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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary CT angiography: A retrospective study of 220 cases
V K Maurya1, R Ravikumar2, Pankaj Sharma3
1Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India.
Insights
Coronary CT angiography (CCTA) effectively diagnoses coronary artery disease (CAD) in suspected patients. CCTA offers a valuable alternative to catheter coronary angiography (CCA), particularly for post-procedure assessments.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is a leading global cause of illness and death.
- Catheter coronary angiography (CCA) is the standard for CAD diagnosis, but coronary CT angiography (CCTA) shows promise.
Purpose of the Study:
- To evaluate the diagnostic performance of CCTA in patients with suspected CAD.
- To compare CCTA findings with established CAD classifications.
Main Methods:
- Coronary CT angiography (CCTA) was performed on 220 patients using a 40-slice multi-detector CT scanner.
- Patients were categorized into normal, non-obstructive (<50% stenosis), obstructive (>50% stenosis), or non-diagnostic groups.
Main Results:
- CCTA identified normal coronary arteries in 43.6% of patients, non-obstructive disease in 18.6%, and obstructive CAD in 30.5%.
- Obstructive CAD involved single-vessel (56.7%), double-vessel (37.3%), and triple-vessel (6%) disease, with the left anterior descending artery most frequently affected.
- Median calcium scores differed significantly between non-obstructive (60) and obstructive (300) CAD groups.
Conclusions:
- CCTA demonstrates high negative predictive value, potentially avoiding invasive CCA.
- CCTA is valuable for assessing patients post-stent placement and coronary artery bypass graft surgery.
Background:
Coronary artery disease (CAD) is a common cause of morbidity and mortality worldwide. Although catheter coronary angiography (CCA) is the gold standard in the diagnosis and management of CAD, coronary CT angiography (CCTA) has shown promising results for the same.
Methods:
CCTA was done using 40 slice multi-detector CT (Somatom Sensation, Siemens, Germany) machine in 220 patients of suspected CAD. Patients were classified as (a) normal (no calcific or soft plaque), (b) non-obstructive coronary disease (<50% stenosis), (c) obstructive coronary disease (>50% stenosis), or (d) a non-diagnostic study.
Results:
96 (43.6%) cases were found to have normal coronary arteries on CCTA, 41 (18.6%) patients were classified as having non-obstructive disease, 67 (30.5%) patients were defined to have obstructive CAD, and 16 cases (7.3%) were inconclusive. Significantly obstructive triple vessel disease was noted in 4 (6%) cases. Double vessel disease was seen in 25 (37.3%) cases and single vessel disease was seen in 38 (56.7%). Single most common vessel with obstructive CAD was left anterior descending artery and was noted in 30 (44.7%) out of 67 such cases. The least affected vessel was left circumflex in 15 cases (22.3%). Median calcium score for non-obstructive CAD was 60 (range 30-95), and for obstructive CAD 300 (range 120-780).
Conclusion:
Key benefits of CCTA lie in the avoidance of CCA since it has a high negative predictive value. CCTA has a definite role in post-stent and post-coronary artery bypass graft patients.
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