Coronary Artery CT Angiography Research Articles

Feasibility of Weight-based Tube Voltage and Iodine Delivery Rate for Coronary Artery CT Angiography.

The objective of this study was to evaluate the feasibility of weight-based tube voltage and iodine delivery rate (IDR) for coronary artery CT angiography (CCTA). A total of 193 patients (mean age: 58 ± 12 years) with suspected coronary heart disease indicated for CCTA between May and October 2022 were prospectively enrolled. The subjects were divided into five groups according to body weight: < 60 kg, 60 - 69 kg, 70 - 79 kg, 80 - 89 kg, and ≥ 90 kg. The tube voltage and IDR settings of each group were as follows: 70 kVp/0.8 gI/s, 80 kVp/1.0 gI/s, 80 kVp/1.1 gI/s, 100 kVp/1.5 gI/s, and 100 kVp/1.5 gI/s, respectively. Objective image quality data included the CT value and standard deviation (noise) of the aortic root (AR), the proximal left anterior descending branch (LAD), and the distal right coronary artery (RCA), as well as the signal-to-noise ratio and contrast-to-noise ratio of the LAD and RCA. Subjective image quality assessment was performed based on the 18-segment model. Contrast and radiation doses, as well as effective dose (ED), were recorded. All continuous variables were compared using either the one-way ANOVA or the Kruskal-Wallis rank sum test. No significant differences were observed in all objective and subjective parameters of image quality between the groups (P > 0.05). However, significant differences in contrast and radiation doses were observed (P < 0.05). The contrast doses across the weight groups were 27 mL, 35 mL, 38 mL, 53 mL, and 53 mL, respectively, while the ED were 1.567 (1.30, 2.197) mSv, 1.53 (1.373, 1.78) mSv, 2.113 (1.963, 2.256) mSv, 4.22 (3.771, 4.483) mSv, and 4.786 (4.339, 5.536) mSv, respectively. Weight-based tube voltage and IDR yielded consistently high image quality, and allowed for further reduction in contrast and radiation exposure during CCTA for coronary artery diseases.

Methodology of generation of CFD meshes and 4D shape reconstruction of coronary arteries from patient-specific dynamic CT

Due to the difficulties in retrieving both the time-dependent shapes of the vessels and the generation of numerical meshes for such cases, most of the simulations of blood flow in the cardiac arteries use static geometry. The article describes a methodology for generating a sequence of time-dependent 3D shapes based on images of different resolutions and qualities acquired from ECG-gated coronary artery CT angiography. The precision of the shape restoration method has been validated using an independent technique. The original proposed approach also generates for each of the retrieved vessel shapes a numerical mesh of the same topology (connectivity matrix), greatly simplifying the CFD blood flow simulations. This feature is of significant importance in practical CFD simulations, as it gives the possibility of using the mesh-morphing utility, minimizing the computation time and the need of interpolation between boundary meshes at subsequent time instants. The developed technique can be applied to generate numerical meshes in arteries and other organs whose shapes change over time. It is applicable to medical images produced by other than angio-CT modalities.

Deep learning-based quantitative image analysis for detecting coronary artery stenosis, calcification, and vulnerable plaque in coronary computed tomography angiography

Abstract Purpose To develop a quantitative image analysis for detecting coronary artery stenosis, calcification, and vulnerable plaque in reconstructed coronary computed tomography angiography. Materials and Methods 2,978 reconstructed coronary artery CT angiography (CCTA) of our hospital in South Korea from 2014 to 2022 were enrolled. For each CCTA scan, a total of 13 images were reconstructed for each coronary artery (CA) by CT Cardiac Package, TeraRecon Inc. A total of 769 CT images were independently selected as the test data set in the last period, while the remaining were utilized in a 4:1 ratio as train and validation datasets. The locations of stenosis and vulnerable plaques were strongly labeled by an expert radiologist with more than 10 years of experience to train a 2D segmentation model (SM). First of all, the correlation between a quantitative stenosis index (QSI) and conventionally measured quantitative angiographic analysis (QCA) was evaluated. We developed an SM for CA and stenosis using 2D nnU-Net. Using SM, the position and length of stenosis per image were evaluated, and a CA diameter profile was analyzed through Full Width at Half Maximum analysis. The QSI is acquired through the calculation of the CA diameter profile. Secondly, images with marked calcifications and calcification scores (CS) were evaluated by an expert cardiologist with more than 15 years of experience. The CS was calculated by measuring the number of voxels over 1100 Hounsfield units in the CA using the previously developed vascular SM. The result of CS was evaluated by visual scoring of the expert cardiologist with a 10-scale. Lastly, the presence or absence of vulnerable plaques per CA was evaluated. In addition, another SM for normal CA and vulnerable plaques were trained. For the evaluation method, sensitivity and specificity were calculated for each CA. Results The correlation between QSI and QCA was 0.715. Visual scoring on the result of CS was 7.150 ±2.354 to 10. The sensitivity and specificity of the vulnerable plaque for evaluating vascular unit classification were 0.929 and 0.910, respectively. Conclusions We developed an automated quantitative image analysis for evaluating QSI, detecting calcification, and vulnerable plaque in CCTA, which could be used in the actual screening setting.

