Coronary artery ectasia diagnosed using multidetector computed tomography: morphology and relation to coronary artery calcification

Coronary artery ectasia (CAE) is usually considered a variant of coronary artery atherosclerosis; however, a definite link has not yet been confirmed. As not all patients with CAE are symptomatic, the real incidence is unknown. The aim of this study was to evaluate the prevalence of CAE and its clinical and angiographic characteristics as well as its relation to coronary artery calcification and any associated vascular abnormality by using multidetector computed tomography (MDCT). We prospectively enrolled 2,600 patients (mean age 55 ± 10 years) who were scheduled for computed tomography coronary angiography (CTCA). CTCA was performed using 64-MDCT with dedicated software for calcium measurement. CAE was defined as an arterial segment with a diameter of >1.5 times the diameter of the adjacent normal segment. The presence of ≥70 % diameter stenosis of any major epicardial vessel was considered an obstructive lesion. CAE was encountered in 192 (7.4 %) patients and showed gender predominance in men (88 %). Patients with CAE were more hypertensive but less diabetic. Left anterior descending artery was the most commonly affected vessel. Only 16 % of CAE patients had no atherosclerotic lesion. Coronary artery calcium score (CACS) and prevalence of ascending aorta aneurysm were shown to be significantly higher in CAE patients compared to patients having no ectasia. A significant negative correlation was noted between CACS and Markis classification. CTCA is a feasible technique to identify and evaluate morphology of CAE. The link between CACS and CAE may favor the consideration that ectasia is an advanced form of atherosclerosis.     

零钙化积分冠状动脉CTA表现分析

目的 分析零冠状动脉钙化积分(CACS)患者64层冠状动脉CTA(CTCA)表现,并评估诊断准确率。 方法 对328例零CACS的疑似冠心病患者,分析CTCA表现,包括有无狭窄、斑块形态、位置和狭窄程度。其中69例有传统冠状动脉造影结果,计算零CACS患者CTCA诊断狭窄≥70%的敏感度、特异度、准确度、阳性预测值和阴性预测值。 结果 328例零CACS患者,CTCA示37例(37/328,11.28%)存在不同程度的狭窄和斑块,无或轻度狭窄26例(26/37,70.27%),中度狭窄8例(8/37,21.62%),重度狭窄3例(3/37,8.11%)。54个狭窄斑块包括软斑块39个(39/54,72.22%)、混合斑块8个(8/54,14.81%)及7个钙化斑块(7/54,12.96%)。基于病例(69例)和基于冠状动脉节段(997个节段)CTCA诊断狭窄≥70%的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为97.14%(34/35)、94.12%(32/34)、95.65%(66/69)、94.44%(34/36)、96.97%(32/33)和94.23%(49/52)、99.58%(941/945)、99.30%(990/997)、92.45%(49/53)、99.68%(941/944)。 结论 CTCA可显示零CACS患者冠状动脉的不同程度狭窄和斑块,且诊断准确度较高。     

Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis

To determine via meta-analysis the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTA) for assessment of significant obstructive coronary artery stenosis at different coronary artery calcium score (CACS) levels. Data of 12,053 versus 5,890 segments, 906 versus 758 arteries and 1,120 versus 514 patients in low versus high CACS subgroups from 19 eligible studies were compared. The per-patient prevalence of coronary artery disease was 48% versus 68%, respectively. Subgroups were stratified by different CACS thresholds ranging from 100 to 400. Meta-analyses of per-patient data comparing overall low versus high CACS subgroups resulted in a sensitivity of 97.5 (95.5–99)% versus 97 (94.5–98.5)%, specificity of 85 (82–88)% versus 66.5 (58–74.5)%, diagnostic odds ratio of 153 (81–290) versus 40 (20–83), positive predictive value of 85 (82–87)% versus 86 (84–88)%, negative predictive value of 97.5 (95–99)% versus 91 (88–94)% and overall accuracy of 91% versus 89% with 95% confidence interval, respectively. The drop in specificity was significant (P = 0.035), while the sensitivity and overall accuracy were insignificantly changed (P > 0.05). Meta-analyses of independent subgroups at CACS levels ≤10 and ≤100 demonstrated high specificities of 90 (94–100)% and 88.5 (81–91.5)%, whereas at CACS levels ≥400 the specificity declined significantly to 42 (28–56)% but with consistently retained high sensitivity of 97.5 (94–99)%. The specificity of CTA decreases with increasing CACS, while the sensitivity remains high independent of that. The suggested CACS thresholds are arbitrary and do not necessarily warrant cancelling angiography. Diagnostic studies are needed to explore whether a specific CACS threshold may serve as a pre-angiographic gatekeeper to prevent likely equivocal angiographies.     

