OBJECTIVES This study sought to demonstrate the feasibility of a dedicated algorithm for automated quantification of stenosis severity on multislice computed tomography in comparison with... Show moreOBJECTIVES This study sought to demonstrate the feasibility of a dedicated algorithm for automated quantification of stenosis severity on multislice computed tomography in comparison with quantitative coronary angiography (QCA). BACKGROUND Limited information is available on quantification of coronary stenosis, and previous attempts using semiautomated approaches have been suboptimal. METHODS In patients who had undergone 64-slice computed tomography and invasive coronary angiography, the most severe lesion on QCA was quantified per coronary artery using quantitative coronary computed tomography (QCCTA) software. Additionally, visual grading of stenosis severity using a binary approach (50% stenosis as a cutoff) was performed. Diameter stenosis (percentage) was obtained from detected lumen contours at the minimal lumen area, and corresponding reference diameter values were obtained from an automatic trend analysis of the vessel areas within the artery. RESULTS One hundred patients (53 men; 59.8 +/- 8.0 years) were evaluated, and 282 (94%) vessels were analyzed. Good correlations for diameter stenosis were observed for vessel-based (n = 282; r = 0.83; p < 0.01) and patient-based (n = 93; r = 0.86; p < 0.01) analyses. Mean differences between QCCTA and QCA were -3.0% +/- 12.3% and -6.2% +/- 12.4%. Furthermore, good agreement was observed between QCCTA and QCA for semiquantitative assessment of diameter stenosis (accuracy of 95%). Diagnostic accuracy for assessment of > or =50% diameter stenosis was higher using QCCTA compared with visual analysis (95% vs. 87%; p = 0.08). Moreover, a significantly higher positive predictive value was observed with QCCTA when compared with visual analysis (100% vs. 78%; p < 0.05). Although the visual approach showed a reduced diagnostic accuracy for data sets with moderate image quality, QCCTA performed equally well in patients with moderate or good image quality. However, in data sets with good image quality, QCCTA tended to have a reduced sensitivity compared with visual analysis. CONCLUSIONS Good correlations were found for quantification of stenosis severity between QCCTA and QCA. QCCTA showed an improved positive predictive value when compared with visual analysis. Show less
OBJECTIVES This study sought to demonstrate the feasibility of a dedicated algorithm for automated quantification of stenosis severity on multislice computed tomography in comparison with... Show moreOBJECTIVES This study sought to demonstrate the feasibility of a dedicated algorithm for automated quantification of stenosis severity on multislice computed tomography in comparison with quantitative coronary angiography (QCA). BACKGROUND Limited information is available on quantification of coronary stenosis, and previous attempts using semiautomated approaches have been suboptimal. METHODS In patients who had undergone 64-slice computed tomography and invasive coronary angiography, the most severe lesion on QCA was quantified per coronary artery using quantitative coronary computed tomography (QCCTA) software. Additionally, visual grading of stenosis severity using a binary approach (50% stenosis as a cutoff) was performed. Diameter stenosis (percentage) was obtained from detected lumen contours at the minimal lumen area, and corresponding reference diameter values were obtained from an automatic trend analysis of the vessel areas within the artery. RESULTS One hundred patients (53 men; 59.8 +/- 8.0 years) were evaluated, and 282 (94%) vessels were analyzed. Good correlations for diameter stenosis were observed for vessel-based (n = 282; r = 0.83; p < 0.01) and patient-based (n = 93; r = 0.86; p < 0.01) analyses. Mean differences between QCCTA and QCA were -3.0% +/- 12.3% and -6.2% +/- 12.4%. Furthermore, good agreement was observed between QCCTA and QCA for semiquantitative assessment of diameter stenosis (accuracy of 95%). Diagnostic accuracy for assessment of >= 50% diameter stenosis was higher using QCCTA compared with visual analysis (95% vs. 87%; p = 0.08). Moreover, a significantly higher positive predictive value was observed with QCCTA when compared with visual analysis (100% vs. 78%; p < 0.05). Although the visual approach showed a reduced diagnostic accuracy for data sets with moderate image quality, QCCTA performed equally well in patients with moderate or good image quality. However, in data sets with good image quality, QCCTA tended to have a reduced sensitivity compared with visual analysis. CONCLUSIONS Good correlations were found for quantification of stenosis severity between QCCTA and QCA. QCCTA showed an improved positive predictive value when compared with visual analysis. (J Am Coll Cardiol Img 2010;3:699-709) (c) 2010 by the American College of Cardiology Foundation Show less