Epicardial fat can predict the in-atrial thrombus in patients with atrial fibrillation

Abstract Background Thromboprophylaxis is important in the management of patients with atrial fibrillation. Epicardial adipose tissue (EAT) is involved in the formation of the pre-thrombotic state. However, the potential of EAT in predicting the risk of thromboembolism in atrial fibrillation remains unknown. Objective To study the imaging features of EAT and its potential in predicting the risk of in-atrial thrombus in atrial fibrillation. Methods Patients were divided into the group with (thrombus group) and without (non-thrombus group) intra-atrial thrombosis according to the results of transesophageal echocardiography (TEE). The EAT volume, mean EAT density and EAT volume/whole heart volume ratio measured on coronary artery CT angiography (CA-CTA) were compared between the two groups. Result A total of 347 atrial fibrillation patients undergoing both TEE and CA-CTA were included and 38 cases were complicated with in-atrial thrombus. Using quartile values, EAT volume, mean EAT density, the ratio of EAT volume/whole heart volume are divided into four grades according to the values. By analyzing the ROC curve and comparing the area under the curve of AUC, EAT volume and EAT volume/whole heart volume ratio show potential diagnostic value in predicting the risk of in-atrial thrombus in atrial fibrillation. In addition, 38 cases without in-atrial thrombus were included in the non-thrombotic group after matching the propensity score by age and gender. On multivariate analysis, patients in the thrombus group had the larger EAT volume (P=0.000, P&amp;lt;0.05) and higher ratio of EAT volume/whole heart volume ratio (P=0.004, P&amp;lt;0.05) when compared with patients in the non-thrombotic group, but there was no difference of mean EAT density (P=0.224, P&amp;gt;0.05) between the two groups. On logistic regression analysis, patients in the thrombus group had the larger EAT volume when compared with patients in the non-thrombotic group (P=0.003, P&amp;lt;0.05). Conclusions EAT may be a potential marker in predicting the risk of in-atrial thrombus in atrial fibrillation. However, much more efforts and testing would be needed before our conclusion could be tried in other people and to elucidate pathogenic mechanisms of EAT.Figure 1Epicardial fat measuremeFigure 2ROC curve

Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children.

Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children. Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability. Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval. Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient's body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.

Radiation Exposure Dose Reduction according to ECG Window Acquisition Range Setting in Coronary Artery CT Angiography

This study was to reduce the radiation exposure dose of recipients by setting the ECG window acquisition range appropriately during Coronary artery CT Angiography (CCTA) examination. Group 1 (control group) opened ECG window acquisition range to 65% to 75% using the relative delay scan (RDS), which is divided by percentage (%) based on the R-R peak interval of recipient's Average HR, and tested by setting pitch to auto. Group 2 fixed the pitch according to the recipient's HR under the same conditions as Group 1. Group 3 used absolute delay scan (ADS), which is divided by milliseconds (ms) based on the R-R peak interval of recipient's Average HR and fixed the ECG window acquisition range by 60 ms intervals. Group 4 narrowed the scan range from 68% to 73% under the same conditions as Group 1. The values of the mean, minimum, maximum, the volume CT dose index (CTDIvol), and dose length product (DLP) were compared. The exposure dose was reduced by more than 10% when acquired with ADS, not RDS mainly obtained from CCTA. Also, compared to the existing RDS, when the scan range was reduced by half, it was reduced by more than 20%. In conclusion, In CCTA testing, setting the ECG window acquisition range to 5% or 60 ms can reduce radiation exposure without compromising the best phase image acquisition and image quality.

