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Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single
Michael L Steigner1, Dimitrios Mitsouras, Amanda G Whitmore
1Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Insights
Coronary contrast opacification gradients were evaluated using 320-detector row coronary CT angiography (CTA). Gradients based on lumen area and diameter are reproducible and linear in normal coronary arteries, showing promise for lesion assessment.
Area of Science:
- Cardiovascular imaging
- Radiology
- Medical physics
Background:
- Coronary contrast opacification gradients require precise definition and evaluation.
- Prospectively ECG-gated single heart beat 320-detector row coronary CT angiography (CTA) offers advanced imaging capabilities.
Purpose of the Study:
- To define and evaluate coronary contrast opacification gradients using 320-detector row coronary CTA.
- To assess the feasibility and reproducibility of these gradients in normal and diseased coronary arteries.
Main Methods:
- Retrospective analysis of 320-detector row coronary CTA data from 36 patients with normal coronary arteries.
- Measurement of Hounsfield Units at 1-mm intervals to calculate distance (G(d)), lumen area (G(a)), and short-axis diameter (G(s)) gradients.
- Evaluation of gradients in 22 patients with coronary artery lesions (> or =50% stenosis).
Main Results:
- Gradients G(a) and G(s) were significantly different from zero, highly linear (r=0.77-0.84), and consistent across the left anterior descending, left circumflex, and right coronary arteries.
- The distance gradient G(d) showed non-linearities in some vessels and was smaller in the right coronary artery.
- Gradients in patients with lesions were significantly different from those in normal arteries.
- Low variation was observed for gradients across cardiac phases, heart rates, body mass index, and readers.
Conclusions:
- Measurement of contrast opacification gradients using coronary CTA is feasible and reproducible in normal coronary arteries.
- Gradients defined by lumen area and diameter are highly linear, consistent across major coronary arteries, and minimally affected by patient parameters.
- Preliminary findings for lesion assessment are promising, warranting further investigation.
Background:
To define and evaluate coronary contrast opacification gradients using prospectively ECG-gated single heart beat 320-detector row coronary angiography (CTA).
Methods And Results:
Thirty-six patients with normal coronary arteries determined by 320 x 0.5-mm detector row coronary CTA were retrospectively evaluated with customized image postprocessing software to measure Hounsfield Units at 1-mm intervals orthogonal to the artery center line. Linear regression determined correlation between mean Hounsfield Units and distance from the coronary ostium (regression slope defined as the distance gradient G(d)), lumen cross-sectional area (G(a)), and lumen short-axis diameter (G(s)). For each gradient, differences between the 3 coronary arteries were analyzed with ANOVA. Linear regression determined correlations between measured gradients, heart rate, body mass index, and cardiac phase. To determine feasibility in lesions, all 3 gradients were evaluated in 22 consecutive patients with left anterior descending artery lesions > or =50% stenosis. For all 3 coronary arteries in all patients, the gradients G(a) and G(s) were significantly different from zero (P<0.0001), highly linear (Pearson r values, 0.77 to 0.84), and had no significant difference between the left anterior descending, left circumflex, and right coronary arteries (P>0.503). The distance gradient G(d) demonstrated nonlinearities in a small number of vessels and was significantly smaller in the right coronary artery when compared with the left coronary system (P<0.001). Gradient variations between cardiac phases, heart rates, body mass index, and readers were low. Gradients in patients with lesions were significantly different (P<0.021) than in patients considered normal by CTA.
Conclusions:
Measurement of contrast opacification gradients from temporally uniform coronary CTA demonstrates feasibility and reproducibility in patients with normal coronary arteries. For all patients, the gradients defined with respect to the coronary lumen cross-sectional area and short-axis diameters are highly linear, not significantly influenced by the coronary artery (left anterior descending artery versus left circumflex versus right coronary artery), and have only small variation with respect to patient parameters. Preliminary evaluation of gradients across coronary artery lesions is promising but requires additional study.
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