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Patterns of Opacification in Coronary CT Angiography: Contrast Differences and Gradients

  • Cardiac Computed Tomography (S Achenbach and T Villines, Section Editor)
  • Published:
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Abstract

Iodinated contrast delivery is a key component of coronary computed tomography (CT) angiography. However, the purpose of contrast delivery has been limited to morphology alone. Specifically, iodine opacification of the coronary lumen has been used to separate it from the coronary artery wall and lesions within the coronary arteries. Because contrast is delivered to the coronary arteries according to the coronary blood flow, there is flow information encoded within the contrast opacification which, depending on CT hardware and acquisition protocol, can be recognized in coronary CT angiography. In addition, metrics related to flow have been identified and studied. They include coronary contrast opacification differences and contrast opacification gradients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mark DB, Berman DS, Budoff MJ, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010;55(23):2663–99.

    Article  PubMed  Google Scholar 

  2. Rochitte CE, George RT, Chen MY, et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J. 2014;35(17):1120–30.

  3. Yoon YE, Koo BK. Noninvasive functional assessment using computed tomography: when will they be ready for clinical use? Cardiovasc Diagn Ther. 2012;2(2):106–12.

    PubMed Central  PubMed  Google Scholar 

  4. Vavere AL, Simon GG, George RT, et al. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. J Cardiovasc Comput Tomogr. 2011;5(6):370–81.

    Article  PubMed  Google Scholar 

  5. George RT, Arbab-Zadeh A, Cerci RJ, et al. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320-MDCT: the CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study. AJR Am J Roentgenol. 2011;197(4):829–37.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hsiao EM, Rybicki FJ, Steigner M. CT coronary angiography: 256-slice and 320-detector row scanners. Curr Cardiol Rep. 2010;12(1):68–75.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Kumamaru KK, Hoppel BE, Mather RT, et al. CT angiography: current technology and clinical use. Radiol Clin N Am. 2010;48(2):213–35. vii.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Rybicki FJ, Otero HJ, Steigner ML, et al. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging. 2008;24(5):535–46.

    Article  PubMed  Google Scholar 

  9. Lackner K, Bovenschulte H, Stutzer H, et al. In vitro measurements of flow using multislice computed tomography (MSCT). Int J Cardiovasc Imaging. 2011;27(6):795–804.

    Article  PubMed  Google Scholar 

  10. Nagao M, Kido T, Watanabe K, et al. Functional assessment of coronary artery flow using adenosine stress dual-energy CT: a preliminary study. Int J Cardiovasc Imaging. 2011;27(3):471–81.

    Article  PubMed Central  PubMed  Google Scholar 

  11. de Feyter PJ. CT functional imaging using intracoronary gradient analysis: an indispensable boost for CT coronary angiography. Eur Heart J Cardiovasc Imaging. 2012;13(12):971–2.

    Article  PubMed  Google Scholar 

  12. Steigner ML, Mitsouras D, Whitmore AG, et al. Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging. 2010;3(2):179–86. This study introduced the relationship between contrust opacification and coronary blood flow and defined coronary gradient.

  13. Choi JH, Min JK, Labounty TM, et al. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC Cardiovasc Imaging. 2011;4(11):1149–57.

    Article  PubMed  Google Scholar 

  14. Einstein AJ. TAG-is it it?: improving coronary computed tomography angiography with the isotemporal transluminal contrast attenuation gradient. J Am Coll Cardiol. 2013;61(12):1280–2.

    Article  PubMed  Google Scholar 

  15. Wong DT, Ko BS, Cameron JD, et al. 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. 2013;61(12):1271–9. This is the most recent validation of 320 detector row CT contrast opacification gradients. This article shows correlation between gradient values and fractional flow reserve.

    Article  PubMed  Google Scholar 

  16. Yoon YE, Choi JH, Kim JH, et al. 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. 2012;5(11):1088–96.

    Article  PubMed  Google Scholar 

  17. Meier P, Zierler KL. On the theory of the indicator-dilution method for measurement of blood flow and volume. J Appl Physiol. 1954;6(12):731–44.

