CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses
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Two-dimensional axial and manually-oriented reformatted images are traditionally used to analyze coronary data provided by multidetector-row computed tomography angiography (MDCTA). While apparently more accurate in evaluating calcified vessels, 2D methods are time-consuming compared with automated 3D approaches. The purpose of this study was to evaluate the performance of a modified automated 3D approach (using manual vessel isolation and different window and level settings) in a population with high calcium scores who underwent coronary half-millimeter 16-detector-row CT angiography (16×0.5-MDCTA).
ECG-gated 16×0.5-MDCTA (16×0.5 mm cross-sections, 0.35×0.35×0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iopamidol (120-ml, 300 mg/ml) in 19 consecutive patients (11 male, 62±10 years-old). Native arteries were independently evaluated for ≥50%-stenoses using both manual 2D and modified automated 3D approaches. Stents and bypass grafts were excluded. Conventional coronary angiography was visually analyzed by 2 observers.
Median Agatston calcium score was 434. Sensitivities, specificities, positive and negative predictive values for detection of ≥50% coronary stenoses using the 2D and modified 3D approaches were, respectively: 74%/63%, 76%/80%, 45%/34%, and 91%/93% (p=NS for all comparisons). Overall diagnostic accuracies were 75 and 78%, respectively (p=NS). Uninterpretable vessels were, respectively: 37% (77/209) and 35% (73/209) – p=NS. Time to analyze a single study was 160±23 and 53±11 min, respectively (p<0.01).
This modified automated 3D approach is equivalent to and significantly less time consuming than the traditional manual 2D method for evaluation of ≥50%-stenoses by 16×0.5-MDCTA in native coronary arteries of patients with high calcium scores.
Key words:computed tomography coronary angiography coronary disease imaging stenosis
half-millimeter 16-detector-row CT angiography
coronary artery disease
conventional coronary angiography
curved multiplanar reformation
The Johns Hopkins Hospital
left anterior descending
multidetector-row computed tomography angiography
thin-slab maximum intensity projection
right coronary artery
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Grant support: this work was funded by the National Institutes on Aging (Bethesda, MD) RO1- AG021570-01 grant, by the Johns Hopkins Reynolds Cardiovascular Center (D. W. Reynolds Foundation, Las Vegas, NV), by the Zerbini Foundation (Fundação E. J. Zerbini, São Paulo, SP, Brazil), and partly supported by Toshiba Medical Systems Corporation (Otawara, Japan). Dr Cordeiro is funded by the Brazilian National Research Council (CNPq, Brasília, DF, Brazil) as a postdoctoral fellow (fellowship grant 202706/02-8) in the Division of Cardiology of The Johns Hopkins University School of Medicine (Baltimore, MD).
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