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Quantification of Nonculprit Coronary Lesions: Comparison of Cardiac 64-MDCT and Invasive Coronary Angiography

¹ Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
² Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
³ Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
⁴ Department of Medicine 2, University Hospital Erlangen, Erlangen, Germany.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Graph shows correlation between CT cross-sectional area and quantitative coronary angiography for degree of stenosis of nonculprit coronary lesions (R = 0.59, p < 0.05).

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Quantitative coronary angiography (QCA) image of proximal RCA shows 38% stenosis.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Corresponding maximum-intensity-projection (MIP) diameter-analysis CT image shows 45% stenosis. Measurements 1, 2, and 3 are of proximal, nonculprit lesion, and distal reference segments.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Cross-sectional MDCT multiplanar reformat (MPR) diameter-analysis images through proximal (C), nonculprit lesion (D), and distal reference (E) segments show 46% stenosis. Note that calcified plaque (arrow, D) was excluded from luminal diameter measurements.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Cross-sectional MDCT multiplanar reformat (MPR) diameter-analysis images through proximal (C), nonculprit lesion (D), and distal reference (E) segments show 46% stenosis. Note that calcified plaque (arrow, D) was excluded from luminal diameter measurements.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Cross-sectional MDCT multiplanar reformat (MPR) diameter-analysis images through proximal (C), nonculprit lesion (D), and distal reference (E) segments show 46% stenosis. Note that calcified plaque (arrow, D) was excluded from luminal diameter measurements.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). CT cross-sectional luminal area analysis images through proximal (F), nonculprit lesion (G), and distal reference (H) segments show 56% stenosis. Note that plaque (arrow, G) was excluded from luminal diameter measurements.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2G —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). CT cross-sectional luminal area analysis images through proximal (F), nonculprit lesion (G), and distal reference (H) segments show 56% stenosis. Note that plaque (arrow, G) was excluded from luminal diameter measurements.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2H —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). CT cross-sectional luminal area analysis images through proximal (F), nonculprit lesion (G), and distal reference (H) segments show 56% stenosis. Note that plaque (arrow, G) was excluded from luminal diameter measurements.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2I —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Coronary artery software area analysis of MDCT images for proximal (I), nonculprit lesion (J), and distal reference (K) segments shows 40% stenosis. Note software was unable to exclude some mixed plaque (arrow, J) from analysis despite manual window adjustments, resulting in some falsely high luminal measurements.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2J —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Coronary artery software area analysis of MDCT images for proximal (I), nonculprit lesion (J), and distal reference (K) segments shows 40% stenosis. Note software was unable to exclude some mixed plaque (arrow, J) from analysis despite manual window adjustments, resulting in some falsely high luminal measurements.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2K —53-year-old man with acute coronary syndrome. Invasive coronary angiography showed culprit lesion (> 75% stenosis) in left anterior descending coronary artery territory (not shown), which was stented. Nonculprit coronary lesion was identified in proximal segment of right coronary artery (RCA). Coronary artery software area analysis of MDCT images for proximal (I), nonculprit lesion (J), and distal reference (K) segments shows 40% stenosis. Note software was unable to exclude some mixed plaque (arrow, J) from analysis despite manual window adjustments, resulting in some falsely high luminal measurements.

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