Coronary artery disease
Noninvasive Assessment of Coronary Plaque Burden Using Multislice Computed Tomography

https://doi.org/10.1016/j.amjcard.2005.01.043Get rights and content

We performed coronary plaque imaging with 16-row multislice computed tomography in 85 patients who had stable angina pectoris and a high pretest likelihood of having coronary plaque to evaluate plaque burden, i.e., extent (number of diseased coronary segments) and size (small vs large) of plaque. We also assessed type of plaque (calcified, noncalcified, or mixed) and its anatomic distribution. Of 85 patients included, 78 (92%) had fully evaluable multislice computed tomograms that allowed assessment of coronary plaque burden, including major and side branches (≥2 mm), yielding a total of 855 segments. These 78 patients (92% men; mean age ± SD 58 ± 11.5 years) were in sinus rhythm, with heart rates of <70 beats/min (spontaneous or induced by β blocker). Plaque was detected in 57% of all segments (487 of 855). The mean number of segments with plaque per patient ± SD was 6.2 ± 3.9. Plaque was classified as large in 33% of segments and small in 67%. Overall, 65% of plaques were calcified, 24% were noncalcified, and 11% were mixed. Plaques were predominantly located in the proximal and middle segments of the main coronary vessels.

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Methods

Over a 4-month period, 85 patients who had stable angina pectoris underwent 16-row MSCT coronary angiography and conventional coronary angiography. Patients were eligible for inclusion if they were in sinus rhythm with a heart rate of <70 beats/min (spontaneously or after oral β blockade), and were able to hold their breath for 20 seconds. Patients who had known allergy to contrast media, impaired renal function (serum creatinine >120 mmol/L), acute coronary syndromes, and previous coronary

Results

Over a 4-month period, 85 eligible patients who had stable angina underwent multislice computed tomography. The mean interval between conventional coronary angiography and multislice computed tomography was 13 ± 5.2 days. Multislice computed tomograms were not of diagnostic quality in 7 patients. Motion artifacts were present in 6 patients due to premature beats2 or residual motion despite a heart rate of <70 beats/min.4 Extravasation of contrast material during the injection resulted in low

Discussion

The major objectives of noninvasive imaging of coronary arteries are to identify significant luminal stenoses and to identify plaques that may become responsible for an acute coronary syndrome.

The diagnostic performance of current 16-row MSCT scanners in the detection of significant (>50% luminal decrease) coronary plaques has been reported.12, 13, 14 The sensitivity has been reported to be 92% to 95% with a specificity of 86% to 93% compared with invasive conventional coronary angiography. Our

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