Top

Published in:

01-12-2008 | Cardiac

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

Authors: Sebastian Leschka, Paul Stolzmann, Hans Scheffel, Simon Wildermuth, André Plass, Michele Genoni, Borut Marincek, Hatem Alkadhi

Published in: European Radiology | Issue 12/2008

Abstract

To assess the prevalence and morphological characteristics of coronary artery ectasia (CAE) with CT coronary angiography (CTCA) in comparison to conventional catheterangiography (CCA). Dual-source CTCA examinations from 677 consecutive patients (223 women; median age 57 years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement ≥1.5 times the diameter of adjacent normal coronary segments. Vessel diameters and contrast attenuation within and proximal to ectatic segments were measured. CCA was used to compare measurements obtained from CTCA with the coronary flow velocity by using the thrombolysis in myocardial infarction (TIMI) frame count. CTCA identified CAE in 20 of 677 (3%) patients. CCA was performed in ten of these patients. CAE diameter measurements with CTCA (10.0 ± 5.4 mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 ± 4.9 mm), but had higher diameters (levels of agreement: −1.0 to 3.4 mm). Contrast attenuation was significantly lower in the ectatic (343 ± 63 HU) than in the proximal (394 ± 60 HU) segments (p < 0.01). The attenuation difference significantly correlated with the CAE ratio (r = 0.67, p < 0.01) and the TIMI frame count (r = 0.58, p < 0.05). The prevalence of CAE in a population examined by CTCA is around 3%. Contrast attenuation measurements with CTCA correlate well with the flow alterations assessed with CCA.

Falsetti HL, Carrol RJ (1976) Coronary artery aneurysm. A review of the literature with a report of 11 new cases. Chest 69:630–636PubMedCrossRef

Swaye PS, Fisher LD, Litwin P et al (1983) Aneurysmal coronary artery disease. Circulation 67:134–138PubMed

Manginas A, Cokkinos DV (2006) Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur Heart J 27:1026–1031PubMedCrossRef

Lam CS, Ho KT (2004) Coronary artery ectasia: a 10-year experience in a tertiary hospital in Singapore. Ann Acad Med Singapore 33:419–422PubMed

Suzuki H, Takeyama Y, Hamazaki Y et al (1994) Coronary spasm in patients with coronary ectasia. Cathet Cardiovasc Diagn 32:1–7PubMedCrossRef

Kruger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A (1999) Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms (“dilated coronopathy”). J Am Coll Cardiol 34:1461–1470PubMedCrossRef

Perlman PE, Ridgeway NA (1989) Thrombosis and anticoagulation therapy in coronary ectasia. Clin Cardiol 12:541–542PubMedCrossRef

Huikuri HV, Mallon SM, Myerburg RJ (1991) Cardiac arrest due to spontaneous coronary artery dissection in a patient with coronary ectasia-a case report. Angiology 42:148–151PubMedCrossRef

Satoda M, Tatsukawa H, Katoh S (1998) Images in cardiovascular medicine. Sudden death due to rupture of coronary aneurysm in a 26-year-old man. Circulation 97:705–706PubMed

10.

Ramappa P, Kottam A, Kuivanemi H, Thatai D (2007) Coronary artery ectasia - is it time for a reappraisal? Clin Cardiol 30:214–217PubMedCrossRef

11.

Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R (1976) Clinical significance of coronary arterial ectasia. Am J Cardiol 37:217–222PubMedCrossRef

12.

Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154PubMedCrossRef

13.

Leschka S, Alkadhi H, Plass A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487PubMedCrossRef

14.

Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323PubMedCrossRef

15.

Ong TK, Chin SP, Liew CK et al (2006) Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. Am Heart J 151:1323 e1321–1323 e1326

16.

Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557PubMedCrossRef

17.

Achenbach S, Ropers D, Kuettner A et al (2006) Contrast-enhanced coronary artery visualization by dual-source computed tomography-initial experience. Eur J Radiol 57:331–335PubMedCrossRef

18.

