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Clinical significance of transluminal attenuation gradient in 320-row area detector coronary CT angiography

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Abstract

The clinical significance of the transluminal attenuation gradient (TAG) has not been established. We evaluated the incremental diagnostic value of TAG by 320-row area detector computed tomography (320-ADCT). Subjects were 65 patients who underwent one-rotation scanning by 320-ADCT and invasive coronary angiography (ICA) within 3 months. TAG values were obtained for the major epicardial vessels 2 mm or more each in RCA, LAD and LCX using automatic analysis software. Moreover, TAG values that excluded calcified lesions in calculation of the regression line were also evaluated (excluded-TAG). In LAD, 21 intermediate lesions underwent functional flow reserve (FFR), and the incremental diagnostic value for functional stenosis was evaluated. The TAG values in the normal vessels were − 8.3 ± 5.0 (HU/cm) for the RCA (n = 32), − 23.3 ± 4.3 for the LAD (n = 9) and − 20.6 ± 10.0 for the LCX (n = 32). The RCA value was significantly higher (p < 0.001). The TAG values with stenosis degrees of ≤ 25%, 26–75%, ≥ 76% on ICA were − 8.3 ± 5.0 (n = 32) vs − 10.3 ± 7.2 (n = 25) vs − 10.0 ± 5.4 (n = 4) in the RCA, − 23.3 ± 4.3 (n = 9) vs − 21.0 ± 11.5 (n = 35) vs − 23.5 ± 15.3 (n = 10) in the LAD and − 21.1 ± 15.1 (n = 32) vs − 21.1 ± 15.1 (n = 16) vs − 17.7 ± 15.7 (n = 6) in the LCX, with no significant difference among the three groups. The excluded-TAG values also showed no significant difference. The area under the curve in the diagnosis of FFR < 0.8 in 21 LAD cases was 0.542 for CT only, 0.694 for CT + TAG, and 0.694 for CT + excluded-TAG. In single time-phase scanning by 320-ADCT, TAG does not offer an incremental diagnostic value.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan

    Etsuro Kato, Shinichiro Fujimoto, Kazuhisa Takamura, Yuko Kawaguchi, Chihiro Aoshima, Makoto Hiki & Hiroyuki Daida

  2. Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Kanako K. Kumamaru

Authors
  1. Etsuro Kato
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  2. Shinichiro Fujimoto
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  3. Kazuhisa Takamura
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  4. Yuko Kawaguchi
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  5. Chihiro Aoshima
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  6. Makoto Hiki
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  7. Kanako K. Kumamaru
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  8. Hiroyuki Daida
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Correspondence to Shinichiro Fujimoto.

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Conflict of interest

Dr. Daida has received speakers’ Bureau/Honoraria from Astellas Pharma Inc., AstraZeneca K. K., MSD. K. K., Kyowa Hakko Kirin Company, Ltd., Kowa Pharmaceutical Company, Ltd., Daiichi-Sankyo Company, Ltd., Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corp., Bayer Yakuhin, Ltd., as well as research funds from Kyowa Hakko Kirin Company Ltd., Philips Electronics Japan, Ltd. Astellas Pharma Inc., ABBOTT JAPAN CO., Ltd., Sanofi K. K., Eisai Co., Ltd., Shionogi & Co., Ltd., Daiichi-Sankyo Company, Ltd., Dainippon Sumitomo Pharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Bayer Yakuhin, Ltd., Pfizer Co., Ltd., Philips Electronics Japan, Ltd., FUJIFILM Corporation, Bristol-Myers Squibb Company, Boston Scientific Japan K. K., SANWA KAGAKU KENKYUSHO Co., Ltd., MSD. K. K. and Toshiba Medical Systems that are unrelated to this project. All other authors have no potential conflict of interest.

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Kato, E., Fujimoto, S., Takamura, K. et al. Clinical significance of transluminal attenuation gradient in 320-row area detector coronary CT angiography. Heart Vessels 33, 462–469 (2018). https://doi.org/10.1007/s00380-017-1081-5

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  • DOI: https://doi.org/10.1007/s00380-017-1081-5

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