Accurate determination of high-risk coronary lesion type by multidetector cardiac computed tomography.
BACKGROUND
Coronary arteriography (CA) is the standard method to image coronary lesions. Multidetector cardiac computerized tomography (MDCT) provides high-resolution images of coronary arteries, allowing a noninvasive alternative to determine lesion type. To date, no studies have assessed the ability of MDCT to categorize coronary lesion types.


OBJECTIVE
The objective of this study was to determine the accuracy of lesion type categorization by MDCT using CA as a reference standard.


METHODS
Patients who underwent both MDCT and CA within 2 months of each other were enrolled. MDCT and CA images were reviewed in a blinded fashion. Lesions were categorized according to the SCAI classification system (Types I-IV). The origin, proximal and middle segments of the major arteries were analyzed. Each segment comprised a data point for comparison. Analysis was performed using the Spearman Correlation Test.


RESULTS
Four hundred eleven segments were studied, of which 110 had lesions. The lesion distribution was as follows: 35 left anterior descending (LAD), 29 circumflex (Cx), 31 right coronary artery (RCA), 2 ramus intermedius, 8 diagonal, 4 obtuse marginal and 2 left internal mammary arteries. Correlations between MDCT and CA were significant in all major vessels (LAD, Cx, RCA) (p < 0.001). The overall correlation coefficient was 0.67. Concordance was strong for lesion Types II-IV (97%) and poor for Type I (30%).


CONCLUSIONS
High-risk coronary lesion types can be accurately categorized by MDCT. This ability may allow MDCT to play an important noninvasive role in the planning of coronary interventions.
Alasnag
Mirvat
M
Veterans Affairs Loma Linda Healthcare System, Loma Linda University School of Medicine, Loma Linda, California, USA. mirvatalasnag@yahoo.com
Umakanthan
Branavan
B
Foster
Gary P
GP
D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000145:classification* / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D006801:Humans; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*