Application of radial artery in total arterial coronary revascularization in elderly patients

To summarize the application experience and clinical effect of radial artery in total arterial coronary revascularization (TAR) in elderly patients. Retrospectively analyzed the clinical data of patients who underwent TAR at the University of Hong Kong Shenzhen Hospital from July 1, 2020 to May 30, 2022. Patients were divided into ≥ 65-year-old group and < 65-year-old group according to age. The radial artery blood flow, diameter, intimal integrity and Allen test were evaluated by ultrasound before operation. The distal ends of radial artery were collected for pathological examination during operation. Coronary artery CT angiography (CTA) was examined postoperatively and follow up. The safety and reliability of ultrasonic assessment of radial artery and application of radial artery in elderly patients with TAR were summarized and analyzed. A total of 101 patients received TAR, including 35 cases aged ≥ 65 years old, 66 cases aged < 65 years old; 78 cases used bilateral radial arteries, and 23 cases used unilateral radial arteries. 4 cases of bilateral internal mammary arteries. All the proximal ends of the radial artery were anastomosed to the proximal end of the ascending aorta, 34 cases were performed of "Y" grafts, and 4 cases were sequential anastomoses. There was no in-hospital death and perioperative cardiovascular events. Perioperative cerebral infarction occurred in 3 patients. 1 patients was reoperated for bleeding. Intra-aortic balloon pump (IABP) assistance was used in 21 patients. Poor wound healing occurred in 2 cases and healed well after debridement. Follow-up of 2 to 20 months after discharge showed no internal mammary artery occlusion and 4 radial artery occlusions; no major adverse cardiovascular and cerebrovascular event (MACCE) occurred, and the survival rate was 100%. There was no significant difference in the above perioperative complications and follow-up endpoints between the two age groups. By adjusting the order of bypass anastomosis and optimizing the preoperative evaluation method, radial artery combined with internal mammary artery can obtain better outcome early in TAR, and can be safely and reliably applied to elderly patients.

One-stop combined CT angiography of coronary and craniocervical arteries: recommended as the first examination for patients suspected of coronary or craniocervical artery disease.

To investigate the potential diagnostic value of one-stop combined CT angiography (CTA) as the first examination for patients suspected of coronary artery disease (CAD) or craniocervical artery disease (CCAD), and compare its clinical performance with two consecutive CTA scans. Patients with suspected but unconfirmed CAD or CCAD were prospectively enrolled and grouped randomly to undergo coronary and craniocervical CTA using the combined protocol (group 1) or the consecutive protocol (group 2). Diagnostic findings were evaluated for both the targeted and non-targeted regions. The objective image quality, overall scan time, radiation dose, and contrast medium dosage were compared between the two groups. Each group enrolled 65 patients. A substantial number of lesions were found in non-targeted regions, which was 44/65 (67.7%) by patients for group 1 and 41/65 (63.1%) for group 2, reiterating the necessity of extending the scan coverage. Specifically, lesions in non-targeted regions were detected more often for patients suspected of CCAD than for those suspected of CAD (71.4% vs 61.7%). With 21.5% (~51.1s) reduction of scan time and 21.8% (~20.8mL) less contrast medium as compared to the consecutive protocol, high-quality images were obtained by the combined protocol. One-stop combined CTA enables effective detection of lesions in non-targeted regions at a lower cost of scan time and contrast medium than two separate examinations and is thus worth taking as the first examination for patients suspected of CAD or CCAD. • Extending the scan range for coronary or craniocervical CTA has the potential to reveal lesions in non-targeted regions. • One-stop combined CTA as enabled on high-speed wide-detector CT delivers high-quality images at a lower cost of contrast medium and operational time than two consecutive CTA scans. • Patients with suspected but unconfirmed CAD or CCAD may benefit from the one-stop combined CTA in the first examination.

Feasibility and accuracy of coronary artery calcium score on virtual non-contrast images derived from a dual-layer spectral detector CT: A retrospective multicenter study.

