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Assessment of Coronary Plaque Presence and Composition by 320-Slice Cardiac Computed Tomography: A Comparative Study Using Intravascular Ultrasound
S164
Heart, Lung and Circulation 2010;19S:S1–S268
Abstracts
ABSTRACTS
390 Assessment of Coronary Plaque Presence and Composition by 320-Slice Cardiac Computed Tomography: A Comparative Study Using Intravascular Ultrasound S. Lehman ∗ , Y. Malaiapan, P. Antonis, M. Zhang, J. Cameron, I. Meredith, S. Seneviratne MonashHeart, Australia Background: Non-invasive determination of coronary plaque burden and composition may be important for the prediction of future cardiovascular events. We determined the diagnostic accuracy of latest generation 320-slice CT angiography for the detection and characterisation of coronary plaque on a per-segment basis compared with gold standard intravascular ultrasound (IVUS). Methods: We analysed the datasets of 13 patients with suspected or known coronary artery disease who underwent both 320-slice CT with 350 ms gantry rotation, 320 mm × 0.5 mm collimation (Aquilion One, Toshiba Japan), 60–90 mls contrast agent and IVUS (iLab, Boston Scientific USA) within a 4-week time period. Diagnostic image quality was achieved in all segments on CT. The arteries were divided into coronary segments using the AHA 17-segment coronary model referenced to fiduciary landmarks on both modalities. CT and IVUS studies were interpreted by independent blinded expert observers as containing calcified, non-calcified, or mixed (calcified and non-calcified) plaque. Results: There were 31 coronary segments in 22 arteries available for analysis. Plaque was present in 29/31 (93.5%): non-calcified 11/31 (35.5%), calcified 0/31 (0%) and mixed 18/31 (58.1%) by IVUS. The sensitivity for CT in the detection of plaque was 93.3% and the specificity 100%. CT correctly identified the presence of calcification in 18/18 (100%) of segments with mixed plaques but failed to detect the non-calcified component of plaque in segments containing calcium in 3 of these (16.7%). Conclusions: 320-Slice CT is highly accurate for the detection of coronary plaque burden. Limitations remain in the assessment of non-calcified plaque components within segments containing calcium.
computed tomography (MDCT) in assessing global LV function, and no data exists regarding its ability to assess LV regional wall motion (RWM). Methods: We evaluated 50 consecutive patients (mean age 60 ± 14 years, 66% male) who underwent 320-slice MDCT (dose-modulated retrospective electrocardiogram-triggering) and 2D-echocardiography within 30 days for investigation of known or suspected coronary disease. Two blinded cardiologists measured LV volumes on MDCT and visually assessed RWM with a 4-point scale using a 17-segment model. A separate experienced echocardiologist, blinded to MDCT findings, assessed LV RWM on 2D-echocardiograms and determined LV volumes and LV ejection fraction (LVEF) using the Simpson’s biplane method. 2D-echocardiography served as the reference standard. Results: Mean LVEF was 59 ± 8% (range 26–75%) on 2D-echocardiography and 60 ± 9% (range 27–76%) on MDCT. Using linear regression analysis, MDCT agreed very well with 2D-echocardiography for assessment of LVEDV (r = 0.94; P < 0.001), LVESV (r = 0.97; P < 0.001) and LVEF (r = 0.95; P < 0.001). Mean differences (±S.D.) of 14 ± 13 ml, 5 ± 7 ml and 1 ± 3% were observed between MDCT and 2D-echocardiography for LVEDV, LVESV and LVEF, respectively. 81/850 (9.5%) LV segments had abnormal RWM on 2D-echocardiography. Agreement for assessment of RWM between 2D-echocardiography and MDCT was excellent (96%, k = 0.76). Conclusion: Accurate assessment of global and regional LV function is feasible with 320-slice MDCT, with MDCT demonstrating slightly larger ventricular volumes when compared to 2D-echocardiography. doi:10.1016/j.hlc.2010.06.397 392 Assessment of Left Ventricular Ejection Fraction by 128detector CT in the Setting of Severe Aortic Stenosis: A Comparison with Cardiac MRI G. Liew 1,∗ , B. Lorraine 2 , D. Wong 1 , K. Teo 1 , S. Worthley 1 1 Department of Cardiology, Royal Adelaide Hospital, Adelaide,
Australia doi:10.1016/j.hlc.2010.06.396 391 Assessment of Global and Regional Left Ventricular Function and Volumes with 320-Slice MDCT: A Comparison with 2D-Echocardiography A. Nasis ∗ , S. Moir, S. Seneviratne, S. Healy, J. Cameron, P. Mottram Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia Background: Left ventricular (LV) function and volumes have important treatment and prognostic implications in patients with coronary artery disease. Limited data exists regarding the accuracy of 320-slice multidetector
2 Department of Radiology, Royal Adelaide Hospital, Adelaide,
Australia Background: Cardiac magnetic resonance imaging (CMR) has arguably become the gold standard in the assessment of left ventricular ejection fraction (LVEF). Improved temporal resolution with current multi-detector computed tomography (MDCT) has enabled functional assessment in addition to coronary vasculature. We sought to determine the accuracy of 128-detector CT in LVEF assessment as compared to CMR. Methods: Eighteen patients (age 83.9 ± 4.9 years; male 44%) with severe aortic stenosis underwent MDCT (128detector, Siemens Definition AS+, Germany) and CMR (1.5T, Siemens Avanto, Germany). CT images were reconstructed at 2mm thick slices and 10 phases; analysis performed using Vitrea 2 (Vital Images, USA). Short axis
