Quantitative analysis of myocardial contrast enhancement by first-pass 64-multidetector computed tomography in patients with coronary heart disease.
BACKGROUND
Although multidetector computed tomography (MDCT) allows non-invasive assessment of coronary artery stenosis, the presence of calcified lesions often lead to an overestimation of the stenosis. The present study was an evaluation of whether enhancement of first-pass myocardial data can improve the diagnostic accuracy of 64-MDCT.


RESULTS
Data from 70 patients with single-vessel disease who underwent 64-MDCT followed by catheter-based coronary angiography (CAG) were analyzed. Myocardial enhancement was quantified by exaimining the signal densities at diastole. Among a total of 83 plaque segments, 35 calcified plaque segments were detected and 46 segments were found to have more than 50% coronary stenosis on catheter-based CAG. The average diameter stenosis was 75.2+/-12.8%. Diagnosis by 64-MDCT of significant stenosis (segment-based analysis) had a sensitivity, specificity and accuracy for segments without calcified lesions of 92%, 100% and 99.7%, respectively, and 95.2%, 50%, and 77.1%, respectively, for calcified lesions. Taking into account the myocardial enhancement by calculating the decrease of the standardized signal densities in percent, these parameters could be improved to 95.2%, 85.7% and 91.4%, respectively, for segments with calcified lesions.


CONCLUSIONS
The diagnostic accuracy of 64-MDCT for stenosis with calcified lesions in particular can be improved by taking into account the myocardial enhancement data.
Yoshida
Ken
K
Department of Medicine and Cardiology, Osaka Ekisaikai Hospital, Nishi-ku, Osaka, Japan. m1492122@msic.med.osaka-cu.ac.jp
Shimada
Kenei
K
Tanaka
Atsushi
A
Jissho
Satoshi
S
Tanaka
Hidemasa
H
Yoshiyama
Minoru
M
Yoshikawa
Junichi
J
D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole / Q000502:physiology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*
D003287:Contrast Media