This retrospective study was to evaluate the feasibility and accuracy of coronary artery calcium score (CACS) from virtual non-contrast (VNC) images in comparison with that from true non-contrast (TNC) images. A total of 540 patients with suspected of coronary artery disease (CAD) who underwent a dual-layer spectral detector CT (SDCT) in three hospitals were eligible for this study and 233 patients were retrospectively enrolled for further analysis. The CACS was calculated from both TNC and VNC images and compared. Linear regression analysis of the CACS was performed between TNC and VNC images. The correlation of overall CACS from VNC and TNC images was very strong (r = 0.923, p < 0.001). The CACS from VNC images were lower than that from TNC images (221 versus. 69, p < 0.001). When the regression equation of the overall coronary artery was applied, the mean calibrated CACS-VNC was 221 which had a significant difference from the CACS-TNC (p = 0.017). When the regression equation of each coronary branch artery was applied, the mean calibrated CACS-VNC was 221, which had a significant difference from the CACS-TNC (p = 0.003). But the mean difference between the CACS-TNC and the calibrated CACS-VNC in either way was less than 1. The agreement on risk stratification with CACS-TNC and CCACS-VNC was almost perfect. This multicenter study with dual-layer spectral detector CT showed that it was feasible to calculate CACS from the VNC images derived from the spectral coronary artery CT angiography scan, and the results were in good accordance with the TNC images after correction. Therefore, the TNC scan could be omitted, reducing the radiation dose to patients and saving examination time while using dual-layer spectral detector CT.

Role of coronary CT imaging diagnosis of coronary functional stenosis

Coronary heart disease is a major disease harmful to human health, and coronary angiography, as the gold standard for the diagnosis of coronary heart disease, can directly observe the degree of coronary artery diameter stenosis. However, the invasive and expensive cost of coronary angiography limits its clinical application, and some studies have shown that coronary anatomical stenosis can not fully reflect the myocardial ischemia, and put forward the concept of functional stenosis. With the development of CT technology, coronary artery CT angiography has become a new method to detect functional stenosis. This paper reviews the role of coronary artery CT angiography in the detection of functional coronary artery stenosis.

Abstract 9412: Establishing a Coronary Calcium Scoring Threshold as a Gateway to Invasive Testing for Firefighters Undergoing Fitness for Duty Exams

Introduction: Heart disease is the leading cause of death amongst active firefighters. Firefighters undergo exercise treadmill test as a part of fitness for duty examinations screening for heart disease. It has been previously shown that coronary artery calcium (CAC) scoring and CT angiography (CTA) together can be used cost effectively in further screening for obstructive coronary artery disease amongst firefighters. A coronary artery calcium score threshold to predict obstructive CAD however is yet to be established. Methods: Firefighters in the County of Los Angeles Fire Department underwent fitness for training tests over a twenty-year period using treadmill ECG tests for cardiac screening. Those with positive tests were referred for further evaluation with coronary calcium scoring (CCS). Individuals with a CCS of &amp;gt; 10 went on to have CTA as prior studies have shown that CCS &amp;lt; 10 is highly unlikely to correlate with obstruction. We used receiver-operating characteristic (ROC) analysis to determine the optimal sensitivity and specificity of a CCS threshold needed to predict which individuals were likely to have a CTA showing greater than 50% stenosis. Results: Annually, about 3000 firefighters undergo fitness for duty testing in Los Angeles County. In our sample population from 1999 to 2019, a total of 1425 firefighters had a positive treadmill test. All 1425 of these firefighters underwent CCS with scores varying from 0 to 1400, the distribution vastly skewed toward 0. A ROC curve analysis indicated that a CCS score of 75 was the optimal cutoff for sensitivity (82%) and specificity (62%), in predicting a stenosis greater than 50% in any segment in the CTA firefighter population. However, given the high stress associated with firefighter duty and the high mortality both on-duty and after-duty, we believe prioritization should be geared toward detection and prevention. For this reason, we chose to maximize sensitivity in our statistical analysis and determined that a CAC score of 10 (sensitivity 95%, specificity 13%) to be the most appropriate threshold. Conclusion: For future testing, a CCS threshold score of 10 can confidently be used to guide further testing for obstructive coronary artery disease with CTA.

