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125 ct based characterization
1. Editorial Slides
VP Watch – December 18, 2002 - Volume 2, Issue 50
Is CT-Based Characterization Of CoronaryIs CT-Based Characterization Of Coronary
Plaque/Artery Possible?Plaque/Artery Possible?
Provided by:
P.J. de Feijter, M.D.
Department of Cardiology and Radiology, Erasmus University
Rotterdam, The Netherlands
2. MS-CT : Goal
Visualizing and characterizing the diseased coronary
arterial wall in living patients. To evaluate:
- progression / regression
- risk factor modification
- coronary plaque treatment
- vulnerability to rupture
- site and extent of coronary obstruction
3. Milestones in Coronary Plaque
Imaging with (MS)-CT
- First EBCT coronary angiography
Achenbach NEJM 1998;339:1964
Rensing Circulation 1998; 98:2509
- First 4 slice MS-CT coronary angiography
Nieman Lancet 2001; 357: 599
- First in vivo 4 slice MS-CT coronary plaque imaging
Schroeder S. et al JACC 2001;37:1430-5
- First 16 slice MS-CT coronary angiography
Nieman Circulation 2002; 106: 2051
- Preliminary results 16 slice MS-CT
coronary plaque imaging
4. Coronary Plaque Imaging :
the “extreme” challenge
- small caliber vessels
- small size of plaques
- continuous cardiac and respiratory motion
- calcification (obscures underlying structures)
- modest attenuation variation between lipid-rich
and fibrous tissue components
5. 16 Slice MS-CT Coronary
Angiography
Suspected CAD : 58 subjects (53 male; 58 ± 12 yrs)
Average heart rate : 56 ± 6 b.p.m. (with additional ß-blocker)
Detection of ≥ 50% stenosis in all coronary vessels > 2.0mm
No exclusion of vessels (or segments)
Sensitivity : 95% Pos.Pred.Value : 80%
Specificity : 86% Neg.Pred.Value : 97%
Nieman Circulation 2002;106:2051
13. Work-Up High Risk Patients
Clinical presentation
< 60 yrs old Diabetes Acute coronary syndrome
Biochemical markers
Elevated C-PR
Non-invasive MS-CT
Localization of plaque Characterization of plaque
Invasive techniques
IVUS Palpography Thermography OCT
14. As reported in this week’s VP
Watch, Teichholz et al. showed
quantitative assessment of
atherosclerosis by EBT.
Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography.
Am J Cardiol. 2002 Dec 15;90(12):1416-9.
15. They showed 3 new EBT parameters for
a region of interest (ROI):
Mean value of Hounsfield Units (HU) within
the ROI
Standard deviation (SD) of HU within the
ROI
Percent of voxels with HU < 0 within the ROI
Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography.
Am J Cardiol. 2002 Dec 15;90(12):1416-9.
16. The mean voxel intensity (HU) within the ROI in
the proximal LAD was lower in patients with CAD
compared to normals subjects.
The standard deviation of voxel intensities within
the ROI in the proximal LAD was higher in patients
with CAD as compared to normal subjects.
The percent of voxels with HU < 0 within the ROI
in the proximal LAD was higher in patients with
CAD.
Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography.
Am J Cardiol. 2002 Dec 15;90(12):1416-9.
18. • 16 MS-CT Coronary Imaging:
– A reliable non-invasive technique to detect
coronary obstructions if combined with intensive
heart rate control to <65 b.p.m.
– Can be used for identification of soft, intermediate
and calcific plaques.
– Offers great potential as an initial non-invasive
technique to identify vulnerable plaque / artery in
at risk population
Conclusion:
19. Conclusion:
• Growing body of evidence suggest
that CT-based characterization of
coronary plaques and/or artery is
possible, and this technology may
serve as the first line imaging tool for
screening vulnerable patients.
• Combination of CT with serum
markers of vulnerability may provide a
much more powerful predictive value.
20. Department of Cardiology1
and
Radiology2
Erasmus University
Rotterdam, The Netherlands
P.J. de Feijter1, 2
K. Nieman1 2
N.R.A. Mollet1 2
R. Raaijmakers2
F. Cademartiri2
J. Ligthart1
P. Lemos1
P.Pattynama2
P.W. Serruys1
Most of the Editorial Slides of this week were provided
by Dr de Feijter and his colleagues: