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Subtraction coronary computed tomography in patients with severe calcification

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Abstract

To investigate the clinical usefulness of subtraction coronary computed tomographic angiography (CCTA) in patients with severe calcification. A 320-row area detector CT system was used in this study. The subjects were 78 patients (47 men and 31 women, 739 years of age) with an Agatston score of >300 who were able to undergo prospective one-beat scanning during a single breath-hold. The CCTA findings were compared against invasive coronary angiography. The diagnostic capabilities of CCTA for the severely calcified segments with and without the additional information provided by subtraction CCTA were compared. Severe calcification was observed in 174 (31.9 %) of the 546 segments, and non-assessable regions were observed in 74 (13.6 %) of the segments. The addition of subtraction CCTA information improved the diagnostic accuracy for segments with severe calcification from 67.8 to 82.8 % on a per-segment basis and from 70.1 to 82.1 % on a per-patient basis, with non-assessable segments considered to be stenotic. When non-assessable segments were considered to be an incorrect diagnosis, the diagnostic accuracy was improved from 48.3 to 75.9 % on a per-segment basis and from 43.3 to 79.1 % on a per-patient basis. In addition, when evaluation was limited to non-assessable segments, subtraction CCTA provided a diagnostic accuracy of 81.1 % when non-assessable segments were considered to be stenotic or 66.2 % when non-assessable segments were considered to be an incorrect diagnosis. Subtraction CCTA improves the diagnostic capabilities of CCTA in patients with severe calcification.

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Acknowledgments

The authors would like to thank Dr. Kunihiro Yoshioka and Dr. Ryouichi Tanaka of the Department of Radiology at Iwate Medical University for kindly providing the subtraction CCTA software.

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Authors and Affiliations

  1. Takase Clinic, Takasaki, Gunma, Japan

    Makoto Amanuma, Tomonari Sano, Takako Sekine, Tomoya Takayanagi, Hideyuki Matsutani, Takehiro Arai, Hitomi Morita, Kazumasa Ishizaka & Shinichi Takase

  2. Jukokai Central Hospital, Miyoshi, Aichi, Japan

    Takeshi Kondo

  3. Toshiba Medical Systems Corporation, Otawara, Tochigi, Japan

    Kazumasa Arakita & Akiko Iwasa

Authors
  1. Makoto Amanuma
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  2. Takeshi Kondo
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  3. Tomonari Sano
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  4. Takako Sekine
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  5. Tomoya Takayanagi
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  6. Hideyuki Matsutani
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  7. Takehiro Arai
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  8. Hitomi Morita
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  9. Kazumasa Ishizaka
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  10. Kazumasa Arakita
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  11. Akiko Iwasa
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  12. Shinichi Takase
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Corresponding author

Correspondence to Makoto Amanuma.

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Conflict of interest

Dr. M. Amanuma, RTs T. Sano, T. Takayanagi, T. Arai, and S. Takase have a contract of research cooperation with The Toshiba Medical Systems Corporation. This investigation was not funded. Drs. K. Arakita and A. Iwasa are employees of Toshiba Medical Systems Corporation. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Amanuma, M., Kondo, T., Sano, T. et al. Subtraction coronary computed tomography in patients with severe calcification. Int J Cardiovasc Imaging 31, 1635–1642 (2015). https://doi.org/10.1007/s10554-015-0746-3

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  • DOI: https://doi.org/10.1007/s10554-015-0746-3

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