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Coronary Artery Assessment on Electrocardiogram-Gated Thoracoabdominal Multidetector Computed Tomographic Angiography for Aortic Evaluation

Willemink, Martin J. MD*; Meijs, Matthijs F.L. MD, PhD; Cramer, Maarten J. MD, PhD; Thijssen, Anthony S. MD*; Moll, Frans L. MD, PhD; de Jong, Pim A. MD, PhD*; Leiner, Tim MD, PhD*; Budde, Ricardo P.J. MD, PhD*

Journal of Computer Assisted Tomography:
doi: 10.1097/RCT.0b013e3182ab2add
Cardiovascular & Thoracic Imaging
Abstract

Objective: The objective of this study was to evaluate coronary image quality, stenosis grade, and diagnostic confidence in patients undergoing electrocardiogram-gated thoracoabdominal multidetector computed tomographic angiography (CTA) for aortic evaluation.

Methods: Seventy-five consecutive patients underwent retrospectively electrocardiogram-gated thoracoabdominal CTA reconstructed at each 12.5% of the R wave to R wave (R-R) interval. Two observers in consensus scored the coronary arteries per segment (15-segment American Heart Association model) for image quality, stenosis grade, and stenosis-assessment confidence.

Results: Nondiagnostic image quality prohibited coronary evaluation in 14 patients. In the remaining patients, 2% of segments was scored absent, 24% was scored nondiagnostic, 12% was scored diagnostically limited, and 61% was scored at least acceptable. Acceptable or higher image quality was seen in 82% of the proximal and middle segments. Significant stenosis (>50%) was seen in 57% of the patients. Stenosis-severity scoring confidence was moderate to high in 79% of 673 assessable segments.

Conclusions: Electrocardiogram-gated thoracoabdominal CTA allows concomitant assessment of the proximal and middle coronary arteries and may serve as a combined tool for aortic-disease workup. Aortic CTA showed significant coronary artery stenosis in 57% of the patients evaluated for aortic pathology.

Author Information

From the Departments of *Radiology, †Cardiology, and ‡Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Received for publication July 9, 2013; accepted October 17, 2013.

Reprints: Martin J. Willemink, MD, Department of Radiology, Utrecht University Medical Center, PO Box 85500, E01.132, 3508 GA Utrecht, The Netherlands (e-mail: m.willemink@umcutrecht.nl).

The Department of Radiology of the Utrecht University Medical Center received research support from Philips Healthcare.

© 2014 by Lippincott Williams & Wilkins