Is there a role for CT coronary angiography in patients with symptomatic angina? Effect of coronary calcium score on identification of stenosis

Present guidelines discourage the use of CT coronary angiography (CTCA) in symptomatic angina patients. We examined the relation between coronary calcium score (CS) and the performance of CTCA in patients with stable and unstable angina in order to understand under which conditions CTCA might be a gate-keeper to conventional coronary angiography (CCA) in such patients. We included 360 patients between 50 and 70 years old with stable and unstable angina who were clinically referred for CCA irrespective of CS. Patients received CS and CCTA on 64-slice scanners in a multicenter cross-sectional trial. The institutional review board approved the study. Diagnostic performance of CTCA to detect or rule out significant coronary artery disease was calculated on a per patient level in pre-defined CS categories. The prevalence of significant coronary artery disease strongly increased with CS. Negative CTCA were associated with a negative likelihood ratio of <0.1 independent of CS. Positive CTCA was associated with a high positive likelihood ratio of 9.4 if CS was <10. However, for higher CS the positive likelihood ratio never exceeded 3.0 and for CS >400 it decreased to 1.3. In the 62 (17%) patients with CS <10, CTCA reliably identified the 42 (68%) of these patients without significant CAD, at no false negative CTCA scans. In symptomatic angina patients, a negative CTCA reliably excludes significant CAD but the additional value of CTCA decreases sharply with CS >10 and especially with CS >400. In patients with CS <10, CTCA provides excellent diagnostic performance.     

Variation in atherosclerotic plaque composition according to increasing coronary artery calcium scores on computed tomography angiography

Increasing coronary artery calcium scores (CACS) are independently associated with cardiac events. Recent advents in coronary computed tomography angiography (CCTA) have allowed us to better characterize individual plaque. Currently, it is unknown if higher CACS are likely to be associated with more calcified or mixed and heterogeneous plaque burden on CCTA. The study population consisted of 1,043 South Korean asymptomatic subjects (49 ± 10 years, 62% men) who underwent CCTA (64-slice MDCT). Plaques were classified on contrast-enhanced CCTA as non-calcified, mixed, and calcified on a per-segment basis according to the modified American Heart Association classification. The majority of the study participants had no coronary calcification (n = 866, 83%), whereas CACS> 0 was observed in 177 participants (17%). Only 40 (5%) participants in absence of CACS had exclusively non-calcified plaque, whereas 10 (1.2%) had significant coronary artery disease. With increasing CACS, study participants were more likely to have exclusively mixed or combination atherosclerotic plaques (P = 0.001). Among individuals with CACS 1–10, the prevalence of at least two coronary segments with mixed plaques was 4%, increasing up to 18 and 41% with CACS of 11–100 and >100. The respective prevalence of ≥2 coronary segments (calcified plaques) with increasing CACS were 6%, 16 and 26% (P = 0.01) and of non-calcified plaques were 6%, 6 and 11% (P = 0.71). In multivariable adjusted analyses, those with CACS >100 were 7.17 times (95% CI: 1.36–37.68) more likely to have ≥2 coronary segments with calcified plaque comparing with CACS 1–10. On the other hand the respective risk was higher for presence of ≥2 segments with mixed plaques (odds ratio: 15.81, 95% CI: 3.14–79.58). Absence of CAC is associated with a negligible presence of any atherosclerotic disease as detected by CCTA in asymptomatic population. A higher CACS is more likely to be associated with heterogeneous coronary plaque (combination of calcified, non-calcified, and mixed plaques), and appears to be more strongly associated with a higher burden of mixed plaque.     

