鲁蓓
中国医学科学院阜外医院 医务科
AIM:To assess the diagnostic value of coronary computed tomography angiography (CCTA) in acute type A aortic dissection (ATAAD) with coronary artery involvement and to evaluate whether CCTA could provide potentially useful information for selecting the surgical method.MATERIALS AND METHODS:Patients with ATAAD treated from January 2019 to December 2020 were reviewed retrospectively. Involvement of the coronary arteries based on CCTA findings were grouped into three major types and five subtypes. Interobserver and intraobserver diagnostic agreement for five subtypes were determined. The patients were divided into the coronary artery bypass grafting (CABG) and non-CABG groups, and the proportions of the five subtypes between the two groups were compared.RESULTS:A total of 95 patients were enrolled in this study. Interobserver and intraobserver diagnostic agreement were both substantial in the left and right coronary arteries. Overall, the proportions of the five subtypes of coronary artery involvement were significantly different between the two groups (p<0.001). The proportion of Type A was elevated in the non-CABG group compared with the CABG group (22.6% versus 71.9%); by contrast, the proportions of Type B1 (35.5% versus 14.1%), Type B2 (19.4% versus 10.9%), Type C1 (6.5% versus 0%), and Type C2 (16.1% versus 3.1%) were elevated in the CABG group.CONCLUSION:CCTA is reliable in evaluating coronary artery involvement by ATAAD. The present retrospective study indicated that CABG may be considered if the intimal flap disrupts the coronary orifice and causes luminal stenosis >50%, particularly Type B, or if an intimal tear occurs in the coronary orifice (Type C), which deserve further validation through prospective studies.
Clinical radiology 2024
Objective: To determinate the range of quantitative myocardial perfusion parameters (MBF, MBV) in subjects without coronary artery lesions by dynamic computed tomography myocardial perfusion imaging (CTP). Methods: Subjects with occasional chest tightness or family history of coronary artery disease coming to Fuwai Hospital underwent coronary computed tomography angiography (CCTA) were prospectively enrolled. A total of 34 subjects [mean age (50±7) years, range from 33 to 65 years; 15 male and 19 female] were enrolled. Coronary lesions were not confirmed in any subjects using CCTA and volunteered for stress and rest dynamic CTP examination. MBF and MBV values were calculated in each myocardial segment using a 17-segment model. The global ranges of MBF and MBV were analyzed, and the gender variability and regional variability were compared. Results: The mean global MBF and MBV at rest and under stress were (115.5±27.4) ml·100 g-1·min-1, (212.8±40.8) ml·100 g-1·min-1 and (17.6±4.0) ml/100 g, (25.8±4.6) ml/100 g, respectively. The absolute and resolute reserves of MBF and MBV [(102.8±41.5) ml·100 g-1·min-1, 107.7%±52.5%; (9.3±5.2) ml/100 g, 62.1%±47.4%] were highest in the right coronary artery territory, but without any significant differences. The stress MBF and absolute reserve of MBF in females were higher than those of males [(228.6±39.9) ml·100 g-1·min-1, (113.3±46.2) ml·100 g-1·min-1; (192.8±33.4) ml·100 g-1·min-1, (77.0±41.2) ml·100 g-1·min-1] (both P<0.05). The MBF resolute reserve, rest MBV, stress MBV and MBV absolute and resolute reserves were higher in females, but without significant differences (all P>0.05). Conclusion: The mean global MBF and MBV at rest and under stress were (115.5±27.4) ml·100 g-1·min-1, (212.8±40.8) ml·100 g-1·min-1 and (17.6±4.0) ml/100 g, (25.8±4.6) ml/100 g. The MBF under stress perfusion and MBF absolute reserve of females are higher than those of males.
