecutively causing nonexisting vascular discontinuance or wall irregularity.

View larger version (158K): [in a new window]   Figure 5b. Three-dimensional reformations obtained after ECG-gated multi-detector row CT. Comparison between (a) excellent and (b) poor imaging techniques. (a) Nearly artifact-free image of left ventricle and LCAs in patient with heart rate of 56.5 bpm. Structures labeled are segment 9 (diagonal branch 1 [D1]), segment 10 (diagonal branch 2 [D2]), segment 12 (marginal branch 1 [M1]), and segment 14 (marginal branch 2 [M2]). (b) Distinct motion artifacts in patient with elevated heart rate (70.4 bpm), in same view as a. Structures labeled are segment 9 (diagonal branch 1 [D1]), segment 10 (diagonal branch 2 [D2]), segment 12 (marginal branch 1 [M1], and segment 14 (marginal branch 2 [M2]). Arrows = marked motion artifacts consecutively causing nonexisting vascular discontinuance or wall irregularity.

View larger version (113K): [in a new window]   Figure 6a. VE image obtained in coronary arteries depicts left main branch to junction of LCX and LCA. Diagonal branch 1 (D1) also is shown. (a) Image obtained in patient with heart rate of 56.5 bpm provides excellent display of vascular lumen and 50% soft-plaque stenosis (arrows) of proximal LCA. (b) Image obtained in patient with medium heart rate (68 bpm) shows distinct motion artifacts (arrows) simulating nonexisting atherosclerosis and stenosis.

View larger version (117K): [in a new window]   Figure 6b. VE image obtained in coronary arteries depicts left main branch to junction of LCX and LCA. Diagonal branch 1 (D1) also is shown. (a) Image obtained in patient with heart rate of 56.5 bpm provides excellent display of vascular lumen and 50% soft-plaque stenosis (arrows) of proximal LCA. (b) Image obtained in patient with medium heart rate (68 bpm) shows distinct motion artifacts (arrows) simulating nonexisting atherosclerosis and stenosis.

View larger version (151K): [in a new window]   Figure 7a. Transverse CT scans obtained at level of proximal LCA for comparison between patients with (a) low and (b) elevated heart rate. (a) Well differentiated vascular anatomy in patient with heart rate of 56.6 bpm. D1 = diagonal branch 1, S = septal branch, V = cardiac vein. (b) Distinct motion artifacts obtained at elevated heart rate (72.2 bpm) suggest nonexisting wall irregularity and vascular stenosis. D2 = diagonal branch 2, S = septal branch, and V = cardiac vein.

View larger version (154K): [in a new window]   Figure 7b. Transverse CT scans obtained at level of proximal LCA for comparison between patients with (a) low and (b) elevated heart rate. (a) Well differentiated vascular anatomy in patient with heart rate of 56.6 bpm. D1 = diagonal branch 1, S = septal branch, V = cardiac vein. (b) Distinct motion artifacts obtained at elevated heart rate (72.2 bpm) suggest nonexisting wall irregularity and vascular stenosis. D2 = diagonal branch 2, S = septal branch, and V = cardiac vein.

View larger version (143K): [in a new window]   Figure 8a. MPRs (view from left side) cut orthogonally to vessel lumen for comparison between patients with (a) low and (b) elevated heart rates. (a) Nearly artifact-free MPR shows very small vascular structures in patient with heart rate of 56.6 bpm. A = anterior, D1 = diagonal branch, S = septal branch. (b) MPR in patient with elevated heart rate (72.2 bpm) shows distinct blurring of coronary vessels. Vessels in caudal parts of heart show fewer motion artifacts because of fixation of heart at diaphragm. V = cardiac vein.

View larger version (147K): [in a new window]   Figure 8b. MPRs (view from left side) cut orthogonally to vessel lumen for comparison between patients with (a) low and (b) elevated heart rates. (a) Nearly artifact-free MPR shows very small vascular structures in patient with heart rate of 56.6 bpm. A = anterior, D1 = diagonal branch, S = septal branch. (b) MPR in patient with elevated heart rate (72.2 bpm) shows distinct blurring of coronary vessels. Vessels in caudal parts of heart show fewer motion artifacts because of fixation of heart at diaphragm. V = cardiac vein.