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Subtraction coronary CT angiography using second-generation 320-detector row CT

The International Journal of Cardiovascular Imaging volume 31, pages 51–58 (2015)Cite this article

Abstract

The purpose of this study was to explore the feasibility of subtraction coronary computed tomography angiography (CCTA) by second-generation 320-detector row CT in patients with severe coronary artery calcification using invasive coronary angiography (ICA) as the gold standard. This study was approved by the institutional board, and all subjects provided written consent. Twenty patients with calcium scores of >400 underwent conventional CCTA and subtraction CCTA followed by ICA. A total of 82 segments were evaluated for image quality using a 4-point scale and the presence of significant (>50 %) luminal stenosis by two independent readers. The average image quality was 2.3 ± 0.8 with conventional CCTA and 3.2 ± 0.6 with subtraction CCTA (P < 0.001). The percentage of segments with non-diagnostic image quality was 43.9 % on conventional CCTA versus 8.5 % on subtraction CCTA (P = 0.004). The segment-based diagnostic accuracy for detecting significant stenosis according to ICA revealed an area under the receiver operating characteristics curve of 0.824 (95 % confidence interval [CI], 0.750–0.899) for conventional CCTA and 0.936 (95 % CI 0.889–0.936) for subtraction CCTA (P = 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value for conventional CCTA were 88.2, 62.5, 62.5, and 88.2 %, respectively, and for subtraction CCTA they were 94.1, 85.4, 82.1, and 95.3 %, respectively. As compared to conventional, subtraction CCTA using a second-generation 320-detector row CT showed improvement in diagnostic accuracy at segment base analysis in patients with severe calcifications.

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References

  1. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52(21):1724–1732

    PubMed  Article  Google Scholar 

  2. Vavere AL, Arbab-Zadeh A, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, Clouse ME, Bush DE, Hoe JW, de Roos A, Cox C, Lima JA, Miller JM (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(1):100–108

    PubMed Central  PubMed  Article  Google Scholar 

  3. 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(4):943–953

    PubMed  Article  Google Scholar 

  4. Arbab-Zadeh A, Miller JM, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA (2012) Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (coronary artery evaluation using 64-row multidetector computed tomography angiography) International Multicenter Study. J Am Coll Cardiol 59(4):379–387

    PubMed Central  PubMed  Article  Google Scholar 

  5. Yoshioka K, Miyata Y (1983) Changes in the distribution of the extrajunctional acetylcholine sensitivity along muscle fibers during development and following cordotomy in the rat. Neuroscience 9(2):437–443

    CAS  PubMed  Article  Google Scholar 

  6. Yoshioka K, Tanaka R, Muranaka K (2012) Subtraction coronary CT angiography for calcified lesions. Cardiol Clin 30(1):93–102

    PubMed  Article  Google Scholar 

  7. Tanaka R, Yoshioka K, Muranaka K, Chiba T, Ueda T, Sasaki T, Fusazaki T, Ehara S (2013) Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction. Int J Cardiovasc Imaging 29(Suppl 2):75–81

    PubMed  Article  Google Scholar 

  8. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832

    CAS  PubMed  Article  Google Scholar 

  9. Razeto M, Matthews J, Masood S, Steel J, Arakita K (2013) Accurate registration of coronary arteries for volumetric CT digital subtraction angiography. roc SPIE 8768, international conference on graphic and image processing (ICGIP 2012), pp 876834–876836

  10. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, Nieman K, van Werkhoven JM, Pundziute G, Weustink AC, de Vos AM, Pugliese F, Rensing B, Jukema JW, Bax JJ, Prokop M, Doevendans PA, Hunink MG, Krestin GP, de Feyter PJ (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52(25):2135–2144

    PubMed  Article  Google Scholar 

  11. Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez JC, Muller M (2011) pROC: an open-source package for R and S + to analyze and compare ROC curves. BMC Bioinform 12:77

    Article  Google Scholar 

  12. Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P, Rubin GD, American College of Cardiology Foundation Appropriate Use Criteria Task F, Society of Cardiovascular Computed T, American College of R, American Heart A, American Society of E, American Society of Nuclear C, North American Society for Cardiovascular I, Society for Cardiovascular A, Interventions, Society for Cardiovascular Magnetic R, Kramer CM, Berman D, Brown A, Chaudhry FA, Cury RC, Desai MY, Einstein AJ, Gomes AS, Harrington R, Hoffmann U, Khare R, Lesser J, McGann C, Rosenberg A, Schwartz R, Shelton M, Smetana GW, Smith SC Jr (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56(22):1864–1894

  13. Chen MY, Shanbhag SM, Arai AE (2013) Submillisievert median radiation dose for coronary angiography with a second-generation 320-detector row CT scanner in 107 consecutive patients. Radiology 267(1):76–85

    PubMed Central  PubMed  Article  Google Scholar 

  14. Zhang C, Zhang Z, Yan Z, Xu L, Yu W, Wang R (2011) 320-Row CT coronary angiography: effect of 100-kV tube voltages on image quality, contrast volume, and radiation dose. Int J Cardiovasc Imaging 27(7):1059–1068

    PubMed  Article  Google Scholar 

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Acknowledgments

Dr. Joanne Schuijf and Mrs. Yukie Osawa from Toshiba Medical Systems gave support and suggestions in writing and technical subjects, especially for the dedicated subtraction algorithms. This work was supported by the Japan Society for the Promotion of Science (JSPS KAKENHI, Grant Number 26461803).

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Affiliations

  1. Division of Cardiovascular Radiology, Department of Radiology, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Kunihiro Yoshioka & Ryoichi Tanaka

  2. Center for Radiological Science, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Kenta Muranaka, Tadashi Sasaki, Takanori Ueda, Takuya Chiba, Kouta Takeda & Tsuyoshi Sugawara

Authors
  1. Kunihiro Yoshioka
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  2. Ryoichi Tanaka
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  3. Kenta Muranaka
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  4. Tadashi Sasaki
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  5. Takanori Ueda
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  6. Takuya Chiba
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  7. Kouta Takeda
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  8. Tsuyoshi Sugawara
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Correspondence to Kunihiro Yoshioka.

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Yoshioka, K., Tanaka, R., Muranaka, K. et al. Subtraction coronary CT angiography using second-generation 320-detector row CT. Int J Cardiovasc Imaging 31, 51–58 (2015). https://doi.org/10.1007/s10554-015-0630-1

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  • DOI: https://doi.org/10.1007/s10554-015-0630-1

Keywords

  • Cardiac computed tomography
  • 320-Detector row CT
  • Angiography
  • Coronary artery calcification
  • Subtraction