Skip to main content
SpringerLink
Log in

Reliability of a new method for coronary artery calcium or metal subtraction by 320-row cardiac CT

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the feasibility and diagnostic accuracy of subtraction CTA on patients with highly calcified coronary artery disease (CAD) or previous implanted stents, in comparison with invasive coronary angiography (ICA).

Materials and methods

Twenty-three patients were recruited. All conventional and subtraction CTA exams were performed using a 320-row CT. Subjective image quality score was assessed for each segment using a 4-point scale: 1-uninterpretable to 4-good image quality.

Results

A total of 129 calcified or stented coronary segments were studied. Mean coronary image quality with conventional CTA was 2.73 ± 0.97 and in subtracted CTA 3.3 ± 0.92 (p < 0.01). After metal subtraction, image quality in stented coronary segments with >3 mm of diameter improved from 2.69 ± 0.97 to 3.34 ± 0.89 (p = 0.01) and in those with <3 mm of diameter from 2.11 ± 0.78 to 2.67 ± 0.87 (p = 0.17). There was an improvement in diagnostic accuracy to detect ICA stenosis >50 % by subtraction CTA compared with conventional CTA (AUC 0.93 to 0.87; p = 0.02).

Conclusion

Subtraction CTA is promising in overcoming limitations of conventional CTA due to calcium or metal artefacts, especially if no motion artefact is present or when stents > 3 mm are studied.

Key Points

• Calcium and metal artefacts are still a limitation for conventional coronary CTA

• Diagnostic accuracy is improved by subtraction as compared with conventional CTA

• Subtraction CTA is a promising tool to overcome limitations of conventional CTA

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Members TF, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003

    Article  Google Scholar 

  2. Hamm CW, Bassand J-P, Agewall S, Bax J, Boersma E, Bueno H et al (2011) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevatio. Eur Heart J 32:2999–3054

    Article  PubMed  Google Scholar 

  3. Stolzmann P, Scheffel H, Leschka S, Plass A, Baumüller S, Marincek B et al (2008) Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. AJR Am J Roentgenol 191:1684–1689

    Article  PubMed  Google Scholar 

  4. Vavere AL, Arbab-Zadeh A, Rochitte CE, Dewey M, Niinuma H, Gottlieb I et al (2011) Coronary artery stenoses: accuracy of 64–detector row CT angiography in segments with mild, moderate, or severe calcification—a subanalysis of the CORE-64 trial. Radiology 261:100–108

    Article  PubMed  PubMed Central  Google Scholar 

  5. Abdulla J, Pedersen KS, Budoff M, Kofoed KF (2012) Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging 28:943–953

    Article  PubMed  Google Scholar 

  6. Meijboom WB, van Mieghem C a G, Mollet NR, Pugliese F, Weustink AC, van Pelt N et al (2007) 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol 50:1469–1475

    Article  PubMed  Google Scholar 

  7. Yan RT, Miller JM, Rochitte CE, Dewey M, Niinuma H, Clouse ME et al (2013) Predictors of inaccurate coronary arterial stenosis assessment by CT angiography. JACC Cardiovasc Imaging 6:963–972

    Article  PubMed  PubMed Central  Google Scholar 

  8. Park HB, Lee BK, Shin S, Heo R, Arsanjani R, Kitslaar PH et al (2015) Clinical Feasibility of 3D Automated Coronary Atherosclerotic Plaque Quantification Algorithm on Coronary Computed Tomography Angiography: Comparison with Intravascular Ultrasound. Eur Radiol 25:3073–3083

    Article  PubMed  Google Scholar 

  9. Rixe J, Achenbach S, Ropers D, Baum U, Kuettner A, Ropers U et al (2006) Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. Eur Heart J 27:2567–2572

    Article  PubMed  Google Scholar 

  10. Andreini D, Pontone G, Bartorelli AL, Mushtaq S, Trabattoni D, Bertella E et al (2011) High diagnostic accuracy of prospective ECG-gating 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: In-stent restenosis assessment by low-dose MDCT. Eur Radiol 21:1430–1438

    Article  PubMed  Google Scholar 

  11. Dewey M, Zimmermann E, Deissenrieder F, Laule M, Dübel H-P, Schlattmann P et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875

    Article  PubMed  Google Scholar 

  12. De Graaf FR, Schuijf JD, van Velzen JE, Kroft LJ, de Roos A, Reiber JHC et al (2010) Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur Heart J 31:1908–1915

    Article  PubMed  Google Scholar 

  13. Tanaka R, Yoshioka K, Muranaka K, Chiba T, Ueda T, Sasaki T et al (2013) Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction. Int J Cardiovasc Imaging 29:75–81

    Article  PubMed  Google Scholar 

  14. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC et al (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301:500–507

    Article  CAS  PubMed  Google Scholar 

  15. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  16. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40

    Article  CAS  PubMed  Google Scholar 

  17. MEMBERS WC, Budoff MJ, Cohen MC, Garcia MJ, Hodgson JM, Hundley WG et al (2005) ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competenc. Circulation 112:598–617

    Article  Google Scholar 

  18. Zou KH, O’Malley AJ, Mauri L (2007) Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115:654–657

    Article  PubMed  Google Scholar 

  19. Yoshioka K, Tanaka R, Muranaka K (2012) Subtraction coronary CT angiography for calcified lesions. Cardiol Clin 30:93–102

    Article  PubMed  Google Scholar 

  20. Geleijns J, Joemai RMS, Dewey M, De Roos A, Zankl M, Cantera AC et al (2011) Radiation exposure to patients in a multicenter coronary angiography trial (CORE 64). AJR Am J Roentgenol 196:1126–1132

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study has been performed with technological support from Toshiba Medical Systems- Spain. The scientific guarantor of this publication is Dr. David Viladés Medel. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise (DVM). Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required.

Methodology: prospective, diagnostic study / performed at one institution.

Author information

Authors and Affiliations

  1. Cardiac Imaging Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    David Viladés Medel, Rubén Leta, Francesc Carreras Costa & Guillem Pons-Lladó

  2. Clínica Creu Blanca, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    David Viladés Medel, Rubén Leta, Xavier Alomar Serralach, Francesc Carreras Costa & Guillem Pons-Lladó

Authors
  1. David Viladés Medel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rubén Leta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xavier Alomar Serralach
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesc Carreras Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guillem Pons-Lladó
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Viladés Medel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Viladés Medel, D., Leta, R., Alomar Serralach, X. et al. Reliability of a new method for coronary artery calcium or metal subtraction by 320-row cardiac CT. Eur Radiol 26, 3208–3214 (2016). https://doi.org/10.1007/s00330-015-4130-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-4130-4

Keywords

Search

Navigation