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J Am Coll Cardiol, 2004; 43:842-847, doi:10.1016/j.jacc.2003.09.053
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography

Stephan Achenbach, MD, FESC*{dagger}{ddagger},*, Dieter Ropers, MD{ddagger}, Udo Hoffmann, MD*, Briain MacNeill, MD{dagger}, Ulrich Baum, MD§, Karsten Pohle, MD{ddagger}, Tom J. Brady, MD*, Eugene Pomerantsev, MD, PhD{dagger}, Josef Ludwig, MD{ddagger}, Frank A. Flachskampf, MD, FACC, FESC{ddagger}, Stephan Wicky, MD*, Ik-kyung Jang, MD, PhD, FACC{dagger} and Werner G. Daniel, MD, FACC, FESC{ddagger}

* Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
{dagger} Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
{ddagger} Department of Internal Medicine II (Cardiology), University of Erlangen, Erlangen, Germany
§ Institute of Diagnostic Radiology, University of Erlangen, Erlangen, Germany

Manuscript received June 23, 2003; revised manuscript received August 27, 2003, accepted September 9, 2003.

* Reprint requests and correspondence: Dr. Stephan Achenbach, Department of Internal Medicine II (Cardiology), University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
Stephan.achenbach{at}med2.med.uni-erlangen.de

OBJECTIVES: This study was designed to investigate whether contrast-enhanced multidetector spiral CT (MDCT) permits assessment of remodeling in coronary atherosclerotic lesions.

BACKGROUND: With sufficient image quality, MDCT permits noninvasive visualization of the coronary arteries, but its ability to assess remodeling has not been evaluated.

METHODS: Out of 102 patients in whom MDCT (16-slice scanner, intravenous contrast, 0.75-mm collimation, 420 ms rotation) was performed before invasive coronary angiography, 44 patients with high-quality MDCT data sets showing atherosclerotic plaque in a proximal coronary artery segment were chosen for evaluation. In multiplanar reconstructions orthogonal to the coronary artery, the cross-sectional vessel area was measured for the respective lesion and for a reference segment proximal to the lesion. The "Remodeling Index" was calculated by dividing the vessel area in the lesion by the reference segment. Results were correlated to the presence of stenosis (>50% diameter reduction) in invasive angiography. In a subset of 13 patients, MDCT measurements were verified by IVUS.

RESULTS: Reference vessel area was not significantly different between nonstenotic versus stenotic lesions (20 ± 8 mm2, n = 23 vs. 22 ± 8 mm2, n = 21). The mean Remodeling Index was significantly higher in nonstenotic than in stenotic lesions (1.3 ± 0.2 vs. 1.0 ± 0.2, p < 0.001). In five stenotic lesions, "negative remodeling" (Remodeling Index ≤0.95) was observed. Cross-sectional vessel areas and Remodeling Indices measured by MDCT correlated closely to IVUS (r2 = 0.77 and r2 = 0.82, respectively).

CONCLUSIONS: Multidetector spiral CT may permit assessment of remodeling of coronary atherosclerotic lesions in selected data sets of sufficient quality.

Abbreviations and Acronyms
  ECG = electrocardiogram
  HU = Hounsfield units
  IVUS = intravascular ultrasound
  LAD = left anterior descending coronary artery
  LCX = left circumflex coronary artery
  LM = left main coronary artery
  MDCT = multidetector spiral computed tomography
  RCA = right coronary artery




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