Advertisement

European Radiology

, Volume 29, Issue 12, pp 6837–6845 | Cite as

Does vessel length impact transluminal attenuation gradient in 320-slice coronary CT angiography? Correlation with invasive angiography

  • Nan Xu
  • Kun Peng
  • Shun Dai
  • Lei Zhang
  • Hong Yu
  • Gonghua Dai
  • Liqing Jin
  • Bo Hu
  • Guangyu TangEmail author
Cardiac

Abstract

Objectives

This study aimed to investigate the influence of vessel length on transluminal attenuation gradient (TAG) and establish a new index, VLN-TAG (VLN-TAG (HU/100 mm2) = TAG (HU/10 mm)/vessel length (10 mm)), to estimate the diagnostic value using 320-slice computed tomography (CT).

Methods

A total of 150 coronary arteries from 52 patients who underwent single-beat scanning using 320-slice CT and invasive coronary angiography (ICA) within 2 weeks were retrospectively enrolled. TAG was obtained from the major three epicardial vessels, and its interrelation with the measured length of the vessels was evaluated by Pearson correlation and regression analyses. The changes in TAG and VLN-TAG were compared with the corresponding stenosis severities ascertained by ICA using repeated measures ANOVA.

Results

TAG had a significant interrelation with the measured length of the vessels (r = 0.644, p < 0.001). Neither TAG nor VLN-TAG with different stenosis degrees of < 50, 50–70, and 70–99% on ICA had significant difference among the three groups. Plaque composition had no influence on VLN-TAG in all groups. The combined TAG or VLN-TAG and coronary computed tomography angiography (CCTA) assessment did not significantly change the area under the curve compared with using CCTA only. In the calcified vessels group, adding VLN-TAG to CCTA improved the specificity (92.86 vs 85.71%).

Conclusions

Vessel length is an important factor impacting TAG. TAG does not offer an incremental diagnostic value compared with CCTA only for detecting coronary stenosis.

Key Points

• Transluminal attenuation gradient (TAG) does not improve the diagnostic value of CCTA. Vessel length impacts TAG, but VLN-TAG does not improve the diagnostic value of CCTA.

• Plaque composition had no influence on VLN-TAG in all groups of stenosis degrees. There may be a minimal improvement in specificity when VLN-TAG is applied to the calcified vessels group.

Keywords

Coronary stenosis Multidetector computed tomography Angiography 

Abbreviations

BMI

Body mass index

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

DS

Diameter stenosis

FFR

Fractional flow reserve

ICA

Invasive coronary angiography

LAD

Left anterior descending coronary artery

LCX

Left circumflex coronary artery

NPV

Negative predictive value

PPV

Positive predictive value

RCA

Right coronary artery

TAG

Transluminal attenuation gradient

TDG

Transluminal diameter gradient

Notes

Funding

This study has received funding from the Foundation of Shanghai Municipal Commission of Health and Family Planning (201540232) and Shanghai Science and Technology Commission, International Cooperation and Exchange Project (16410722200).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Guangyu Tang.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