Zhonghua yi xue za zhi 2021
AIM:To compare the uniformity and image quality between contrast media injection protocols adjusted for patient body weight (BW) versus body surface area (BSA) during coronary computed tomography (CT) angiography (CCTA).MATERIALS AND METHODS:Consecutive patients (n=489) with suspected coronary artery disease were randomised prospectively to one of two CCTA protocols. In the BW protocol (n=245), patients received individualised iodine delivery rates (≤50 kg: 1 g/s; 51-60 kg: 1.2 g/s; 61-70 kg: 1.4 g/s; 71-80 kg: 1.6 g/s; 81-90 kg: 1.8 g/s; 91-100 kg: 2 g/s; >100 kg: 2.2 g/s). In the BSA protocol (n=244), patients received 9,600 mg iodine/m2 of contrast medium over 12 seconds. Attenuation and image noise were measured. Signal-to-noise ratio and contrast-to-noise ratio were calculated. Image quality was scored. Attenuation was assessed for correlation with BW and BSA using linear regression.RESULTS:There were no statistically significant differences in mean arterial attenuation (396.8±47.6 versus 395.8±42.2 HU, p=0.804; 95% confidence interval: -7 to 9), image noise (25.2±5.8 versus 25.5±5.4 HU; p=0.549), signal-to-noise ratio (16.7±4.4 versus 16.6±3.6; p=0.902), contrast-to-noise ratio (25.1±5.8 versus 25.8±7.4; p=0.258) or image quality scores (4.1±0.9 versus 4±0.9; p=0.770) between the BW and BSA protocols. There was no correlation between BW and aortic attenuation or between BSA and aortic attenuation (p=0.324 and 0.932, respectively).CONCLUSION:The average contrast media attenuation and image quality was comparable between BW-adjusted protocol and BSA-adjusted protocol.
Clinical radiology 2020
OBJECTIVE:To establish and evaluate two protocols for the noninvasive visualization and assessment of coronary artery bypass graft (CABG) patency on electron beam tomography (EBT).METHODS:Two hundred and fourteen consecutive patients who underwent coronary artery bypass graft surgery were scanned using both EBT angiography with 3-dimensional reconstruction and EBT flow study with time-density-curve analysis.RESULTS:There were 589 CABGs evaluated in this study (10 grafts were excluded because of artifacts). Among them, 133 (98.5%) of 135 arterial grafts were patent, and 345 (77.7%) of 444 saphenous-vein grafts were patent. Within 5 years or between 5 and 10 years after operation, arterial graft patency exceeded venous graft patency (P < 0.001). Three-dimensional EBT angiography achieved higher sensitivity, specificity and accuracy (97.7%, 94.1% and 96.7%, respectively) than did EBT flow study (88.4%, 82.4% and 85.2%, respectively) for evaluating occlusion or patency of CABG. The intra-graft flow of patent arterial and venous grafts were 4.9 +/- 2.2 ml.min-1.g-1 and 6.9 +/- 2.8 ml.min-1.g-1, respectively (P < 0.001).CONCLUSION:The combination of EBT three-dimensional reconstruction and flow study can be more effective in the assessment of CABG anatomy and quantification of patent CABG blood flow.
Chinese medical journal 2001
RATIONALE AND OBJECTIVES:The authors performed this study to evaluate the effect of window level and gray-scale threshold on the demonstration of coronary artery lumina at three-dimensional electron-beam computed tomographic (CT) angiography.MATERIALS AND METHODS:Forty-four coronary artery branches in postmortem pigs were evaluated with electron-beam CT angiography, and the findings were compared with those from conventional angiography. Images from electron-beam CT angiography were reconstructed with maximal intensity projection (MIP), multiplanar reformation (MPR), and shaded-surface display (SSD). Four categories of window level and gray-scale threshold were evaluated.RESULTS:Three-dimensional electron-beam CT angiography accurately depicted the luminal diameters of the coronary arteries compared with conventional angiography (r = 0.83-0.90, P < .0001). The length of lumina visualized at electron-beam CT angiography was significantly shorter than that visualized with conventional angiography (P < .001). The use of MPR enabled visualization of longer segments of coronary arteries than did the use of MIP or SSD (P < .05). The higher the window level and gray-scale threshold used, the smaller the coronary luminal diameters measured (P < .05). The most accurate window level and gray-scale threshold (82.6 HU +/- 29.8 and 89.5 HU +/- 29.7, respectively) were found to correspond to the attenuation of the lumina (275.8 HU +/- 58.8). Results of simple linear regression showed a strong correlation between luminal attenuation and window level (r = 0.89, P < .0001) or gray-scale threshold (r = 0.95, P < .0001).CONCLUSION:Electron-beam CT angiography shows promise in the visualization of coronary artery lumina. For accurate display of lumina, a proper window level and gray-scale threshold for three-dimensional rendering techniques should be determined and used on the basis of the attenuation of the target vessel.
