Noninvasive analysis of coronary artery disease with combination of MDCT and functional MRI.
OBJECTIVE
We evaluated the diagnostic accuracy of an eight-row multidetector computed tomography coronary angiography (MDCT-CA) in detecting high-grade (>50%) stenoses in the three main coronary arteries in patients with coronary artery disease (CAD). Side branches were excluded. We correlated magnetic resonance imaging (MRI) findings of the myocardium with MDCT-CA of the coronary arteries.


METHODS
Fourteen CAD patients underwent conventional coronary angiography (CCA), MDCT-CA, and MRI. We determined the calcium burden with non-enhanced MDCT scan. Then MDCT-CA was performed after intravenous contrast injection during a single breathhold. The left ventricular (LV) MR cine imaging was assessed at rest and perfusion defects were observed during pharmacologic stress after contrast administration. Delayed contrast-enhanced MRI was performed to picture infarctions.


RESULTS
MDCT-CA had sensitivity 82%, specificity 94%, positive predictive value 79%, and negative predictive value 95% of stenoses of more than 50% in the main coronary arteries when compared with CCA. LV wall dysfunction, perfusion defects, and infarctions were detected in 50%-78% of sectors assigned to calcifications or stenoses, but also in sectors supplied by normally perfused coronary arteries.


CONCLUSIONS
CCA and MDCT-CA revealed comparable results in evaluating stenotic lesions above 50% in the main subepicardial coronary branches. There were no significant correlations between the degree of stenosis or calcification at MDCT-CA and the MR findings, but the combined information of MDCT-CA and MRI showed the variability of myocardial changes in regions perfused by significantly stenosed, calcified, and normal main coronary arteries.
Holmström
Miia
M
Department of Radiology, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00029 HUS, Finland. Miia.holmstrom@hus.fi
Vesterinen
Paula
P
Hänninen
Helena
H
Sillanpää
Mikko A
MA
Kivistö
Sari
S
Lauerma
Kirsi
K
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D005188:False Negative Reactions; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007089:Image Enhancement; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D015588:Observer Variation; D010477:Perfusion; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology
D003287:Contrast Media