Quality of visualization of coronary venous system in 64-slice computed tomography

Multi-slice computed tomography (MSCT) can be used to visualize the anatomy of the coronary venous system (CVS). A pre-procedural evaluation of target veins is a very important element of cardiac resynchronization. Thus, the quality of visualization of the CVS is of great importance. The aim of this study was to analyze the quality of visualization of CVS in MSCT.

In 220 subjects (129 male, average age 57.2 ± 11.8 years), a 64-slice CT (Aquilion 64, Toshiba, Japan) was performed. A scan with ECG-gating was performed using a slice thickness of 0.5 mm during a breath-hold. In each case, 3D volume rendering and 2D MPR reconstructions were created (Vitrea 2). The quality of visualization was graded independently by two cardiologists and a radiologist trained in MSCT on a 0-5 points scale for the coronary sinus and main veins [0 = not visible (lack of vein); 5 = visible as a smoothly bordered vascular structure].

The best visualization of the CVS was obtained for coronary sinus (4.10 ± 1.08), the worst for antero-lateral vein (2.11 ± 1.10). The average number of visible veins was 3.2 per case. Statistically, more veins were visible in older subjects - in the group aged 60+ the average number of visible veins was 3.6 ± 1.1 per case, whereas in those aged under 60 it was 2.9 ± 1.2 (p = 0.0001). There were no statistical gender differences in the quality of CVS visualization.

The target veins for cardiac resynchronization therapy should be the lateral and postero-lateral, which are usually well visible. Such a strategy could increase the usefulness of MSCT.