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Objective:To evaluate and compare the diagnostic values between myocardial perfusion imaging (MPI)and dual source CT coronary angiography(DS-CTCA)in coronary artery stenosis in the diabetic patients with coronary heart disease(CHD),and to elucidate the clinical application values of MPI combined with DS-CTA in the diabetic patients with CHD.Methods:A total of 52 diabetic patients with CHD underwent the examinations of MPI and DS-CTCA were selected.The degrees of coronary artery stenosis of branches of coronary artery were compared between MPI examination and DS-CTCA examination,including left main coronary artery(LM),left anterior descending coronary artery(LAD),left circumflex branch(LCX)and right coronary artery(RCA).Based on the coronary angiography(CAG)regarded as the golden standard,the specificity,sensitivity and accuracy of each imaging examination method were compared;the specificities,sensitivities and accuracies of parallel diagnosis and serial diagnosis of two kinds of methods were also compared.Results:The stenosis degrees of LM and LAD were no different between MPI examination and DS-CTCA examination(P>0.05),but the stenosis degrees of LCX and RCA were different between two imaging examination methods(P<0.05).Compared with MPI examination, the sensitivity of DS-CTCA examination in the diabetic patients with CHD was decreased(71.0%vs 90.1%),and the difference was significant(P=0.035);the specificity of DS-CTCA examination in the diabetic patients with CHD was increased(85.7%vs 58.4%),and the difference was significant(P=0.027);but the accuracies of two examinations in the diabetic patients with CHD were no different(76.4%vs 78.4%)(P=0.062).Compared with parallel diagnosis,the specificity and accuracy of serial diagnosis were increased(93.5% vs 33.8%,P=0.001;94.7%vs 71.2%,P = 0.030);but the sensitivities had no difference(95.4% vs 93.1%,P = 0.074). Conclusion:The diagnostic accuracy of evaluating the degree of coronary artery stenosis in the diabetic patients with CHD is not different between DS-CTCA examination and MPI examination. And the serial diagnosis of two examination methods can improve the diagnostic accuracy.
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Obective: To evaluate and compare the diagnostic values between myocardial perfusion imaging (MPD and dual source CT coronary angiography (DS-CTCA) in coronary artery stenosis in the diabetic patients with coronary heart disease (CHD), and to elucidate the clinical application values of MPI combined with DS-CTA in the diabetic patients with CHD. Methods: A total of 52 diabetic patients with CHD underwent the examinations of MPI and DS-CTCA were selected. The degrees of coronary artery stenosis of branches of coronary artery were compared between MPI examination and DS-CTCA examination, including left main coronary artery (LM), left anterior descending coronary artery (LAD), left circumflex branch (LCX) and right coronary artery (RCA). Based on the coronary angiography (CAG) regarded as the golden standard, the specificity, sensitivity and accuracy of each imaging examination method were compared; the specificities, sensitivities and accuracies of parallel diagnosis and serial diagnosis of two kinds of methods were also compared. Results: The stenosis degrees of LM and LAD were no different between MPI examination and DS-CTCA examination (P>0.05), but the stenosis degrees of LCX and RCA were different between two imaging examination methods (P<0.05). Compared with MPI examination, the sensitivity of DS-CTCA examination in the diabetic patients with CHD was decreased (71.0% vs 90.1%), and the difference was significant (P=0.035); the specificity of DS-CTCA examination in the diabetic patients with CHD was increased (85.7% vs 58.4%), and the difference was significant (P=0.027); but the accuracies of two examinations in the diabetic patients with CHD were no different (76.4%-us 78.4%) (P=0.062). Compared with parallel diagnosis, the specificity and accuracy of serial diagnosis were increased (93.5% vs 33.8%, P = 0.001; 94.7% vs 71.2%, P = 0.030); but the sensitivities had no difference (95.4% vs 93.1%, P= 0.074). Conclusion: The diagnostic accuracy of evaluating the degree of coronary artery stenosis in the diabetic patients with CHD is not different between DS-CTCA examination and MPI examination. And the serial diagnosis of two examination methods can improve the diagnostic accuracy.
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Objective To investigate the feasibility of subtraction coronary computed tomography angiography (Sub-CCTA) for the diagnosis of coronary heart disease in the segment with severe calcification.Methods A retrospective analysis was performed on 27 patients who underwent clinically indicated digital subtraction angiography (DSA) and CCTA using a 320-detector row CT.Compared with the results of DSA,sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Con-CCTA and Sub-CCTA were calculated.The clinical diagnostic accuracy of the two imaging methods was evaluated using the receiver operating characteristic (ROC) curve.The stenosis of coronary segments was divided into four grades (Ⅰ,Ⅱ,Ⅲ,Ⅳ).Kappa coefficient was used to measure agreement between two imaging methods.Image quality of 4-scale grade scoring method was used and t test was conducted.Results A total of 52 segments with severe calcification were evaluated.The scores of image quality in Con-CCTA and Sub-CCTA were 2.8 ± 0.5 and 3.4 ± 0.7,respectively.There was significant difference between them (t =5.9,P ＜ 0.05).Compared with the result of DSA as the golden standard,the Kappa coefficients were 0.55 and 0.81 respectively in Con-CCTA and Sub-CCTA for the quantitative evaluation of the severe calcified segments.The sensitivity,specificity,positive predictive value and negative predictive value and accuracy of Con-CCTA were 81.0％,63.1％,63.1％,81.1％ and 70.8 ％;and for Sub-CCTA they were 90.5 ％,85.2％,82.1 ％,92.0％ and 87.5 ％ respectively.Compared with Con-CCTA,the area under the ROC curve of Con-CCTA and Sub-CCTA were 0.84 (95％CI:0.70-0.93) and 0.96 (95％ CI:0.86-1.00),respectively,and the difference was statistically significant (P =0.03).Conclusions Sub-CCTA can improve the diagnostic accuracy of coronary artery stenosis in severe calcified segment.Application of subtraction technique in CCTA can reduce or even eliminate the artifacts caused by severe calcified plaque,and has a good clinical application prospect.