Flohr TG, McCollough CH, Bruder H et al (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268PubMedCrossRef

19.

Scheffel H, Alkadhi H, Plass A et al (2006) Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control. Eur Radiol 16:2739–2747PubMedCrossRef

20.

Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791PubMedCrossRef

21.

Fox K, Garcia MA, Ardissino D et al (2006) Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 27:1341–1381PubMedCrossRef

22.

Hendel RC, Patel MR, Kramer CM et al (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48:1475–1497PubMedCrossRef

23.

Wells TA, Peebles CR, Gray HG (2008) Giant left anterior descending coronary artery aneurysm. Int J Cardiol 126(2):e27–e28 Epub 2007 Mar 28PubMedCrossRef

24.

Goz M, Cakir O (2007) Multiple coronary artery aneurysms that cause thrombosis: 22-month follow-up results with multi-slice spiral computerized tomography without surgery. Int J Cardiol 119(2):e48–e50 Epub 2007 May 2PubMedCrossRef

25.

Morise AP, Haddad WJ, Beckner D (1997) Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med 102:350–356PubMedCrossRef

26.

Leschka S, Scheffel H, Desbiolles L et al (2007) Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG pulsing windowing. Invest Radiol 42:543–549PubMedCrossRef

27.

Stolzmann P, Scheffel H, Schertler T et al (2008) Radiation dose estimates in dual-source computed tomography coronary angiography. Eur Radiol 18:592–599PubMedCrossRef

28.

Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40PubMed

29.

Gibson CM, Cannon CP, Daley WL et al (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–888PubMed

30.

Aintablian A, Hamby RI, Hoffman I, Kramer RJ (1978) Coronary ectasia: incidence and results of coronary bypass surgery. Am Heart J 96:309–315PubMedCrossRef

31.

Hartnell GG, Parnell BM, Pridie RB (1985) Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J 54:392–395PubMedCrossRef

32.

Frauenfelder T, Boutsianis E, Schertler T et al (2007) In-vivo flow simulation in coronary arteries based on computed tomography datasets: feasibility and initial results. Eur Radiol 17:1291–1300PubMedCrossRef

33.

Akyurek O, Berkalp B, Sayin T, Kumbasar D, Kervancioglu C, Oral D (2003) Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 145:66–72PubMedCrossRef

34.

Hamaoka K, Onouchi Z, Kamiya Y, Sakata K (1998) Evaluation of coronary flow velocity dynamics and flow reserve in patients with Kawasaki disease by means of a Doppler guide wire. J Am Coll Cardiol 31:833–840PubMedCrossRef

35.

Papadakis MC, Manginas A, Cotileas P et al (2001) Documentation of slow coronary flow by the TIMI frame count in patients with coronary ectasia. Am J Cardiol 88:1030–1032PubMedCrossRef

36.

Kosar F, Acikgoz N, Sahin I, Topal E, Aksoy Y, Cehreli S (2005) Effect of ectasia size or the ectasia ratio on the thrombosis in myocardial infarction frame count in patients with isolated coronary artery ectasia. Heart Vessels 20:199–202PubMedCrossRef

Title: Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography
Authors: Sebastian Leschka
Paul Stolzmann
Hans Scheffel
Simon Wildermuth
André Plass
Michele Genoni
Borut Marincek
Hatem Alkadhi
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 12/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1087-6

At a glance: The STEP trials

Springer Medicine

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2008

New observations concerning the interpretation of magnetic resonance spectroscopy of meningioma

Automated classification of normal and pathologic pulmonary tissue by topological texture features extracted from multi-detector CT in 3D

Differentiation of total occlusion and high-grade stenosis in coronary CT angiography

Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data

Value of comprehensive renal ultrasound in children with acute urinary tract infection for assessment of renal involvement: comparison with DMSA scintigraphy and final diagnosis

Training on a vascular interventional simulator: an observational study