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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated,
S Achenbach1, T Giesler, D Ropers
1Department of Internal Medicine II, Institute of Medical Physics, University of Erlangen-Nürnberg, Germany. stephan.achenbach@rzmail.uni-erlangen.de
Insights
Multislice spiral computed tomography (MSCT) can detect coronary artery stenoses. However, image quality limitations, primarily due to motion artifacts, can affect its clinical utility.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Multislice spiral computed tomography (MSCT) enables coronary artery visualization.
- Retrospective ECG-gating is used for image reconstruction in MSCT.
Purpose of the Study:
- To investigate the ability of MSCT with retrospective ECG gating to identify high-grade coronary artery stenoses and occlusions.
- To compare MSCT findings with quantitative coronary angiography.
Main Methods:
- 64 patients underwent MSCT with specific parameters (4x1 mm slices, 500-ms rotation, 1.5 mm/rotation table feed).
- Intravenous contrast agent and retrospective ECG-gating were utilized.
- Coronary arteries and side branches (diameter >/=2.0 mm) were assessed for evaluability, stenosis (>70%), and occlusions.
Main Results:
- 174 out of 256 coronary arteries (68%) were evaluable; 30% of patients had all arteries evaluated.
- Coronary motion artifacts were the primary cause of unevaluable arteries.
- MSCT detected 58% of high-grade stenoses/occlusions (32/58); sensitivity was 91% and specificity 84% for stenosis in evaluable arteries.
Conclusions:
- MSCT with retrospective ECG gating can accurately detect coronary artery stenoses when image quality is adequate.
- Clinical use is currently limited by image quality issues, mainly from coronary motion.
- Further advancements are needed to overcome motion-related artifacts for improved diagnostic accuracy.
Background:
Multislice spiral computed tomography (MSCT) with retrospectively ECG-gated image reconstruction permits coronary artery visualization. We investigated the method's ability to identify high-grade coronary artery stenoses and occlusions.
Methods And Results:
A total of 64 consecutive patients were studied by MSCT (4x1 mm cross-sections, 500-ms rotation, table feed 1.5 mm/rotation, intravenous contrast agent, retrospectively ECG-gated image reconstruction). All coronary arteries and side branches with a luminal diameter >/=2.0 mm were assessed concerning evaluability and the presence of high-grade stenoses (>70% diameter stenosis) or occlusions. Results were compared with quantitative coronary angiography. Of 256 coronary arteries (left main, left anterior descending, left circumflex and right coronary artery, including their respective side branches), 174 could be evaluated (68%). In 19 patients (30%), all arteries were evaluable. Artifacts caused by coronary motion were the most frequent reason for unevaluable arteries. Overall, 32 of 58 high-grade stenoses and occlusions were detected by MSCT (58%). In evaluable arteries, 32 of 35 lesions were detected, and the absence of stenosis was correctly identified in 117 of 139 arteries (sensitivity, 91%; specificity, 84%). If analysis was extended to all stenoses with >50% diameter reduction, sensitivity was 85% (40 of 47) and specificity was 76% (96 of 127).
Conclusions:
MSCT with retrospective ECG gating permits the detection of coronary artery stenoses with high accuracy if image quality is sufficient, but its clinical use may presently be limited due to degraded image quality in a substantial number of cases, mainly due to rapid coronary motion.
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