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Objective:To investigate the effect and application feasibility of low tube voltage, low concentration of contrast agent volume to CTA in the diagnosis of coronary artery stenosis and its effect.Methods: Seventy two cases of suspected patients with coronary atherosclerosis selected as the object Using random number table method, all patients were divided into group A and group B 36 cases in each group, two groups of patients underwent 320 slice CTA examination, in group A the tube voltage is 120kV, the contrast agent was 350mgI/mL iodixanol group, B tube voltage is set to 100kV, the contrast agent was 270mgI/mL iodixanol. According to the examination results of group A, group B and catheter coronary angiography (CCA), evaluated group A, group B of acquiring the image quality and radiation dose of patients, and analyzed the sensitivity of A, B and CCA examination of the extent of coronary artery stenosis degree and deliberately.Results: The quartering method showed no significant difference between the group A and the group B of image quality. There was significant difference between the two groups of patients with the image noise and enhance the effect (t=-4.736, 11.927;P<0.05); Group B of coronary artery stenoses (more than 50%) and severe stenosis (more than 75%) sensitivity, specially degree and coincidence rate compared with the results of CCA showed no significant difference. Kappa consistency analysis showed that the two consistency is good(kappa=1.320,P<0.001).Conclusion: In the premise of ensuring the image quality with low tube voltage, low concentration of contrast agent volume coronary CTA examination had safety and reliability of inspection.
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OBJECTIVE: The purpose of this study is to determine the effects of propranolol on the left ventricular (LV) volume during CT coronary angiography. MATERIALS AND METHODS: The LV volume of 252 normal Chinese subjects (126 subjects with propranolol medication and 126 age- and gender-matched Chinese subjects without medication) was estimated using 64 slices multi-detector CT (MDCT). The heart rate difference was analyzed by the logistic linear regression model with variables that included gender, age, body height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the dosage of propranolol. The following global LV functional parameters were calculated: the real-end diastolic volume (EDV), the real-end systolic volume (ESV) and the real-ejection fraction (EF). RESULTS: The female subjects had a greater decrease of heart rate after taking propranolol. The difference of heart rate was negatively correlated with the dosage of propranolol. The real-EDV, the real-ESV and the real-EF ranged from 48.1 to 109 mL/m2, 6.1 to 57.1 mL/m2 and 41% to 88%, respectively. There was no significant difference in the SBP and DBP between the groups without and with propranolol medication (123 +/- 17 and 80 +/- 10 mmHg; 120 +/- 14 and 80 +/- 11 mmHg, respectively). The real-EDV showed no significant difference between these two groups, but the real-ESV and real-EF showed significant differences between these two groups (69.4 +/- 9.3 and 70.6 +/- 8.9 mL/m2; 23.5 +/- 5.7 and 25.6 +/- 3.7 mL/m2, 66.5 +/- 5.1% and 63.5 +/- 4.6%, respectively). CONCLUSION: The difference of heart rate is significantly influenced by gender and the dosage of propranolol. Propranolol will also increase the ESV, which contributes to a decreased EF, while the SBP, DBP and EDV are not statistically changed.
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Female , Humans , Male , Middle Aged , Adrenergic beta-Antagonists/administration & dosage , Case-Control Studies , China , Contrast Media , Coronary Angiography , Diastole , Electrocardiography , Heart Rate/drug effects , Logistic Models , Propranolol/administration & dosage , Radiographic Image Interpretation, Computer-Assisted , Systole , Tomography, X-Ray Computed , Triiodobenzoic Acids , Ventricular Function, Left/drug effectsABSTRACT
OBJECTIVE: To evaluate the depiction rate and morphologic features of myocardial bridging (MB) of the left anterior descending coronary artery (LAD) using dual-source CT (DSCT). MATERIALS AND METHODS: CT scans from a total of 1,353 patients who underwent DSCT were reviewed retrospectively for LAD-MB. Seventy-eight patients were excluded due to poor image quality or poor enhancement of the coronary artery. The length and depth of the MB were analyzed and classified as superficial or deep with respect to the depth ( 1 mm) of the LAD tunneled segment. Superficial MB was subdivided into complete or incomplete types according to full or partial encasement of the myocardium. RESULTS: Of the 1,275 patients included in this study, 557 cases of MB were found from 536 patients (42%). Superficial MB was observed in 368 of 557 (66%) cases, and deep MB was seen in 189 of 557 (34%) cases. Superficial MB showed 2 types: complete (128 of 368, 35%) and incomplete (240 of 368, 65%). The mean length of a tunneled segment for superficial MB was 16.4 +/- 8.6 mm. The mean length and depth of a tunneled segment for deep MB were 27.6 +/- 12.8 mm and 3.0 +/- 1.4 mm, respectively. The incidence of atherosclerotic plaques in a 2-cm-long segment proximal to MB was 16%. CONCLUSION: The depiction rate of LAD-MB using DSCT in a large series of patients was 42%, with two-thirds of MB segments being the superficial type.