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Clinical Value of MDCT in the Diagnosis of Coronary Artery Disease in Patients with a Low Pretest Likelihood of Significant Disease

Konstantin Nikolaou1, Carsten Rist1, Bernd J. Wintersperger1, Tobias F. Jakobs1, Roland van Gessel2, Miles A. Kirchin3, Andreas Knez4, Franz von Ziegler4, Maximilian F. Reiser1 and Christoph R. Becker1

1 Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University of Munich, Grosshadern Campus, Marchioninistr. 15, Munich 81377, Germany.
2 Bracco Altana Pharma GmbH, Konstanz, Germany.
3 Worldwide Medical Affairs, Bracco Imaging SpA, Milan, Italy.
4 Department of Cardiology, University Hospitals-Grosshadern, Ludwig-Maximilians University of Munich, Munich, Germany.


Figure 1
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  		Fig. 1A —64-year-old woman with atypical chest pain. Conventional X-ray angiography image shows significant stenosis (55%) in left anterior descending coronary artery (arrow) and stenosis of first diagonal branch (arrowhead).

 

Figure 2
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  		Fig. 1B —64-year-old woman with atypical chest pain. Stenoses are clearly visible (arrows, arrowheads) on multiplanar reformatted image (multiplanar reconstruction, B), volume-rendered image (C), and maximum intensity projection (D) of 16-MDCT data set. Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle.

 

Figure 3
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  		Fig. 1C —64-year-old woman with atypical chest pain. Stenoses are clearly visible (arrows, arrowheads) on multiplanar reformatted image (multiplanar reconstruction, B), volume-rendered image (C), and maximum intensity projection (D) of 16-MDCT data set. Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle.

 

Figure 4
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  		Fig. 1D —64-year-old woman with atypical chest pain. Stenoses are clearly visible (arrows, arrowheads) on multiplanar reformatted image (multiplanar reconstruction, B), volume-rendered image (C), and maximum intensity projection (D) of 16-MDCT data set. Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle.

 

Figure 5
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  		Fig. 2A —70-year-old woman with noncardiac chest pain. Conventional X-ray angiography image shows significant stenosis (51%) in left anterior descending coronary artery (arrow).

 

Figure 6
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  		Fig. 2B —70-year-old woman with noncardiac chest pain. Mixed plaque (arrows) causing this stenosis can be identified in multiplanar reconstruction (B), volume-rendered image (C), and maximum intensity projection (D) of MDCT images. Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle, RV = right ventricle.

 

Figure 7
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  		Fig. 2C —70-year-old woman with noncardiac chest pain. Mixed plaque (arrows) causing this stenosis can be identified in multiplanar reconstruction (B), volume-rendered image (C), and maximum intensity projection (D) of MDCT images. Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle, RV = right ventricle.

 

Figure 8
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  		Fig. 2D —70-year-old woman with noncardiac chest pain. Mixed plaque (arrows) causing this stenosis can be identified in multiplanar reconstruction (B), volume-rendered image (C), and maximum intensity projection (D) of MDCT images. Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle, RV = right ventricle.

 

Figure 9
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  		Fig. 3A —55-year-old man with noncardiac chest pain and high-risk-factor profile. No significant stenosis can be found by invasive catheterization in left anterior descending coronary artery (LAD) (arrow).

 

Figure 10
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  		Fig. 3B —55-year-old man with noncardiac chest pain and high-risk-factor profile. MDCT multiplanar reconstruction (B), volume-rendered image (C), and maximum intensity projection (D) reveal false-positive significant stenosis (arrows) caused by mixed plaque in course of LAD between branching of first and second diagonal branches. However, this visual effect was an artifact because large plaque grows toward outside border of vessel, but lumen diameter as compared with pre- and postdiseased vessel segments is preserved (positive remodeling effect). Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle, RV = right ventricle.

 

Figure 11
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  		Fig. 3C —55-year-old man with noncardiac chest pain and high-risk-factor profile. MDCT multiplanar reconstruction (B), volume-rendered image (C), and maximum intensity projection (D) reveal false-positive significant stenosis (arrows) caused by mixed plaque in course of LAD between branching of first and second diagonal branches. However, this visual effect was an artifact because large plaque grows toward outside border of vessel, but lumen diameter as compared with pre- and postdiseased vessel segments is preserved (positive remodeling effect). Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle, RV = right ventricle.

 

Figure 12
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  		Fig. 3D —55-year-old man with noncardiac chest pain and high-risk-factor profile. MDCT multiplanar reconstruction (B), volume-rendered image (C), and maximum intensity projection (D) reveal false-positive significant stenosis (arrows) caused by mixed plaque in course of LAD between branching of first and second diagonal branches. However, this visual effect was an artifact because large plaque grows toward outside border of vessel, but lumen diameter as compared with pre- and postdiseased vessel segments is preserved (positive remodeling effect). Ao = aorta, LA = left atrium, PA = pulmonary artery, LV = left ventricle, RV = right ventricle.

 

Figure 13
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  		Fig. 4A —Receiver operating characteristic (ROC) curve analysis compares diagnostic accuracy for correct detection of significant coronary artery disease on per-patient basis. ROC curves show diagnostic accuracy of iomeprol 300 group (A), iomeprol 400 group (B), and combined patient population (C). AUC = area under the curve.

 

Figure 14
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  		Fig. 4B —Receiver operating characteristic (ROC) curve analysis compares diagnostic accuracy for correct detection of significant coronary artery disease on per-patient basis. ROC curves show diagnostic accuracy of iomeprol 300 group (A), iomeprol 400 group (B), and combined patient population (C). AUC = area under the curve.

 

Figure 15
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  		Fig. 4C —Receiver operating characteristic (ROC) curve analysis compares diagnostic accuracy for correct detection of significant coronary artery disease on per-patient basis. ROC curves show diagnostic accuracy of iomeprol 300 group (A), iomeprol 400 group (B), and combined patient population (C). AUC = area under the curve.

 

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