References

  1. 1.
    Montalescot G, Sechtem U, Achenbach S 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(38):2949–3003CrossRefGoogle Scholar
  2. 2.
    Hamm CW, Bassand JP, Agewall S 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 elevation of the European Society of Cardiology (ESC). Eur Heart J 32(23):2999–3054CrossRefGoogle Scholar
  3. 3.
    Abbara S, Arbab-Zadeh A, Callister TQ et al (2009) SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 3(3):190–204CrossRefGoogle Scholar
  4. 4.
    Raff GL, Abidov A, Achenbach S et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3(2):122–136CrossRefGoogle Scholar
  5. 5.
    Salavati A, Radmanesh F, Heidari K, Dwamena BA, Kelly AM, Cronin P (2012) Dual source computed tomography angiography for diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. J Cardiovasc Comput Tomogr 6(2):78–90CrossRefGoogle Scholar
  6. 6.
    Min JK, Shaw LJ, Berman DS (2010) The present state of coronary computed tomography angiography: a process in evolution. J Am Coll Cardiol 55(10):957–965CrossRefGoogle Scholar
  7. 7.
    Yoon YE, Koo BK (2012) Non-invasive functional assessment using computed tomography: when will they be ready for clinical use? Cardiovasc Diagn Ther 2(2):106–112PubMedPubMedCentralGoogle Scholar
  8. 8.
    Choi JH, Min JK, Labounty TM et al (2011) Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC Cardiovasc Imaging 4:1149–1157CrossRefGoogle Scholar
  9. 9.
    Wong DT, Ko BS, Cameron JD et al (2013) Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: a comparison with fractional flow reserve. J Am Coll Cardiol 61:1271–1279CrossRefGoogle Scholar
  10. 10.
    Kim HJ, Kim SM, Choi JH, Choe YH (2017) Influence of scan technique on intracoronary transluminal attenuation gradient in coronary CT angiography using 128-slice dual source CT: multi-beat versus one-beat scan. Int J Cardiovasc Imaging 33:937–946CrossRefGoogle Scholar
  11. 11.
    Nakanishi R, Matsumoto S, Alani A et al (2015) Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFR(CT)) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies. Int J Cardiovasc Imaging 31:1251–1259CrossRefGoogle Scholar
  12. 12.
    Yoon YE, Choi JH, Kim JH et al (2012) Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve. JACC Cardiovasc Imaging 5:1088–1096CrossRefGoogle Scholar
  13. 13.
    Choi JH, Koo BK, Yoon YE et al (2012) Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve. Eur Heart J Cardiovasc Imaging 13:1001–1007CrossRefGoogle Scholar
  14. 14.
    Stuijfzand WJ, Danad I, Raijmakers PG et al (2014) Additional value of transluminal attenuation gradient in CT angiography to predict hemodynamic significance of coronary artery stenosis. JACC Cardiovasc Imaging 7:374–386CrossRefGoogle Scholar
  15. 15.
    Ko BS, Wong DT, Nørgaard BL et al (2016) Diagnostic performance of transluminal attenuation gradient and noninvasive fractional flow reserve derived from 320-detector row CT angiography to diagnose hemodynamically significant coronary stenosis: an NXT substudy. Radiology 279:75–83CrossRefGoogle Scholar
  16. 16.
    Chow BJ, Kass M, Gagné O et al (2011) Can differences in corrected coronary opacification measured with computed tomography predict resting coronary artery flow? J Am Coll Cardiol 57(11):1280–1288CrossRefGoogle Scholar
  17. 17.
    Saba OI, Hoffman EA, Reinhardt JM (2003) Maximizing quantitative accuracy of lung airway lumen and wall measures obtained from X-ray CT imaging. J Appl Physiol (1985) 95:1063–1075CrossRefGoogle Scholar
  18. 18.
    Steigner ML, Mitsouras D, Whitmore AG et al (2010) Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging 3:179–186CrossRefGoogle Scholar
  19. 19.
    Park EA, Lee W, Park SJ, Kim YK, Hwang HY (2016) Influence of coronary artery diameter on intracoronary transluminal attenuation gradient during CT angiography. JACC Cardiovasc Imaging 9(9):1074–1083CrossRefGoogle Scholar
  20. 20.
    Yang F, Dong J, Wang W et al (2017) Evaluation of stenosis severity of coronary calcified lesions using transluminal attenuation gradient: clinical application of 320-row volume CT. Minerva Med 108(4):305–316PubMedGoogle Scholar
  21. 21.
    Kato E, Fujimoto S, Takamura K et al (2017) Clinical significance of transluminal attenuation gradient in 320-row area detector coronary CT angiography. Heart Vessels 33(5):462–469CrossRefGoogle Scholar
  22. 22.
    Zheng M, Wei M, Wen D et al (2015) Transluminal attenuation gradient in coronary computed tomography angiography for determining stenosis severity of calcified coronary artery: a primary study with dual-source CT. Eur Radiol 25(5):1219–1228CrossRefGoogle Scholar
  23. 23.
    Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefGoogle Scholar
  24. 24.
    Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (2011) Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol 57:1237–1247CrossRefGoogle Scholar
  25. 25.
    Koo HJ, Yang DH, Kim YH et al (2016) CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve. Int J Cardiovasc Imaging 32(Suppl 1):1–19CrossRefGoogle Scholar
  26. 26.
    Ko BS, Seneviratne S, Cameron JD et al (2016) Rest and stress transluminal attenuation gradient and contrast opacification difference for detection of hemodynamically significant stenoses in patients with suspected coronary artery disease. Int J Cardiovasc Imaging 32(7):1131–1141CrossRefGoogle Scholar
  27. 27.
    Yin WH, Lu B, Gao JB et al (2015) Effect of reduced X-ray tube voltage, low iodine concentration contrast medium, and sinogram-affirmed iterative reconstruction on image quality and radiation dose at coronary CT angiography: results of the prospective multicentre REALISE trial. J Cardiovasc Comput Tomogr 9(3):215–224CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Nan Xu
    • 1
    • 2
  • Kun Peng
    • 1
  • Shun Dai
    • 3
  • Lei Zhang
    • 4
  • Hong Yu
    • 2
  • Gonghua Dai
    • 2
  • Liqing Jin
    • 2
  • Bo Hu
    • 5
  • Guangyu Tang
    • 1
    Email author
  1. 1.Department of Radiology, Tenth People’s HospitalTongji University School of MedicineShanghaiChina
  2. 2.Department of Radiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
  3. 3.Department of Radiology, Tongren HospitalShanghai JiaoTong University School of MedicineShanghaiChina
  4. 4.Department of RadiologyShanghai General HospitalShanghaiChina
  5. 5.Department of Cardiovascular Medicine, Shanghai East HospitalTongji University School of MedicineShanghaiChina

Personalised recommendations