Standardized approach to result analysis and interpretation of initial experience of coronary computed tomography angiography in a tertiary care hospital.

Tahira Nishtar,Tabish Ahmad,Fatima Ahmad,Nadeem Ullah

doi:10.12669/pjms.36.4.2174

Abstract

Objective:To have a systematic standardized approach to performing and interpretation of coronary CT Angiography (CTA) in order to maintain and enhance the diagnostic accuracy of the imaging modality.Methods:This retrospective observational study was performed in Radiology Department, Lady Reading Hospital, Medical Teaching Institute, Peshawar, Pakistan from August 2018 to September 2019. Patients referred for coronary CT angiography were screened and prepared in radiology department. The examination was performed on Toshiba-160 slice CT Scanner (Prime Aquilion) utilizing standardized protocols tailored towards optimum image acquisition. Interpretation of the images were based on the guidelines provided by the Society of Cardiovascular Computed Tomography (SCCT).Results:Total 95 CTCA procedures were performed in the department, out of which 85 were included in study showing 49(57%) as normal and 36(42%) were positive for coronary disease. Of the abnormal cases 16(18.8%) had mild disease, nine (10.6%) patients had moderate disease, while severe disease was noted in 11 (12.9%) cases. Coronary quantitative stenosis revealed five cases (5.9%) with LAD involvement only and five (5.9%) with severe triple vessel disease. The remaining varied in degree of stenosis and number of segments involved. Post CABG were 14 cases (16%) and native arteries showed triple vessel disease. CTA for percutaneous stent patency were three (3.5%) cases with 100% stent patency.Conclusion:Patient selection with tailored protocols are the mainstay for achieving optimal images. This form the basis for accurate interpretation, based on a standardized and systematic approach, utilizing various post processing tools, in order to maintain the high diagnostic accuracy of this semi-invasive, safe imaging modality in a variety of patients suspected of coronary artery disease, coronary artery bypass grafts and stent patency.

Highlights

Correspondence: January 2, 2020 March 24, 2020 April 4 2020CTCA has become the mainstay imaging modality for assessing the status of coronary vessels
It is preferred over catheter angiography as it is safe, non-invasive imaging modality with short scan time
Coronary CT angiography is performed as a semi-invasive imaging modality for assessment of presence or absence of coronary artery disease.[7]

Summary

Introduction

CTCA has become the mainstay imaging modality for assessing the status of coronary vessels. It is preferred over catheter angiography as it is safe, non-invasive imaging modality with short scan time. The primary mainstay of the coronary CTA procedure is patient selection and appropriate procedural protocols with the aim to acquire ideal images which is a prerequisite for the secondary. Coronary CTA is today a widely accepted semi invasive imaging modality for both cardiologists and radiologists. The main strength of this imaging modality is dependent on its high negative predictive value,[1] with patients having a normal study being excluded from undergoing further workup/procedures. A false positive result may lead to further workup

Methods

Results

Conclusion