Heart, Lung and Circulation 2010;19S:S1–S268
Abstracts
ABSTRACTS
390 Assessment of Coronary Plaque Presence and Composition by 320-Slice Cardiac Computed Tomography: A Comparative Study Using Intravascular Ultrasound S. Lehman ∗ , Y. Malaiapan, P. Antonis, M. Zhang, J. Cameron, I. Meredith, S. Seneviratne MonashHeart, Australia Background: Non-invasive determination of coronary plaque burden and composition may be important for the prediction of future cardiovascular events. We determined the diagnostic accuracy of latest generation 320-slice CT angiography for the detection and characterisation of coronary plaque on a per-segment basis compared with gold standard intravascular ultrasound (IVUS). Methods: We analysed the datasets of 13 patients with suspected or known coronary artery disease who underwent both 320-slice CT with 350 ms gantry rotation, 320 mm × 0.5 mm collimation (Aquilion One, Toshiba Japan), 60–90 mls contrast agent and IVUS (iLab, Boston Scientific USA) within a 4-week time period. Diagnostic image quality was achieved in all segments on CT. The arteries were divided into coronary segments using the AHA 17-segment coronary model referenced to fiduciary landmarks on both modalities. CT and IVUS studies were interpreted by independent blinded expert observers as containing calcified, non-calcified, or mixed (calcified and non-calcified) plaque. Results: There were 31 coronary segments in 22 arteries available for analysis. Plaque was present in 29/31 (93.5%): non-calcified 11/31 (35.5%), calcified 0/31 (0%) and mixed 18/31 (58.1%) by IVUS. The sensitivity for CT in the detection of plaque was 93.3% and the specificity 100%. CT correctly identified the presence of calcification in 18/18 (100%) of segments with mixed plaques but failed to detect the non-calcified component of plaque in segments containing calcium in 3 of these (16.7%). Conclusions: 320-Slice CT is highly accurate for the detection of coronary plaque burden. Limitations remain in the assessment of non-calcified plaque components within segments containing calcium.
computed tomography (MDCT) in assessing global LV function, and no data exists regarding its ability to assess LV regional wall motion (RWM). Methods: We evaluated 50 consecutive patients (mean age 60 ± 14 years, 66% male) who underwent 320-slice MDCT (dose-modulated retrospective electrocardiogram-triggering) and 2D-echocardiography within 30 days for investigation of known or suspected coronary disease. Two blinded cardiologists measured LV volumes on MDCT and visually assessed RWM with a 4-point scale using a 17-segment model. A separate experienced echocardiologist, blinded to MDCT findings, assessed LV RWM on 2D-echocardiograms and determined LV volumes and LV ejection fraction (LVEF) using the Simpson’s biplane method. 2D-echocardiography served as the reference standard. Results: Mean LVEF was 59 ± 8% (range 26–75%) on 2D-echocardiography and 60 ± 9% (range 27–76%) on MDCT. Using linear regression analysis, MDCT agreed very well with 2D-echocardiography for assessment of LVEDV (r = 0.94; P < 0.001), LVESV (r = 0.97; P < 0.001) and LVEF (r = 0.95; P < 0.001). Mean differences (±S.D.) of 14 ± 13 ml, 5 ± 7 ml and 1 ± 3% were observed between MDCT and 2D-echocardiography for LVEDV, LVESV and LVEF, respectively. 81/850 (9.5%) LV segments had abnormal RWM on 2D-echocardiography. Agreement for assessment of RWM between 2D-echocardiography and MDCT was excellent (96%, k = 0.76). Conclusion: Accurate assessment of global and regional LV function is feasible with 320-slice MDCT, with MDCT demonstrating slightly larger ventricular volumes when compared to 2D-echocardiography. doi:10.1016/j.hlc.2010.06.397 392 Assessment of Left Ventricular Ejection Fraction by 128detector CT in the Setting of Severe Aortic Stenosis: A Comparison with Cardiac MRI G. Liew 1,∗ , B. Lorraine 2 , D. Wong 1 , K. Teo 1 , S. Worthley 1 1 Department of Cardiology, Royal Adelaide Hospital, Adelaide,
Australia doi:10.1016/j.hlc.2010.06.396 391 Assessment of Global and Regional Left Ventricular Function and Volumes with 320-Slice MDCT: A Comparison with 2D-Echocardiography A. Nasis ∗ , S. Moir, S. Seneviratne, S. Healy, J. Cameron, P. Mottram Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia Background: Left ventricular (LV) function and volumes have important treatment and prognostic implications in patients with coronary artery disease. Limited data exists regarding the accuracy of 320-slice multidetector
2 Department of Radiology, Royal Adelaide Hospital, Adelaide,
Australia Background: Cardiac magnetic resonance imaging (CMR) has arguably become the gold standard in the assessment of left ventricular ejection fraction (LVEF). Improved temporal resolution with current multi-detector computed tomography (MDCT) has enabled functional assessment in addition to coronary vasculature. We sought to determine the accuracy of 128-detector CT in LVEF assessment as compared to CMR. Methods: Eighteen patients (age 83.9 ± 4.9 years; male 44%) with severe aortic stenosis underwent MDCT (128detector, Siemens Definition AS+, Germany) and CMR (1.5T, Siemens Avanto, Germany). CT images were reconstructed at 2mm thick slices and 10 phases; analysis performed using Vitrea 2 (Vital Images, USA). Short axis