Imaging in CABG Patients

Coronary artery bypass grafting (CABG) is one of the most common major surgical procedures performed. Atherosclerosis however is a progressive condition; it is probably therefore that patients with CABG will represent with ischemic symptoms. The purpose of this review is to provide familiarity with testing in CABG patients to assist clinicians in their decision-making. CT angiography of coronary arteries and grafts (CCTA) has evolved into an alternative approach to diagnose graft disease or occlusion. As such, CCTA may help risk stratify patients post-CABG. CCTA thus joins the armamentarium of traditional functional tests that can be used. The consequences of which type of test is chosen are discussed. Through discussion of the contemporary literature for imaging in CABG patients, this review will focus on the strengths and weaknesses of both anatomical and functional approaches. It appears that the impact of which index test is chosen is as important post-CABG as it is in patients with suspected CAD.

Pulmonary Artery Dilatation Is a Common Finding in a Coronary Artery CT Angiography Population

Background/Aim: Dilatation of the main pulmonary artery (mPA) is a common incidental finding in chest imaging and often leads to consultation. The aim of this study was to determine the prevalence of mPA dilatation in a coronary artery CT angiography (CCTA) population. Patients and Methods: The study investigated 985 consecutive patients scheduled for diagnostic CCTA. The transverse axial diameter of the mPA was measured. The prevalence of mPA dilatation was estimated using different reference values (Framingham Heart Study: 28.9 mm for males and 26.9 mm for females, Bozlar: 29.5 mm for both genders and Karazincir: 32.6 mm for males and 31.9 mm for females). Results: The patient mean age was 53.0±9.7 years (66.5% were women). Body surface area (BSA) correlated moderately with the mPA diameter (r=0.423, p&lt;0.001). The prevalence of mPA dilatation varied from 5.9% (Karazincir) to 33.7% (Framingham Heart Study) in the overall study population. Conclusion: The prevalence of mPA dilatation is high in a CCTA patient population when using a cut-off value from the Framingham Heart Study.

The investigation and prognosis in patients with non-alcoholic fatty liver disease and coronary vulnerable plaque

Objective: To investigate the prevalence and prognosis of non-alcoholic fatty liver disease (NAFLD) complicated with coronary vulnerable plaque (VP). Method: Consecutive patients were included who had undergone coronary artery CT angiography (CCTA) from January 1, 2011 to January 30, 2015 at the First People's Hospital of Neijiang. NAFLD was diagnosed according to the liver imaging findings (liver/spleen CT ratio≤1.0) and clinical data. Baseline data, diagnosis, vulnerable plaque were recorded and followed up. The end points included all-cause death rate, cardiac death rate, non-fatal myocardial infarction rate, and elective coronary revascularization rate. Result: A total of 1 069 patients were eventually recruited in this study, including 316 (29.6%) cases diagnosed as NAFLD. In patients with NAFLD, 130 (41.1%) cases had vulnerable plaque, which was significantly higher than 217 of 753 non-NAFLD patients (28.8%) (P<0.01). The percentages of spotty calcification, low attenuation plaque, positive remodeling and napkin ring sign in NAFLD cohort were 36.5%, 14.2%, 17.6% and 6.8% respectively, while those corresponding in non-NAFLD cohort were 18.4%, 6.3%, 5.8% and 3.2% respectively. The proportion of each vulnerable feature in NAFLD cohort was significantly higher than that in the non-NAFLD cohort, with P values of 0.016, 0.028, 0.019 and 0.042, respectively. The cardiac mortality rate in NAFLD group was significantly higher than and that of non-NAFLD group (7.0% vs. 3.6%, P=0.044). Multivariate Cox analysis suggested that NAFLD was not an independent risk factor for cardiac death. NAFLD subgroup (n=316) was divided into VP positive group (NAFLD+VP+, n=130) and VP negative group (NAFLD+VP-, n=186). The mean follow-up time was 4.6±1.3 years. All-cause mortality rate, cardiac death rate, elective coronary artery reconstruction rate, non-fatal myocardial infarction rate in NAFLD+VP+group were 20.8%, 12.3%, 25.4%, 13.8% respectively, which were significantly higher than those corresponding rates in NAFLD+VP-group (5.9%, 3.2%, 8.6%, 6.5%) (P<0.01, 0.002,<0.01, and 0.032 respectively). Conclusion: The incidences of cardiac mortality, elective coronary revascularization, and non-fatal myocardial infarction are significantly higher in patients with NAFLD than those without. NAFLD combined with vulnerable plaque of coronary arteries predicts worse prognosis.

