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Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 10/2014

01-10-2014 | Cardiac Computed Tomography (S Achenbach and T Villines, Section Editor)

Patterns of Opacification in Coronary CT Angiography: Contrast Differences and Gradients

Authors: Frank J. Rybicki, Yu-Hsiang Juan, Sachin S. Saboo, Elizabeth George, Rani Sewatkar, Dimitrios Mitsouras

Published in: Current Cardiovascular Imaging Reports | Issue 10/2014

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Abstract

Iodinated contrast delivery is a key component of coronary computed tomography (CT) angiography. However, the purpose of contrast delivery has been limited to morphology alone. Specifically, iodine opacification of the coronary lumen has been used to separate it from the coronary artery wall and lesions within the coronary arteries. Because contrast is delivered to the coronary arteries according to the coronary blood flow, there is flow information encoded within the contrast opacification which, depending on CT hardware and acquisition protocol, can be recognized in coronary CT angiography. In addition, metrics related to flow have been identified and studied. They include coronary contrast opacification differences and contrast opacification gradients.
Literature
1.
Mark DB, Berman DS, Budoff MJ, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010;55(23):2663–99.PubMedCrossRef
2.
Rochitte CE, George RT, Chen MY, et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J. 2014;35(17):1120–30.
3.
Yoon YE, Koo BK. Noninvasive functional assessment using computed tomography: when will they be ready for clinical use? Cardiovasc Diagn Ther. 2012;2(2):106–12.PubMedCentralPubMed
4.
Vavere AL, Simon GG, George RT, et al. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. J Cardiovasc Comput Tomogr. 2011;5(6):370–81.PubMedCrossRef
5.
George RT, Arbab-Zadeh A, Cerci RJ, et al. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320-MDCT: the CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study. AJR Am J Roentgenol. 2011;197(4):829–37.PubMedCentralPubMedCrossRef
6.
7.
8.
Rybicki FJ, Otero HJ, Steigner ML, et al. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging. 2008;24(5):535–46.PubMedCrossRef
9.
Lackner K, Bovenschulte H, Stutzer H, et al. In vitro measurements of flow using multislice computed tomography (MSCT). Int J Cardiovasc Imaging. 2011;27(6):795–804.PubMedCrossRef
10.
Nagao M, Kido T, Watanabe K, et al. Functional assessment of coronary artery flow using adenosine stress dual-energy CT: a preliminary study. Int J Cardiovasc Imaging. 2011;27(3):471–81.PubMedCentralPubMedCrossRef
11.
de Feyter PJ. CT functional imaging using intracoronary gradient analysis: an indispensable boost for CT coronary angiography. Eur Heart J Cardiovasc Imaging. 2012;13(12):971–2.PubMedCrossRef
12.••
Steigner ML, Mitsouras D, Whitmore AG, et al. Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging. 2010;3(2):179–86. This study introduced the relationship between contrust opacification and coronary blood flow and defined coronary gradient.
13.
Choi JH, Min JK, Labounty TM, et al. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC Cardiovasc Imaging. 2011;4(11):1149–57.PubMedCrossRef
14.
Einstein AJ. TAG-is it it?: improving coronary computed tomography angiography with the isotemporal transluminal contrast attenuation gradient. J Am Coll Cardiol. 2013;61(12):1280–2.PubMedCrossRef
15.•
Wong DT, Ko BS, Cameron JD, et al. Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: a comparison with fractional flow reserve. J Am Coll Cardiol. 2013;61(12):1271–9. This is the most recent validation of 320 detector row CT contrast opacification gradients. This article shows correlation between gradient values and fractional flow reserve.PubMedCrossRef
16.
Yoon YE, Choi JH, Kim JH, et al. Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve. JACC Cardiovasc Imaging. 2012;5(11):1088–96.PubMedCrossRef
17.
Meier P, Zierler KL. On the theory of the indicator-dilution method for measurement of blood flow and volume. J Appl Physiol. 1954;6(12):731–44.PubMed
18.
Sherman H. On the theory of indicator-dilution methods under varying blood-flow conditions. Bull Math Biophys. 1960;22(4):417–24.CrossRef
19.
Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256(1):32–61.PubMedCrossRef
20.
Axel L. Cerebral blood flow determination by rapid-sequence computed tomography: theoretical analysis. Radiology. 1980;137(3):679–86.PubMedCrossRef
21.
Wang T, Wu X, Chung N, Ritman EL. Myocardial blood flow estimated by synchronous, multislice, high-speed computed tomography. IEEE Trans Med Imaging. 1989;8(1):70–7.PubMedCrossRef
22.
Choi JH, Koo BK, Yoon YE, et al. Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve. Eur Heart J Cardiovasc Imaging. 2012;13(12):1001–7.PubMedCrossRef
23.
Chow BJ, Kass M, Gagne O, et al. Can differences in corrected coronary opacification measured with computed tomography predict resting coronary artery flow? J Am Coll Cardiol. 2011;57(11):1280–8.PubMedCrossRef
24.
Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34(1):48–55.PubMedCrossRef
25.
Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308(12):1237–45.PubMedCrossRef
26.
Nakazato R, Park HB, Berman DS, et al. Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging. 2013;6(6):881–9.PubMedCrossRef
27.
Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: the NXT trial. J Am Coll Cardiol. 2014;63(12):1145–55.
28.
Steigner ML, Otero HJ, Cai T, et al. Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography. Int J Cardiovasc Imaging. 2009;25(1):85–90.PubMedCrossRef
29.
Achenbach S, Marwan M, Schepis T, et al. High-pitch spiral acquisition: a new scan mode for coronary CT angiography. J Cardiovasc Comput Tomogr. 2009;3(2):117–21.PubMedCrossRef
30.
Li M, Zhang J, Pan J, Lu Z. Obstructive coronary artery disease: reverse attenuation gradient sign at CT indicates distal retrograde flow—a useful sign for differentiating chronic total occlusion from subtotal occlusion. Radiology. 2013;266(3):766–72.PubMedCrossRef
31.
Hoe J. CT coronary angiography of chronic total occlusions of the coronary arteries: how to recognize and evaluate and usefulness for planning percutaneous coronary interventions. Int J Cardiovasc Imaging. 2009;25 Suppl 1:43–54.PubMedCrossRef
32.
Prasad A, Rihal CS, Lennon RJ, et al. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol. 2007;49(15):1611–8.PubMedCrossRef
33.
Rolf A, Werner GS, Schuhback A, et al. Preprocedural coronary CT angiography significantly improves success rates of PCI for chronic total occlusion. Int J Cardiovasc Imaging. 2013;29(8):1819–27.PubMedCrossRef
34.
Stone GW, Kandzari DE, Mehran R, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation. 2005;112(15):2364–72.PubMedCrossRef
35.
Gasparovic H, Rybicki FJ, Millstine J, et al. Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization. Eur J Cardiothorac Surg. 2005;28(2):244–9.PubMedCrossRef
Metadata
Title
Patterns of Opacification in Coronary CT Angiography: Contrast Differences and Gradients
Authors
Frank J. Rybicki
Yu-Hsiang Juan
Sachin S. Saboo
Elizabeth George
Rani Sewatkar
Dimitrios Mitsouras
Publication date
01-10-2014
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 10/2014
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-014-9291-z

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