Diagnosing coronary artery disease by sound analysis from coronary stenosis induced turbulent blood flow: diagnostic performance in patients with stable angina pectoris

Optimizing risk assessment may reduce use of advanced diagnostic testing in patients with symptoms suggestive of stable coronary artery disease (CAD). Detection of diastolic murmurs from post-stenotic coronary turbulence with an acoustic sensor placed on the chest wall can serve as an easy, safe, and low-cost supplement to assist in the diagnosis of CAD. The aim of this study was to evaluate the diagnostic accuracy of an acoustic test (CAD-score) to detect CAD and compare it to clinical risk stratification and coronary artery calcium score (CACS). We prospectively enrolled patients with symptoms of CAD referred to either coronary computed tomography or invasive coronary angiography (ICA). All patients were tested with the CAD-score system. Obstructive CAD was defined as more than 50 % diameter stenosis diagnosed by quantitative analysis of the ICA. In total, 255 patients were included and obstructive CAD was diagnosed in 63 patients (28 %). Diagnostic accuracy evaluated by receiver operating characteristic curves was 72 % for the CAD-score, which was similar to the Diamond–Forrester clinical risk stratification score, 79 % (p = 0.12), but lower than CACS, 86 % (p < 0.01). Combining the CAD-score and Diamond–Forrester score, AUC increased to 82 %, which was significantly higher than the standalone CAD-score (p < 0.01) and Diamond–Forrester score (p < 0.05). Addition of the CAD-score to the Diamond–Forrester score increased correct reclassification, categorical net-reclassification index = 0.31 (p < 0.01). This study demonstrates the potential use of an acoustic system to identify CAD. The combination of clinical risk scores and an acoustic test seems to optimize patient selection for diagnostic investigation.     

Computed tomography coronary angiography with a consistent dose below 2 mSv using double prospectively ECG-triggered high-pitch spiral acquisition in patients with atrial fibrillation: initial experience

To evaluate the feasibility and imaging quality of double prospectively ECG-triggered high-pitch spiral acquisition mode (double flash mode) for coronary computed tomography angiography (CTCA) in patients with atrial fibrillation (AF). 47 patients (11 women, 36 men; mean age 64.5 ± 12.1 years) were enrolled for CTCA examinations using a dual-source CT with 2 × 128 × 0.6 mm collimation, 0.28 s rotation time and a pitch of 3.4. Double flash mode was prospectively triggered first at 60 % and later at 30 % of the R–R interval within two cardiac cycles. Image quality was evaluated using a four-point scale (1 = excellent, 4 = non-assessable). From 672 coronary artery segments, 77.5 % (521/672) was rated as score of 1, 20.8 % (140/672) as score of 2, 1.2 % (8/672) as score of 3 and 0.4 % (3/672) was rated as ‘non-assessable’. The average image quality score was 1.25 ± 0.38 on a per segment basis. Mean dose-length product for CTCA was 92.6 ± 28.2 mGy cm, the effective dose was 1.30 ± 0.39 mSv (0.64–1.97 mSv). In patients with AF, double prospectively ECG-triggered high-pitch spiral acquisition mode could be a feasible and valuable scan mode for CTCA with a consistent dose below 2 mSv as well as diagnostic imaging quality.     

64排CT冠状动脉成像诊断冠状动脉狭窄的临床价值

目的 评价64排CT冠状动脉成像(CTCA)技术诊断冠状动脉显著狭窄(≥50%管腔狭窄)的临床价值.方法 采用CTCA对61例临床疑诊冠心病患者进行检查,并于CTCA检查后2周内行选择性冠状动脉造影(SCA).结果 1例患者因冠状动脉严重钙化4支血管CTCA不可评估,其余60例患者240支冠状动脉血管CTCA均可良好显影,240支血管显著狭窄诊断的灵敏度、特异度、阳性预测值及阴性预测值分别为90.0%(72/80)、91.9%(147/160)、84.7%(72/85)、94.8%(147/155).结论 CTCA显示了较高的阴性预测值,可以作为排除冠状动脉显著病变的一种无创标准性检查.     

The presence,characterization and prognosis of coronary plaques among patients with zero coronary calcium scores

Patients with coronary artery calcium (CAC) scores of zero are generally considered not to have atherosclerosis. Recent studies involving computed tomography coronary angiography (CTCA) challenge this assumption. This goal of the present study is to assess the frequency, morphology, location, and the prognosis of patients with plaque detected on CTCA and zero CAC. 1,119 patients (51 ± 12 years, 52% male) with a zero CAC score during CTCA study were retrospectively identified. The CTCA studies were assessed for the presence, morphology, location and severity of all coronary plaques. All-cause mortality was assessed. The prevalence of coronary plaque was 13% (147 patients). Among the 212 plaques identified 154 (73%) were non-calcified, 28 (13%) were calcified, and 30 (14%) were of mixed morphology. Notably, ≥70% stenosis was noted among only 0.4% of all patients. ROC analysis revealed that coronary artery disease risk factors did not add to the prediction of plaque among our patients. Over a mean follow-up of 2.5 ± 0.6 years there were 4 deaths (0.4%), all in patients without coronary plaque on CTCA. The presence of coronary plaque is not uncommon among patients with zero CAC scores. These plaques were rarely associated with hemodynamically significant stenoses and were associated with an excellent prognosis. Clinical factors do not appear to be useful in predicting which patients with zero CAC scores have undetected coronary plaque.     

Grade-response relationship between blood pressure and severity of coronary atherosclerosis in asymptomatic adults: assessment with coronary CT angiography

Hypertension is known to be a strong risk factor for coronary atherosclerosis. We aimed to investigate the prevalence, severity, and plaque characteristics of coronary atherosclerosis according to grade of blood pressure (BP) using coronary CT angiography (CCTA) in asymptomatic adults. We enrolled 8,238 asymptomatic subjects who underwent coronary artery calcium scoring (CACS) and CCTA for health screening purposes. Subjects were classified according to JNC 7 guidelines (normal, systolic BP/diastolic BP < 120/80; pre-hypertension [PH], 120–139/80–89; hypertension stage 1 [H1], 140–159/90–99; hypertension stage 2 [H2], >160/100). Isolated systolic hypertension (ISH; systolic BP > 140, diastolic BP < 80) was additionally categorized. With CCTA, the presence of plaques, severity of stenosis, and plaque types were assessed. Using multiple logistic regression analysis, the adjusted odds ratios (AORs) for plaque, obstructive coronary artery disease (CAD) (luminal stenosis ≥50 %), non-calcified plaque (NCP), and CACS > 100 were assessed according to BP grade. After adjustment for clinical risk factors, the risk of subclinical atherosclerosis, NCP, and CACS > 100 gradually increased from PH stage (all P values for trend <0.05), while the risk of obstructive CAD increased from the H1 stage (AORs of H1 and H2: 1.70 and 2.33, respectively). In the ISH group, the AOR of subclinical atherosclerosis (1.64) was higher than in the H1 group (1.55), while the AOR of obstructive CAD (2.58) was higher than in the H2 group (2.33). Therefore, our study strongly suggests that coronary atherosclerosis in asymptomatic adults shows a grade-response relationship according to hypertension grade.     

Prevalence and Significance of Obstructive Coronary Artery Disease in Patients with Zero Coronary Artery Calcium Score

Abundant data have established coronary artery calcium score (CACS) in the algorithm of cardiovascular risk stratification, especially for those at intermediate risk of coronary artery disease (CAD). Absence of CACS is associated with a very low cardiac event rate in asymptomatic individuals and no further imaging is required. Cardiac event rates in symptomatic patients are comparatively higher but still relatively low and have to be interpreted in the context of the population included. Conflicting results from angiography literature with a reported presence of obstructive CAD in up to 39% of mostly symptomatic patients with zero CACS are explained by the higher-risk patients enrolled. CACS is an excellent test for asymptomatic patients in predicting cardiac events and absence of obstructive CAD but has a limited role in symptomatic and higher-risk patients encountered by a cardiovascular specialist, particularly those referred for CT angiography and invasive coronary angiography. This is especially true for relatively young patients (<45 years of age).     