Werkhoven, J.M. van; Heijenbrok, M.W.; Schuijf, J.D.; Jukema, J.W.; Wall, E.E. van der; Schreur, J.H.M.; Bax, J.J. 2010
Objectives To compare magnetic resonance myocardial perfusion imaging (MRI) with anatomical assessment by multislice computed tomography (MSCT) coronary angiography and conventional coronary... Show moreObjectives To compare magnetic resonance myocardial perfusion imaging (MRI) with anatomical assessment by multislice computed tomography (MSCT) coronary angiography and conventional coronary angiography. Design and patients In this prospective study, 53 patients (60% male, average age 57 +/- 69 years, 83% intermediate pre-test likelihood) underwent 1.5 T MRI, 64-slice MSCT and conventional coronary angiography. Main outcome measures The presence of significant stenosis (>= 50% luminal narrowing) was determined on MSCT and conventional coronary angiography. Ischaemia on MRI was defined as a stress perfusion abnormality in the absence of delayed contrast enhancement. Results A significant stenosis was seen on MSCT in 15 (28%) patients, while ischaemia on MRI was seen in 19 (36%). In the 38 patients without significant stenosis on MSCT, normal perfusion was seen in 29 (76%). In patients with a significant stenosis on MSCT, ischaemia was seen in 10 (67%). In all patients without significant stenosis on MSCT and normal perfusion on MRI (n=29), significant stenosis was absent on conventional coronary angiography. All patients with both MSCT and MRI abnormal (n=10) had significant stenoses on conventional coronary angiography. Conclusion The anatomical and functional data obtained with MSCT and MRI are complementary for the assessment of coronary artery disease. These findings support the sequential or combined assessment of anatomy and function. Show less
Werkhoven, J.M. van; Heijenbrok, M.W.; Schuijf, J.D.; Jukema, J.W.; Boogers, M.M.; Wall, E.E. van der; ... ; Bax, J.J. 2010
Data on the diagnostic accuracy of multislice computed tomographic coronary angiography (CTA) have been mostly derived from patients with a high pretest likelihood of coronary artery disease.... Show moreData on the diagnostic accuracy of multislice computed tomographic coronary angiography (CTA) have been mostly derived from patients with a high pretest likelihood of coronary artery disease. Systematic comparisons with invasive angiography in patients with an intermediate pretest likelihood are scarce. The purpose of the present study was to determine the diagnostic accuracy of CTA in patients without known coronary artery disease with an intermediate pretest likelihood. A total of 61 patients (61% men, average age 57 +/- 9 years) who had been referred for invasive coronary angiography underwent additional 64-slice CTA. A total of 920 segments were identified by invasive coronary angiography, of which 885 (96%) were interpretable on CTA. Invasive coronary angiography identified a significant stenosis (>= 50% luminal narrowing) in 29 segments, of which 23 were detected on CTA. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value was 79%, 98%, 61%, and 99%, respectively, for CTA. On a patient level, the sensitivity, specificity, positive predictive value, and negative predictive value was 100%, 89%, 76%, and 100%, respectively. CTA correctly ruled out the presence of significant stenosis in 40 (66%) of the 61 patients. In conclusion, the results from the present study have confirmed that CTA has excellent diagnostic accuracy in the target population of patients with an intermediate pretest likelihood. The high negative predictive value allowed us to rule out significant stenosis in a large proportion of patients. CTA can, therefore, be used as a highly effective gatekeeper for invasive coronary angiography. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105: 302-305) Show less
