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CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses

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Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

16×0.5-MDCTA:

half-millimeter 16-detector-row CT angiography

2D:

two-dimensional

3D:

three-dimensional

CAD:

coronary artery disease

CCA:

conventional coronary angiography

CPR:

curved multiplanar reformation

CT:

computed tomography

ECG:

electrocardiogram

HU:

Hounsfield units

JHH:

The Johns Hopkins Hospital

kV:

kilovolt

LAD:

left anterior descending

LCx:

left circumflex

LM:

left main

mA:

milliampere

MDCTA:

multidetector-row computed tomography angiography

MIP:

thin-slab maximum intensity projection

mm:

millimeter

MPR:

multiplanar reformation

ms:

millisecond

RCA:

right coronary artery

s:

second

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Acknowledgements

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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Authors and Affiliations

  1. Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

    Marco A. S. Cordeiro, Marcelo S. V. Brito, Miguel A. Rosário Neto, Maria H. A. Siqueira, José R. Parga, Luiz F. Ávila, José A. F. Ramires & Carlos E. Rochitte

  2. Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Marco A. S. Cordeiro, Albert C. Lardo & João A. C. Lima

  3. Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Albert C. Lardo & João A. C. Lima

  4. Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Albert C. Lardo

  5. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Albert C. Lardo

  6. Heart Institute (InCor), University of São Paulo Medical School, Instituto do␣Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, Brasil, CEP 05403-000

    Carlos E. Rochitte

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  1. Marco A. S. Cordeiro
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  2. Albert C. Lardo
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  3. Marcelo S. V. Brito
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  4. Miguel A. Rosário Neto
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  5. Maria H. A. Siqueira
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  6. José R. Parga
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  7. Luiz F. Ávila
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  8. José A. F. Ramires
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  9. João A. C. Lima
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  10. Carlos E. Rochitte
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Corresponding author

Correspondence to Carlos E. Rochitte.

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Cordeiro, M.A.S., Lardo, A.C., Brito, M.S.V. et al. CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses. Int J Cardiovasc Imaging 22, 507–516 (2006). https://doi.org/10.1007/s10554-005-9044-9

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  • DOI: https://doi.org/10.1007/s10554-005-9044-9

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