Evaluation of Coronary Artery Bypass Graft Using Multi-Detector CT Angiography: Comparative Study

Abstract Background: Recurrence of ischemic symptoms after coronary artery bypass graft surgery requires imaging assess-ment of bypass graft lumen to rule-out graft dysfunction. Aim of Study: Is to evaluate the role of 320-row multide-tector CT as a non-invasive imaging modality for assessment of coronary artery bypass grafts. Results: Twenty one patients were referred to assess the patency of coronary artery bypass grafts. All patients were subjected to history taking, clinical examination as well as CT angiography of coronary arteries and coronary artery bypass grafts using 320-row multidetector CT scanner after heart rate control and injection of non-ionic contrast material. Total number of 63 interpretable coronary artery bypass grafts were included in this study. On evaluating 23 arterial grafts, all of LIMA grafts were patent without stenosis except for LIMA to D2 graft which shows subtotal distal anastomotic site occlusion. The only RIMA graft in this study was occluded whereas radial artery graft to OM was patent. On evaluating 40 venous grafts, 11 (27.5%) grafts were considered patent, 3 (7.5%) grafts showed significant (>!50) stenosis and 26 (65%) grafts were occluded. Conclusion: Multidetector CT is considered convenient and reliable non-invasive imaging modality for assessment of suspected graft dysfunction.

Clinical and radiologic characteristics as well as outcomes of patients with primary cardiac angiosarcoma

Objective: To analyze the clinical, radiologic characteristics, and outcome of consecutive patients with primary cardiac angiosarcoma. Methods: The medical records of patients with primary cardiac angiosarcoma diagnosed through pathology at Peking Union Medical College Hospital between January 2001 and May 2018 were obtained. The results of echocardiography, coronary artery CT angiography (CTA), cardiac magnetic resonance (CMR), positron emission computed tomography (PET-CT), operation, postoperative treatment and prognosis of the patients were analyzed. Results: A total of 16 patients were included, 9 were male, 7 were female, the median age was 42.5 years (31.7, 52.5). The interval from symptoms onset to diagnosis was 4.5 months (0.5-18.0 months). Eight patients were diagnosed at non-metastatic phase, while 8 patients were in metastatic phase. The main complaints were dyspnea, short breath, chest pain, hemoptysis, syncope, edema, fever, fatigue, and cough. Three patients (18.8%) had pericardial tamponade in the course of the disease. Echocardiography was performed on all 16 patients, cardiac mass was found in 12 patients, and pericardial effusion or pericardial thickening was observed in 4 patients. In 8 cases with results of coronary CTA, 5 cases presented signs of right atrium occupation, 1 case presented sign of right ventricle occupation, and 1 case presented isolated massive pericardial effusion. None abnormality was found in 1 case. Of the 7 patients who underwent CMR, 6 presented with right atrium mass occupation and 1 mediastinal mass. Four patients received PET-CT examination and results showed that all presented with hypermetabolic lesions: 2 in right atrium, 1 in pericardium, and 1 in mediastinum, and lung metastasis was found in 2 cases. Among the 16 patients, 13 received surgical treatment, 2 received adjuvant chemotherapy, and 1 received chemotherapy and radiotherapy after biopsy. The median overall survival was 3.0 months. Conclusion: Cardiac angiosarcoma is a rare malignancy with poor prognosis, and echocardiography has only limited diagnostic value for angiosarcoma. CMR, CTA or PET-CT examinations could provide valuable clues for the diagnosis of this rare disease.

Application of the One-Stop Cardiac CT Scan on 256-Row Wide Detector Revolution CT in Myocardial Ischemia of Aortic Valve Degeneration Diagnosis

