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(Circulation. 2001;103:2535.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Detection of Coronary Artery Stenoses by Contrast-Enhanced, Retrospectively Electrocardiographically-Gated, Multislice Spiral Computed Tomography
From the Department of Internal Medicine II (S.A., T.G., D.R., H.D., W.M., W.G.D.), the Institute of Medical Physics (S.U., W.A.K.), and the Institute of Diagnostic Radiology (C.S., E.W., W.B., U.B.), University of Erlangen-Nürnberg, Germany.
Correspondence to Dr S. Achenbach, Medizinische Klinik II, Universität Erlangen, Östliche Stadtmauerstr 29, 91054 Erlangen, Germany. E-mail stephan.achenbach{at}rzmail.uni-erlangen.de
Background—Multislice spiral computed tomography (MSCT) with retrospectively ECG-gated image reconstruction permits coronary artery visualization. We investigated the method’s ability to identify high-grade coronary artery stenoses and occlusions.
Methods and
Results—A total of 64 consecutive
patients were studied by MSCT (4x1 mm cross-sections, 500-ms
rotation, table feed 1.5 mm/rotation, intravenous
contrast agent, retrospectively ECG-gated image reconstruction). All
coronary arteries and side branches with a luminal diameter
2.0 mm were assessed concerning evaluability and the presence of
high-grade stenoses (>70% diameter stenosis) or
occlusions. Results were compared with quantitative coronary
angiography. Of 256 coronary arteries (left main, left anterior
descending, left circumflex and right coronary artery,
including their respective side branches), 174 could be evaluated
(68%). In 19 patients (30%), all arteries were evaluable. Artifacts
caused by coronary motion were the most frequent reason for
unevaluable arteries. Overall, 32 of 58 high-grade stenoses and
occlusions were detected by MSCT (58%). In evaluable arteries, 32 of
35 lesions were detected, and the absence of stenosis was
correctly identified in 117 of 139 arteries (sensitivity, 91%;
specificity, 84%). If analysis was extended to all
stenoses with >50% diameter reduction, sensitivity was 85%
(40 of 47) and specificity was 76% (96 of
127).
Conclusions—MSCT with retrospective ECG gating permits the detection of coronary artery stenoses with high accuracy if image quality is sufficient, but its clinical use may presently be limited due to degraded image quality in a substantial number of cases, mainly due to rapid coronary motion.
Key Words: imaging • coronary disease • tomography
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