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CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses.
Marco A S Cordeiro; Albert C Lardo; Marcelo S V Brito; Miguel A Rosário Neto; Maria H A Siqueira; José R Parga; Luiz F Avila; José A F Ramires; João A C Lima; Carlos E Rochitte (Profiled Authors: Joao Lima; Albert Lardo)
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
The international journal of cardiovascular imaging 2006;22(3-4):507-16.
BACKGROUND: Two-dimensional axial and manually-oriented reformatted images are traditionally used to analyze coronary data provided by multidetector-row computed tomography angiography (MDCTA). While apparently more accurate in evaluating calcified vessels, 2D methods are time-consuming compared with automated 3D approaches. The purpose of this study was to evaluate the performance of a modified automated 3D approach (using manual vessel isolation and different window and level settings) in a population with high calcium scores who underwent coronary half-millimeter 16-detector-row CT angiography (16 x 0.5-MDCTA). METHODS: ECG-gated 16 x 0.5-MDCTA (16 x 0.5 mm cross-sections, 0.35 x 0.35 x 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iopamidol (120-ml, 300 mg/ml) in 19 consecutive patients (11 male, 62+/-10 years-old). Native arteries were independently evaluated for >or=50%-stenoses using both manual 2D and modified automated 3D approaches. Stents and bypass grafts were excluded. Conventional coronary angiography was visually analyzed by 2 observers. RESULTS: Median Agatston calcium score was 434. Sensitivities, specificities, positive and negative predictive values for detection of >or=50% coronary stenoses using the 2D and modified 3D approaches were, respectively: 74%/63%, 76%/80%, 45%/34%, and 91%/93% (p=NS for all comparisons). Overall diagnostic accuracies were 75 and 78%, respectively (p=NS). Uninterpretable vessels were, respectively: 37% (77/209) and 35% (73/209) - p=NS. Time to analyze a single study was 160+/-23 and 53+/-11 min, respectively (p<0.01). CONCLUSIONS: This modified automated 3D approach is equivalent to and significantly less time consuming than the traditional manual 2D method for evaluation of >or=50%-stenoses by 16 x 0.5-MDCTA in native coronary arteries of patients with high calcium scores.
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Armin Arbab-Zadeh; John HoeJACC. Cardiovascular imaging 2011;4(2):191-202.
M A S Cordeiro; J M Miller; A Schmidt; A C Lardo; B D Rosen; D E Bush; J A Brinker; D A Bluemke; E P Shapiro; J A C LimaHeart (British Cardiac Society) 2006;92(5):589-97.
Armin Arbab-Zadeh; Julie M Miller; Carlos E Rochitte; Marc Dewey; Hiroyuki Niinuma; Ilan Gottlieb; Narinder Paul; Melvin E Clouse; Edward P Shapiro; John Hoe; et al.
Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study.Journal of the American College of Cardiology 2012;59(4):379-87.
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