Yonsei Med J.  2014 May;55(3):599-605. 10.3349/ymj.2014.55.3.599.

Multidetector Computed Tomography for the Evaluation of Coronary Artery Disease; The Diagnostic Accuracy in Calcified Coronary Arteries, Comparing with IVUS Imaging

• Park JK
• Kim JY
• Kwon HM
• Kim TH
• Oh SJ
• Hong BK
• Yoon YW
• Min PK
• Kwon SW
• Lee BK

• KMID: 2068668
• DOI: http://doi.org/10.3349/ymj.2014.55.3.599

Abstract

PURPOSE
Contrast enhanced multidetector computed tomography (MDCT) has been used as an alternative to coronary angiography for the assessment of coronary artery disease in the patient of the intermediate risk group. However, coronary calcium is a known limiting factor for MDCT evaluation. We investigated the diagnostic accuracy of 64-channel MDCT with each coronary artery calcium score (CACS) by compared with intravascular ultrasound (IVUS) imaging.
MATERIALS AND METHODS
A total of 54 symptomatic patients with intermediate-risk (10 females, mean age 59.9+/-6.9 years, Framingham point scores 9-20) with 162 sites who had a culprit lesion on 64-channel MDCT before performing coronary angiography with IVUS were enrolled. Patients were divided into 4 subgroups depending on CACS: 0, 1-99, 100-399, and >400. Lesion length, external elastic membrane (EEM) cross sectional area (CSA), minimal luminal area, and plaque area were measured and compared between IVUS and MDCT.
RESULTS
The correlation coefficients for the measurements of the EEM CSA, lumen CSA, and plaque area were r=0.514, r=0.837, and r=0.578, respectively. Furthermore, there were close correlation of plaque area between four subgroups of CACS (r=0.671, r=0.623, r=0.562, r=0.571, respectively).
CONCLUSION
Despite the increase in CACS, the geometric analysis of coronary arteries using with 64-channel MDCT was comparable with IVUS in symptomatic patient of the intermediate risk group.

Keyword

Coronary artery disease; coronary calcium score; computed tomography; intravascular ultrasound

MeSH Terms

Aged
Coronary Artery Disease/*diagnosis/*radiography/ultrasonography
Female
Humans
Male
Middle Aged
Multidetector Computed Tomography/*methods
Predictive Value of Tests
Ultrasonography, Interventional/*methods

Figure

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  Fig. 1 Coronary plaques in the mid-left anterior descending artery of a patient presenting with stable angina on MDCT (A and B) and IVUS (C). MDCT, multidetector computed tomography; IVUS, intravascular ultrasound.

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  Fig. 2 Linear correlations between IVUS and MDCT measurements. There are significant correlations for EEM CSA (A), lumen CSA (B), and plaque area (C) between them. MDCT, multidetector computed tomography; IVUS, intravascular ultrasound; EEM, external elastic membrane; CSA, cross-sectional area.

• 

  Fig. 3 Linear correlations of plaque area between IVUS and MDCT measurements on each coronary artery calcium group. IVUS, intravascular ultrasound; MDCT, multidetector computed tomography.

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  Fig. 4 Inter-observer variability between two observers of plaque area in MLA on MDCT (A), Bland and Altman plot (B) and MDCT values of plaque in MLA (C), Bland and Altman plot (D). MLA, minimal luminal area; HU, Hounsfield unit; MDCT, multidetector computed tomography.

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