Academic radiology 2001
This paper evaluated the accuracy of electron beam tomographic angiography (EBA) with conventional coronary arteriography (CCA) using four graded artificial stenoses in a postmortem swine coronary phantom model. The sensitivity, specificity, and accuracy of EBA for diagnosing significant stenosis (> or =50% stenosis) were 94.3%, 96.7%, and 95.8%, respectively. The diagnostic accuracy of EBA had no significant difference with CCA (chi(2)=0.0162; P>.05). EBA three-dimensional (3D) procedures had high interobserver reproducibility (k=.92-.95, P>.05). Maximum intensity projection (MIP) was the most sensitive and curved planar reformation (CPR) was the most accurate 3D procedure for quantitatively identifying coronary stenosis. EBA yields promising results concerning the visualization of coronary artery stenosis with high accuracy for stenoses >50%.
Clinical imaging 2001
RATIONALE AND OBJECTIVES:This study compared the image quality obtained with different scanning and reconstruction parameters for electron-beam computed tomographic (CT) angiography and sought optimal methods for visualizing the coronary artery lumen.MATERIALS AND METHODS:Electron-beam CT angiography with contrast material enhancement was used to image 35 branches of fresh postmortem swine coronary arteries. Different collimation widths, fields of view (FOVs), reconstruction kernels, and algorithms were employed to reconstruct the acquired raw data into CT angiographic images. Image quality was compared and analyzed.RESULTS:The contrast-to-noise ratios (C/Ns) for 1.5-, 2-, and 3-mm section thickness were 28.4 +/- 15.2, 31.9 +/- 9.3, and 33.8 +/- 14.5, respectively (P < .05). The lengths of visualized coronary artery lumina were significantly longer for 1.5-mm scanning (71.6 mm +/- 4.3) than for 2-mm (58.3 mm +/- 5.5) and 3-mm scanning (59.0 mm +/- 8.0) (P < .01). The C/Ns for 12.7-, 18.0-, and 26.0-cm FOV reconstruction were 32.8 +/- 9.9, 28.9 +/- 8.2, and 27.1 +/- 8.2, respectively (not significant), and the visualized luminal lengths were 76.1 mm +/- 12.5, 71.7 mm +/- 14.6, and 65.4 mm +/- 13.1, respectively (not significant). The highest C/N (48.2 +/- 13.3) was achieved with smooth kernels and a cone-beam algorithm, and the lowest (14.7 +/- 3.4) with very sharp kernels and a normal algorithm. Cone-beam algorithm images had significantly higher C/Ns than did normal algorithm images (P < .001), and they demonstrated longer coronary artery lumina (P < .01).CONCLUSION:Collimation width, FOV, reconstruction kernels, and algorithms are important in the processing of high-quality electron-beam coronary angiograms. A 1.5-mm collimation width, 12.7-cm FOV, cone-beam reconstruction algorithm, and very sharp kernels should help in obtaining the best image quality and depicting the longest segments of coronary artery lumen.