Background: Advances in Imaging has been used increasingly to assess coronary lumen and myocardial perfusion with more accuracy. Objectives: The aim of this study was to evaluate the diagnostic performance of one-stop cardiac CT myocardial perfusion imaging (CT-MPI) combined with coronary artery CT angiography (CCTA) for the detection of functionally relevant myocardial ischemia of aortic valve degeneration (AVD). The study was approved by the patient and passed by the ethics committee. Methods: This study was a case-control study using random sampling. A total of 109 (109/480) patients suspected of CAD were prospectively enrolled from January 2017 to December 2018 with chest pain as their chief complaint in Renmin Hospital of Wuhan University, Wuhan, Hubei, China. All patients underwent CT-MPI and CCTA on a wide detector Revolution CT. Myocardial blood flow (MBF) was quantified and compared between normal perfusion and abnormal myocardial segments based on AHA-17-segment model. CCTA images were evaluated qualitatively based on SCCT-18-segment model. Radionuclide myocardial perfusion imaging (MPI) is the gold standard; the diagnostic accuracy of CT-MPI, CCTA, and CT-MPI combination with CCTA in the diagnosis of myocardial ischemia of AVD with hemodynamic stenosis was evaluated. Results: All patients underwent CCTA combined with CT-MPI examination, 69 patients (63.30%) with 182 myocardial segments(15. 52%) were detected with decreased blood perfusion, the MBF value was lower than that of normal segments [(83.06 ± 20.11) mL.100 mL-1.min-1 vs. (120.02 ± 28.71) mL.100 mL-1.min-1; t = 14.361, P < 0.001]. There were 1914 segments (97.56%) that could be used for the diagnosis in CCTA, 302 (15.78%) segments have clinical significance in this study. Compared with the MPI, the diagnostic sensitivity, specificity, positive and negative predictive value of CT-MPI for myocardial ischemia of AVD were 73.33%, 73.68%, 89.80%, 70.00%, respectively, 90.00%, 68.42%, 88.24%, 72.22% for CCTA, and 88.46%, 70.59%, 90.20%, 66.67% combined with CT-MPI and CCTA. Logistic regression analysis was performed that the AVD was associated with the detection rate of calcified plaques (r = 5.207, P < 0.05), and calcification of the aortic valve were associated with the detection of plaques in the three and six segments of coronary arteries (P < 0.05). Conclusions: Both good CCTA and CT-MPI images can be obtained at the one-stop scanning by Revolution CT. This can be used for the diagnosis of AVD combined with myocardial ischemia. Revolution CT can accurately measure myocardial hemodynamic changes, and provide imaging evidence for the diagnosis and treatment of aortic valve degeneration.

GW29-e1028 Clinical Value of Functional Stenosis Score with Coronary artery CT Angiography in Diagnosis of Coronary Heart Disease: a prospective study

To analyze the clinical value of functional stenosis score (FSS) with coronary CT angiography (CCTA) in diagnosis of coronary heart disease (CHD). A total of 1,200 patients with clinically diagnosed or suspected coronary heart disease were enrolled prospectively from January 2015 to April 2015. 248

A Study on the Image Quality improvement of the Coronary artery CT Angiography using the Lowest Heart Rate