    CAS  PubMed  Google Scholar 

  18. Sherman H. On the theory of indicator-dilution methods under varying blood-flow conditions. Bull Math Biophys. 1960;22(4):417–24.

    Article  Google Scholar 

  19. Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256(1):32–61.

    Article  PubMed  Google Scholar 

  20. Axel L. Cerebral blood flow determination by rapid-sequence computed tomography: theoretical analysis. Radiology. 1980;137(3):679–86.

    Article  CAS  PubMed  Google Scholar 

  21. Wang T, Wu X, Chung N, Ritman EL. Myocardial blood flow estimated by synchronous, multislice, high-speed computed tomography. IEEE Trans Med Imaging. 1989;8(1):70–7.

    Article  CAS  PubMed  Google Scholar 

  22. Choi JH, Koo BK, Yoon YE, et al. 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. 2012;13(12):1001–7.

    Article  PubMed  Google Scholar 

  23. Chow BJ, Kass M, Gagne O, et al. Can differences in corrected coronary opacification measured with computed tomography predict resting coronary artery flow? J Am Coll Cardiol. 2011;57(11):1280–8.

    Article  PubMed  Google Scholar 

  24. Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34(1):48–55.

    Article  CAS  PubMed  Google Scholar 

  25. Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308(12):1237–45.

    Article  CAS  PubMed  Google Scholar 

  26. Nakazato R, Park HB, Berman DS, et al. Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging. 2013;6(6):881–9.

    Article  PubMed  Google Scholar 

  27. Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: the NXT trial. J Am Coll Cardiol. 2014;63(12):1145–55.

  28. Steigner ML, Otero HJ, Cai T, et al. Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography. Int J Cardiovasc Imaging. 2009;25(1):85–90.

    Article  PubMed  Google Scholar 

  29. Achenbach S, Marwan M, Schepis T, et al. High-pitch spiral acquisition: a new scan mode for coronary CT angiography. J Cardiovasc Comput Tomogr. 2009;3(2):117–21.

    Article  PubMed  Google Scholar 

  30. Li M, Zhang J, Pan J, Lu Z. Obstructive coronary artery disease: reverse attenuation gradient sign at CT indicates distal retrograde flow—a useful sign for differentiating chronic total occlusion from subtotal occlusion. Radiology. 2013;266(3):766–72.

    Article  PubMed  Google Scholar 

  31. Hoe J. CT coronary angiography of chronic total occlusions of the coronary arteries: how to recognize and evaluate and usefulness for planning percutaneous coronary interventions. Int J Cardiovasc Imaging. 2009;25 Suppl 1:43–54.

    Article  PubMed  Google Scholar 

  32. Prasad A, Rihal CS, Lennon RJ, et al. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol. 2007;49(15):1611–8.

    Article  PubMed  Google Scholar 

  33. Rolf A, Werner GS, Schuhback A, et al. Preprocedural coronary CT angiography significantly improves success rates of PCI for chronic total occlusion. Int J Cardiovasc Imaging. 2013;29(8):1819–27.

    Article  PubMed  Google Scholar 

  34. Stone GW, Kandzari DE, Mehran R, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation. 2005;112(15):2364–72.

    Article  PubMed  Google Scholar 

  35. Gasparovic H, Rybicki FJ, Millstine J, et al. Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization. Eur J Cardiothorac Surg. 2005;28(2):244–9.

    Article  PubMed  Google Scholar 

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Acknowledgments

Dimitrios Mitsouras is supported by NIBIB 1-K01-EB015868 (Mentor Frank J. Rybicki).

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Conflict of Interest

Frank J. Rybicki receives research support from Toshiba Medical Systems Corporation. Yu-Hsiang Juan, Sachin S. Saboo, Elizabeth George, Rani Sewatkar, and Dimitrios Mitsouras declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Frank J. Rybicki.

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This article is part of the Topical Collection on Cardiac Computed Tomography

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Rybicki, F.J., Juan, YH., Saboo, S.S. et al. Patterns of Opacification in Coronary CT Angiography: Contrast Differences and Gradients. Curr Cardiovasc Imaging Rep 7, 9291 (2014). https://doi.org/10.1007/s12410-014-9291-z

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  • DOI: https://doi.org/10.1007/s12410-014-9291-z

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