Academic radiology 2000
OBJECTIVES:To establish and evaluate two protocols for the noninvasive visualization and assessment of coronary artery bypass graft (CABG) patency on electron beam tomography (EBT).METHODS:Two hundred fourteen consecutive patients who underwent CABG surgery were scanned using both EBT angiography with three-dimensional reconstruction and EBT flow study with time-density curve analysis.RESULTS:There was a total of 589 CABGs evaluated in this study (10 grafts were excluded because of artifacts); 133 (98.5%) of 135 arterial grafts were patent, 345 (77.7%) of 444 saphenous vein grafts were patent. Within 5 years or 5-10 years after surgery, arterial graft patency exceeded venous graft patency (p<0.001). Three-dimensional EBT angiography achieved higher sensitivity, specificity, and accuracy (97.7%, 94.1%, and 96.7%, respectively) than EBT flow study (88.4%, 82.4%, and 85.2%, respectively) for evaluating occlusion or patency of CABGs. The intragraft flow of patent arterial and venous grafts were 4.9+/-2.2 ml/min/g and 6.9+/-2.8 ml/min/g, respectively (p<0.001).CONCLUSION:The combination of EBT three-dimensional reconstruction and flow study can be more effectively performed in the assessment of CABG anatomy and quantification of patent CABG flow.
Journal of computer assisted tomography 2000
In this study, the authors evaluated the performance characteristics of contrast-enhanced electron-beam tomography (EBT) with three-dimensional reconstruction in defining the coronary artery lumen in healthy subjects. Thirty patients with normal coronary angiograms by selective coronary arteriography (SCA) underwent contrast-enhanced EBT examination. Measured parameters included degree of luminal enhancement, intravascular contrast-to-noise ratio (CNR), and diameter and length of visualized lumen. Ventricular cavity, aortic blood pool, and coronary artery attenuation were found to be significantly different before and after intravenous injection of contrast material (p < 0.001). CNR decreased from proximal to distal segments within each vessel (p < 0.001), with a peak of 11.2 +/- 2.3 occurring in the proximal left anterior descending coronary artery (LAD) to a low of 4.8 +/- 2.0 in the distal left circumflex (LCX). Luminal diameters visualized by EBT had no significant difference with that of SCA (p > 0.05). Therefore, EBT angiography with three-dimensional reconstruction allows for noninvasive coronary arteriography revealing long segments of the major coronary arteries in normal subjects.
Angiology 2000
BACKGROUND:This study was performed to evaluate the protocols of electron beam tomographic angiography and three-dimensional reconstruction for assessing the diagnostic value of aortic diseases.METHODS:EXPERIMENTAL DESIGN:Retrospective and comparative study.SETTINGS:University hospital.PATIENTS:Between 1996 and 1998, 189 cases who underwent electron beam tomographic angiography and diagnosed with aortic diseases were analyzed retrospectively. The results were compared with surgical and pathological findings in 68 cases. Electron beam tomographic angiography was used single-slice-scanning with ECG-triggering for screening of the thoracic aorta, continuous-volume-scanning, permitted by continuous X-ray exposure with table incremention, was performed for the abdominal aorta scanning without ECG-triggering. Three-dimensional reconstructions were performed with shaded-surface display, multiplanar reformatting and/or maximum intensity projection methods.RESULTS:Electron beam tomography angiography with ECG-triggered sections of single-slice-scanning improved the image quality of the ascending aorta without motion artifacts. Continuous-volume-scanning was suitable for screening of the abdominal aorta because of minimizing exposure time (10-14 sec) and saving contrast media (total contrast material of 45.5+/-6.6 ml was needed). One hundred eighty-nine cases were diagnosed with aortic dissection (97 cases), aortic aneurysm (26 cases), pseudoaneurysm (8 cases), Marfan's syndrome (39 cases), Takayasu's arteritis (5 cases) and congenital aortic malformations (14 cases). Electron beam tomography results were compared with the findings of surgery (as gold standard) in 68 cases, the diagnostic accuracy was 97% (2 cases with aortic aneurysm were erroneously diagnosed with pseudoaneurysm).CONCLUSIONS:Electrocardiographically triggered, contrast-enhanced electron beam tomography is feasible for the diagnosis of all kinds of aortic diseases, with excellent three-dimensional images competitive in quality with conventional selective aortic angiography or digital subtraction angiography.
The Journal of cardiovascular surgery 2000