Prevalence and predictors of coronary artery disease in patients with a calcium score of zero

The absence of coronary calcification is associated with an excellent prognosis. However, a calcium score of zero does not exclude the presence of coronary artery disease (CAD) or the possibility of future cardiovascular events. Our aim was to study the prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Prospective registry consisted of 3,012 consecutive patients that underwent cardiac CT (dual source CT). Stable patients referred for evaluation of possible CAD that had a calcium score of zero (n = 864) were selected for this analysis. The variables that were statistically significant were included in a multivariable logistic regression model. From 864 patients with a calcium score of zero, 107 (12.4 %) had coronary plaques on the contrast CT (10.8 %, n = 93 with nonobstructive CAD and 1.6 %, n = 14 with obstructive CAD). By logistic regression analysis, the independent predictors of CAD in this population were age >55 years [odds ratio (OR) 1.63 (1.05–2.52)], hypertension [OR 1.64 (1.05–2.56)] and dyslipidemia [OR 1.54 (1.00–2.36)]. In the presence of these 3 variables, the probability of having coronary plaques was 21 %. The absence of coronary artery calcification does not exclude the presence of coronary artery disease, but the prevalence of obstructive disease is very low. In this population, the independent predictors of CAD in the setting of a calcium score of zero were hypertension, dyslipidemia, and age above 55 years. In the presence of these 3 predictors, the probability of having CAD was almost 2 times higher than in the general population.     

Prognostic values of coronary artery calcium score and 123I-BMIPP SPECT in patients with non-ischemic heart failure with preserved ejection fraction

This study aimed to determine whether coronary artery calcium score (CACS) can be a prognostic indicator for the development of major adverse cardiac events (MACEs) and compare the value of CACS with that of the ¹²³I-betamethyl-p-iodophenyl-pentadecanoic acid (¹²³I-BMIPP) defect score (BDS) in patients with non-ischemic heart failure with preserved ejection fraction (NIHFpEF). Among 643 consecutive patients hospitalized due to acute heart failure, 108 (74?±?13y) were identified to have NIHFpEF on non-contrast regular chest computed tomography and ¹²³I-BMIPP single-photon emission computed tomography (SPECT). We evaluated whether CACS and BDS were associated with MACEs using multivariate Cox models. Thirty-two MACEs developed at a mean follow-up period of 2.4 years. CACS?>?0 (hazard ratio [HR] 2.38, 95% confidence interval [CI] 1.02–5.54) and higher BDS (HR 16.00, 95% CI 5.88–43.49) were significantly associated with the development of MACEs. The proportion of patients who experienced MACEs was significantly higher in the CACS?>?0 and high BDS group than in the CACS?=?0 and low BDS group (3% vs. 75%, p?<?0.001). CACS, as well as BDS, could serve as potential prognostic indicators in patients with NIHFpEF.

     

Optimizing contrast medium injection protocol individually with body weight for high-pitch prospective ECG-triggering coronary CT angiography

To individually optimize contrast medium protocol for high-pitch prospective ECG-triggering coronary CT angiography using body weight. Ninety patients undergoing high-pitch coronary CT angiography were randomly assigned to 3 contrast medium injection protocols with bolus tracking technique: Group A, 0.7 ml CM per kg patient weight (ml/kg); Group B, 0.6 ml/kg; Group C, 0.5 ml/kg. Each group had 30 patients. The CT values of superior vena cava (SVC), pulmonary artery (PA), ascending aorta (AA), left atrium (LA), left ventricle (LV), left main artery (LM) and proximal segment of right coronary artery (RCA) were measured. The image quality of coronary artery was evaluated on per-segment basis using a 4-point scale (1-excellent, 4-non-diagnosis). The CT value was not significantly different on AA (p = 0.735), LM (p = 0.764), and proximal segment of RCA (p = 0.991). The CT value was significantly different on SVC, PA, LA and LV (all p < 0.05). The mean image quality score was 1.6 ± 0.1, 1.6 ± 0.1 and 1.6 ± 0.1 (p = 0.217). The volume of CM was 47 ± 8, 44 ± 8 and 36 ± 6 ml for 3 groups (p < 0.001). The effective radiation dose was 0.88 ± 0.04, 0.87 ± 0.06, and 0.85 ± 0.07 mSv for 3 groups. Contrast medium could be reduced to 0.5 ml/kg for high-pitch coronary CT angiography without compromising diagnostic image quality, which associated ~50 % reduction of total contrast volume compared with standard contrast protocol with test bolus technique.     

