4.0 Article

Ultra-High-Resolution Coronary CT Angiography for Assessment of Patients with Severe Coronary Artery Calcification: Initial Experience

Journal

RADIOLOGY-CARDIOTHORACIC IMAGING
Volume 3, Issue 4, Pages -

Publisher

RADIOLOGICAL SOC NORTH AMERICA (RSNA)
DOI: 10.1148/ryct.2021210053

Keywords

CT-Angiography; Coronary Arteries; Arteriosclerosis

Funding

  1. Canon Medical Systems

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Initial observations in this study suggest that ultra-high-resolution CT (UHR-CT) may be effective in evaluating severely calcified coronary arterial lesions, overcoming the limitations of conventional CT technology. The study demonstrates high diagnostic accuracy with UHR-CT, even in cases of severe coronary calcification or prior stenting, representing a potential advance in this challenging patient population.
Purpose: Conventional CT technology yields only modest accuracy of coronary artery stenosis assessment in severely calcified lesions. Reported herein are this study's initial observations on the potential of ultra-high-resolution CT (UHR-CT) for evaluating severely calcified coronary arterial lesions. Materials and Methods: Fifteen patients 45 years of age or older, with history of coronary artery disease, referred for invasive coronary angiography, were prospectively enrolled. Patients underwent UHR-CT within 30 days prior to cardiac catheterization. Image noise levels and diagnostic confidence (level 1-5) using UHR-CT were compared with reconstructed images simulating conventional CT technology. Stenosis assessment for the major coronary arteries and the left main coronary artery with UHR-CT and invasive angiography were compared. Results from clinically driven coronary CT using conventional technology were considered for comparison when available. Results: Mean patient age was 67 years (range, 53-79 years). Thirteen patients were men, nine had obesity. Radiation dose was 9.3 mSv owing to expanded x-ray exposure to accommodate research software application (70%-99% of R-R cycle). Overall image noise was considerably greater for UHR-CT (50.9 +/- 7.8 [standard deviation]) versus conventional CT image reconstruction (19.5 +/- 8.3, P<.01), yet diagnostic confidence scores for UHR-CT were high (4.3 +/- 0.9). Average calcium score in patients without stents (n = 6) was 1205, and of 86 vessels evaluated, 22 had 70% or greater stenosis depicted with invasive angiography (26%). Stenosis comparison with invasive angiography yielded 86% (19 of 22) sensitivity and 88% (56 of 64) specificity (95% CI: 65%, 97%; and 77%, 95%, respectively). Conclusion: Initial observations suggest UHR-CT may be effective in overcoming the limitation of conventional CT for accurately evaluating coronary artery stenoses in severely calcified vessels. Summary This study's initial experience with coronary angiography using ultrahigh-resolution CT in patients suspected of having coronary stenoses demonstrates promise for high diagnostic accuracy even in the setting of severe coronary calcification or prior stenting, representing a potentially substantial advance compared with conventional CT technology in this challenging patient population.

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