목적: 관상동맥 CT 혈관 조영술(Coronary artery CT Angiography, 이하 CCTA) 에서 scan시 심박수가 최저인 구간을 분석하여 새로운 프로트콜을 만들고 최저 심박수 구간에서의 검사가 화질 개선에 미치는 영향에 대해 연구하고자 하였다. 대상 및 방법: 2015년 9월부터 2017년 12월까지 본원에서 CCTA 를 시행한 환자 674명의 심박수 변화를 관찰하여 심박수가 가장 낮아지는 시점을 조사하는 선행 연구를 한 뒤 2017년 8월부터 2018년 1월까지 기존의 숨을 들여 마시고 참는 방송 직후에 coronary scan을 시작하는 프로토콜로 검사한 대조군 172명과 심박수가 가장 낮아지는 시점에서 coronary scan을 시작하도록 프로토콜을 수정하여 검사한 실험군 125명의 영상을 심혈관계 판독의 3명이 5점 척도로 해부학적 영역들이 얼마나 잘 보이는 가에 따라 정성적으로 평가 하였다. CT scanner로 사용한 장비는 본원에서 현재 CCTA 검사에 사용하고 있는 256MDCT(256 iCT, Philips Medical System, The Netherlands) 2대와 spectral CT(IQon spectral CT, Philips Healthcare, Eindhoven, The Netherlands) 1대, 심장 영상 재구성과 scan된 시간 동안의 심박수 변화를 분석하기 위해 workstation은 Extended Brilliance Workspace(Version 4.5,Philips Medical System, The Netherlands)를 사용하였다. 결과: Coronary scan 중 최저 심박수 구간은 breath hold 후 평균 4.5sec가 되었을 때였다. 이를 토대로 대조군과 실험군의 영상을 5점 척도로 비교 평가 한 결과 대조군에서 5점은 40.1%, 4점은 35.5%, 3점은 21.5%, 2점은 2.9%, 1점은 0%의 결과를 나타냈고 실험군에서 5점은 80.8%, 4점은 12%, 3점은 7.2%, 2점과 1점에서는 0%의 결과를 나타냈다. 영상 평가 결과 실험군의 영상이 대조군에 비해 임상적으로 진단 가치가 높은 것으로 나타났다 결론: CCTA에서 최저 심박수 구간에서의 coronary scan 은 화질 개선에 효과적이다. 임상에서 좀 더 나은 심장 영상을 얻기 위한 노력은 지속되어야 하고 이 연구가 조금이나마 도움이 될 수 있으리라 사료된다.Purpose: The aim of this study is finding the lowest heart rate point during breath holding time in Coronary Artery CT Angiography (CCTA) and create a new protocol to improve image quality without motion artifact. Material and Methods: We investigated 674 patients who underwent conventional coronary CT angiography to observe heart rate changes during their breath holding time, from September 2015 to December 2017. After our investigation, total of 172 patients take Coronary Scan with our new protocol which is starting scan at the point of lowest heart rate point while their breath holding time, from August 2017 to January 2018. 256 MDCTs and a 128 MDCT were used for Coronary Scan with each protocol which is appropriately modified by their technical specification. A 3D workstation, Extended Brilliance Workspace v4.5 (EBW 4.5), is used for analyzing heart rate variation during the scanned time. Result: The lowest heart rate of the coronary scan was 4.5 seconds after the breath holding. Based on this factor, we compared the image quality of 172 patients examined using existing protocols and 125 patients examined using a protocol that changed the scan start time to 4.5 seconds after breath holding. As a result, it was estimated that the images tested with our new protocols are clinically more valuable for diagnosis of coronary artery with motion free images than the existing protocols. Conclusion: Scanning coronary scan at the point of lower heart rate interval is very important in improving image quality without motion artifact. Efforts to get better heart images in the clinical environment should continue and this research could prove to be of some use.

Single-phase coronary artery CT angiography extracted from stress dynamic myocardial CT perfusion on third-generation dual-source CT: Validation by coronary angiography

BackgroundCT advances allow coronary arterial tree to be entirely covered during one CTP scan. Our aim was to investigate the potential value of single-phase coronary CT angiography (SP-CCTA) extracted from stress dynamic myocardial CT perfusion (CTP) for coronary artery stenosis assessment. MethodsConsecutive symptomatic patients were prospectively recruited and scanned with an ATP-stress dynamic myocardial CTP and routine CCTA protocol using third-generation DSCT. Noise reduction was applied to optimize image quality (IQ), the CTP phase with the best enhancement of the coronary arteries was selected as the SP-CCTA. IQ was assessed qualitatively. Using coronary angiography (CAG) as the reference standard, the diagnostic performance for stenosis detection was compared for SP-CCTA and routine CCTA. Results56 patients underwent the CTP and CCTA examination, among which 39 patients underwent CAG. The qualitative IQ scores of SP-CCTA were similar to that of routine CCTA (p > 0.05). On a per-segment basis, the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and area under the receiver-operating-characteristic curve results of SP-CCTA and routine CCTA for diagnosis of stenosis ≥50% exhibited no significant difference (SP-CCTA: 78.1%, 94.9%, 77.4%, 95.1%, 91.6% and 0.935 vs. routine CCTA: 74.7%, 95.3%, 78.0%, 95.3%, 91.6% and 0.937; all p > 0.05). The mean effective radiation dose of CTP and routine CCTA plus CTP were 3.92 ± 1.72 mSv and 5.98 ± 2.01 mSv (p < 0.05), respectively. ConclusionsThe IQ and diagnostic value of SP-CCTA was equivalent to routine CCTA on third-generation DSCT. SP-CCTA images from CTP may potentially replace a separate routine CCTA, allowing the possibility of “one-stop” cardiac examination for high-risk CAD patients who need myocardial ischemia assessment.