多层螺旋CT诊断冠状动脉疾病的发展趋势

多层螺旋CT（multidetector spiral computed tomography，MDCT）在CAD诊断领域的主要适应证有：测定冠状动脉钙化积分（coronary artery calcium score，CACS）、CT冠状动脉造影、评价心肌功能及冠心病（coronary artery disease，CAD）在治疗后的随访。据报道，CACS用于诊断CAD的敏感性范围在68．0％～100％，特异性范围在21．0％～100％。高CACS是一个敏感性很高但特异性相对较低的指标，与常规冠状动脉造影（coronary angiography，CAG）相比，16排MDCT的冠状动脉造影在诊断冠状动脉狭窄（350％）时具有中高度敏感性和高度阴性预测值（negative predictive value，NPV）。与之相比，64排MDCT的敏感性和NPV更高，但特异性与阳性预测值（positive predictive value，PPV）却无明显提高。将冠状动脉形态学与心肌灌注功能研究相结合，是今后CAD的研究方向。     

Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction

We explore the feasibility of coronary calcium subtraction computed tomography angiography (CCTA) in patients with high calcium scores using invasive coronary angiography as the gold standard. Eleven patients with calcium scores of >400 underwent CCTA using a subtraction protocol followed by invasive coronary angiography. In addition to standard reconstructions, subtracted images were obtained using a dedicated subtraction algorithm. A total of 55 calcified segments were evaluated for image quality [using a 4-point scale ranging from 1 (uninterpretable) to 4 (good)] and the presence of significant (≥50 %) luminal stenosis. Conventional and subtracted CCTA were compared using quantitative coronary angiography (QCA) as the gold standard. The average image quality of conventional CCTA was 2.5 ± 0.6 versus 3.1 ± 0.6 on subtraction CCTA (P < 0.001). The percentage of segments with a score 1 or 2 was reduced from 41.8 to 12.7 % after coronary calcium subtraction (P = 0.002). On QCA, significant stenosis was observed in 16 segments. The area under the receiver operating characteristics curve to detect ≥50 % stenosis on QCA increased from 0.741 [95 % confidence interval (CI) 0.598–0.885] for conventional CCTA to 0.905 (95 % CI 0.791–1.000) for subtraction CCTA (P = 0.003). In patients with extensive calcifications undergoing CCTA, coronary calcium subtraction may improve the evaluation of calcified segments.     

Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering

In patients with large total blood volume contrast material (CM) dilution decreases coronary attenuation in CT coronary angiography (CTCA). As increased blood volume is well paralleled by body surface area (BSA) we assessed a BSA-adapted CM protocol to compensate for dilution effects. Low-dose CTCA with prospective ECG-triggering was performed in 80 patients with a BSA-adapted CM bolus ranging 40–105 ml and injection rate ranging 3.5–5.0 ml/s for a BSA of <1.70 to ≥2.5 m². Eighty control patients matched for BSA who had previously undergone routine CTCA with a fixed CM protocol of 80 ml at 5 ml/s served as reference group. The average vessel attenuation from the proximal right (RCA) and the left main coronary artery (LMA) was assessed. Correlation of BSA with vessel attenuation was assessed in both groups. BSA-matching of all patients was successful (BSA-adapted group 1.98 ± 0.15 m², range 1.66–2.39 m² versus reference group 1.98 ± 0.17 m², range 1.59–2.38 m²; P = 0.74). Mean CM bolus was significantly smaller in the BSA-adapted versus the reference group (70.9 ± 14.1 vs. 80.0 ± 0 ml, P < 0.001). There was no correlation in the BSA-adapted group (r = ?0.07, P = 0.53, SEE = 0.15), while coronary attenuation was inversely related to BSA in the reference group (r = ?0.59, P < 0.001, SEE = 0.14). We have successfully validated a BSA-adapted contrast material protocol which results in a comparable coronary contrast enhancement independent of individual BSA. This was achieved despite a significant reduction in the overall contrast material amount.     

