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Published on: February 16, 2016
Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus
Mansharan Kaur Chainchel Singh1, Saiful Nizam Abdul Rashid2, Suzana Abdul Hamid3
1Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh, Selangor, Malaysia; National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Malaysia.
Insights
Post-mortem Computed Tomography Angiography (PMCTA) using neck vessel contrast effectively assesses coronary artery stenosis, showing high specificity (91.7%) and negative predictive value (96.4%). This technique aids in evaluating calcification and significant blockages.
Area of Science:
- Forensic Radiology
- Cardiovascular Pathology
- Medical Imaging
Background:
- Post-mortem Computed Tomography (PMCT) offers non-invasive imaging but cannot assess vessel lumen patency.
- Post-mortem Computed Tomography Angiography (PMCTA) has been developed to overcome PMCT limitations in diagnosing coronary artery disease.
- Studies correlate PMCTA findings with autopsy and histology for coronary artery disease diagnosis.
Purpose of the Study:
- To evaluate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis.
- To compare PMCTA results with the gold standard of gross and histological evaluation.
- To assess PMCTA using water-based contrast media injected via neck vessels.
Main Methods:
- A cross-sectional study involving 158 arterial sections from 37 subjects.
- Unenhanced PMCT followed by PMCTA using water-based contrast via neck vessels.
- Coronary artery stenosis determined by multiplanar reconstruction and luminal diameter percentage calculation.
Main Results:
- PMCTA demonstrated a sensitivity of 61.5% and specificity of 91.7%.
- Positive predictive value (PPV) was 40.0%, and negative predictive value (NPV) was 96.4%.
- Results were comparable to other PMCTA methods.
Conclusions:
- PMCTA with water-based contrast via neck vessels is a viable technique for assessing coronary artery stenosis.
- This method can evaluate the degree of arterial calcification.
- PMCTA is useful for detecting significant coronary artery stenosis post-mortem.
Background:
Post-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel's lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease.
Objectives:
The aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery.
Method:
This was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic.
Results:
The analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%.
Conclusion:
PMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.
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