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Abstract
64-slice MDCT has shown a sensitivity of 86~99% and a specificity of 79~96% in detecting lesions >50% stenosis. Spatial resolution of current MDCT technology enables reliable detection of nonobstructing noncalcific plaques as well as significantly stenotic lesions. CT densitometry on the plaques may give an insight on vulnerability of the lesions defined as less than 30~50 HU. MDCT coronary angiography has a tendency of overestimation of stenosis degree especially in distal segments of left anterior descending and circumflex arteries and their branches and in heavily calcified lesions as compared with quantitative catheter coronary angiography. Semi-automatic vessel segmentation techniques for coronary CT angiography may help assess the stenosis degree quantitatively. Recently developed dual-source 128-slice CT has shown diagnostic quality images in patients with high heart rates. Along with forth-coming 256-slice CT, new CT technologies are expected to enable highly reliable detection of coronary artery plaques and accurate estimation of stenosis degree.
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Figure 1
64-year-old woman with chest pain. Volume-rendered (A) and maximum intensity projection (B) images of 64-slice CT show mild stenosis (arrows) in proximal left anterior descending branch. Short-axial reformatted image (C) of the lesion shows an eccentric noncalcific plaque (arrow). Mean ROI of the plaque region was 46 HU suggestive of lipid-rich content in the plaque.
Figure 2
64-year-old male with chest pain. Volume-rendered (A) and maximum intensity projection (B) images show stenosis (arrow) in the proximal left anterior descending branch, first diagonal branch and ramus intermedius. Short-axial reformatted image (C) shows eccentric plaques (arrows) in these vessels. Also note hypo-attenuated areas (arrowheads) suggestive of lipid content. Plaque volume was measured using a semiautomated method (D). It showed that plaque consisted of mostly fibrous component (50~130 HU) and the volume of the plaque was 13.13mm3.
Figure 3
48-year-old male with acute myocardial infarction. CT reformatted images (A) show a noncalcific plaque (arrow) in left main coronary artery. Intravascular ultrasonography (B) confirmed presence of fibrous plaque (arrow) without foci of hypoechoic lipid component.
Figure 4
67-year-old female with chest pain. Volume-rendered (A) and axial reformatted (B) images show stenosis (arrow) in the proximal left anterior descending branch. Short-axial reformatted image (C) of the vessel shows significant stenosis (arrow) with eccentric lumen and lipid area (arrowhead). Catheter angiography (D) correlated well with CT angiography in visual grading of stenosis (arrow) of the coronary artery.
Figure 5
66-year-old female with chest pain. Volume-rendered (A) and maximum intensity projection (B) images show stenosis (arrow) in the mid left anterior descending branch. Semiautomatic quantitative approach (C) revealed a 55% stenosis.
Figure 6
65-year-old male with previous myocardial infarction. There are multiple calcifications in proximal to mid left anterior descending branch. Volume-rendered (A) and maximum intensity projection (B) images show dense tubular calcifications (arrows) in mid left anterior descending branch adjacent to the origin of 1st diagonal branch. Short-axial image (C) shows an almost obscured lumen in that segment. However, catheter angiography reveals only mild stenosis in the same segment. This case illustrates an example of overestimation of the stenosis degree at CT angiography due to blooming artifact of calcium.
References
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