Coronary artery calcium scores and cardiovascular risk factors in 31,545 asymptomatic Korean adults

The aims of this study were to identify the distribution of coronary artery calcium score (CACS) by age group and cardiovascular (CV) risk factors and to evaluate the association between CV risk factors and CACS classification in asymptomatic adults. The study included 31,545 asymptomatic Koreans, over 20 years of age with no previous history of malignancy, proven coronary artery disease, or stroke, who underwent CACS computed tomography at the Health Promotion Center, Samsung Medical Center, between January 2005 and June 2013. Mean (±SD) age was 53.8 (±8.5) years overall, 56.1 (±8.3) in men, and 53.3 (±8.5) in women. They were classified into five groups based on their resting CACS: none (CAC?=?0), minimal (0?<?CAC?≤?10), mild (10?<?CAC?≤?100), moderate (100?<?CAC?≤?400), and extensive (400?>?CAC). Older age groups exhibited higher CACS values. The proportion of CACS classification in our study was 55.5?% with no CACS, 9.5?% with minimal CACS, 19.8?% with mild CACS, 10.8?% with moderate CACS, and 4.3?% with extensive CACS. Adjusted odds ratios (ORs) were calculated for CV risk factors to determine their association with CACS. When analyzed according to sex, in males, the adjusted OR for CACS increased with the presence of hypertension (HT), diabetes mellitus (DM), obesity, chronic kidney disease, and smoking status. While, in females, the adjusted OR for CACS increased with the presence of HT, DM, and obesity. CV risk factors appear to be significantly associated with CACS in the Korean population.     

Fusion of CT coronary angiography and whole-heart dynamic 3D cardiac MR perfusion: building a framework for comprehensive cardiac imaging

The purpose of this work was to develop a framework for 3D fusion of CT coronary angiography (CTCA) and whole-heart dynamic 3D cardiac magnetic resonance perfusion (3D-CMR-Perf) image data—correlating coronary artery stenoses to stress-induced myocardial perfusion deficits for the assessment of coronary artery disease (CAD). Twenty-three patients who underwent CTCA and 3D-CMR-Perf for various indications were included retrospectively. For CTCA, image quality and coronary diameter stenoses >?50% were documented. For 3D-CMR-Perf, image quality and stress-induced perfusion deficits were noted. A software framework was developed to allow for 3D image fusion of both datasets. Computation steps included: (1) fully automated segmentation of coronary arteries and heart contours from CT; (2) manual segmentation of the left ventricle in 3D-CMR-Perf images; (3) semi-automatic co-registration of CT/CMR datasets; (4) projection of the 3D-CMR-Perf values on the CT left ventricle. 3D fusion analysis was compared to separate inspection of CTCA and 3D-CMR-Perf data. CT and CMR scans resulted in an image quality being rated as good to excellent (mean scores 3.5?±?0.5 and 3.7?±?0.4, respectively, scale 1–4). 3D-fusion was feasible in all 23 patients, and perfusion deficits could be correlated to culprit coronary lesions in all but one case (22/23?=?96%). Compared to separate analysis of CT and CMR data, coronary supply territories of 3D-CMR-Perf perfusion deficits were refined in two cases (2/23?=?9%), and the relevance of stenoses in CTCA was re-judged in four cases (4/23?=?17%). In conclusion, 3D fusion of CTCA/3D-CMR-Perf facilitates anatomic correlation of coronary lesions and stress-induced myocardial perfusion deficits thereby helping to refine diagnostic assessment of CAD.