Noninvasive analysis of coronary artery disease with combination of MDCT and functional MRI

Acad Radiol. 2006 Feb;13(2):177-85. doi: 10.1016/j.acra.2005.10.003.

Abstract

Rationale and objectives: We evaluated the diagnostic accuracy of an eight-row multidetector computed tomography coronary angiography (MDCT-CA) in detecting high-grade (>50%) stenoses in the three main coronary arteries in patients with coronary artery disease (CAD). Side branches were excluded. We correlated magnetic resonance imaging (MRI) findings of the myocardium with MDCT-CA of the coronary arteries.

Materials and methods: Fourteen CAD patients underwent conventional coronary angiography (CCA), MDCT-CA, and MRI. We determined the calcium burden with non-enhanced MDCT scan. Then MDCT-CA was performed after intravenous contrast injection during a single breathhold. The left ventricular (LV) MR cine imaging was assessed at rest and perfusion defects were observed during pharmacologic stress after contrast administration. Delayed contrast-enhanced MRI was performed to picture infarctions.

Results: MDCT-CA had sensitivity 82%, specificity 94%, positive predictive value 79%, and negative predictive value 95% of stenoses of more than 50% in the main coronary arteries when compared with CCA. LV wall dysfunction, perfusion defects, and infarctions were detected in 50%-78% of sectors assigned to calcifications or stenoses, but also in sectors supplied by normally perfused coronary arteries.

Conclusions: CCA and MDCT-CA revealed comparable results in evaluating stenotic lesions above 50% in the main subepicardial coronary branches. There were no significant correlations between the degree of stenosis or calcification at MDCT-CA and the MR findings, but the combined information of MDCT-CA and MRI showed the variability of myocardial changes in regions perfused by significantly stenosed, calcified, and normal main coronary arteries.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Calcinosis / diagnostic imaging
  • Calcinosis / pathology
  • Calcinosis / physiopathology
  • Contrast Media / administration & dosage
  • Coronary Angiography
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / pathology*
  • Coronary Stenosis / physiopathology
  • False Negative Reactions
  • Female
  • Heart Rate / drug effects
  • Humans
  • Image Enhancement
  • Injections, Intravenous
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Myocardium / pathology
  • Observer Variation
  • Perfusion
  • Predictive Value of Tests
  • Severity of Illness Index
  • Tomography, X-Ray Computed*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / pathology
  • Ventricular Dysfunction, Left / physiopathology

Substances

  • Contrast Media