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Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease

Axel Kuettner, MD^*,*, Andreas F. Kopp, MD^*, Stephen Schroeder, MD, Thilo Rieger, MS^*, Juergen Brunn, MD, Christoph Meisner, MA, Martin Heuschmid, MD^*, Tobias Trabold, MD^*, Christof Burgstahler, MD, Jens Martensen, MS^*, Wolfgang Schoebel, MD, Hans-Konrad Selbmann, PhD and Claus D. Claussen, MD^*

^* Department of Diagnostic Radiology, Tuebingen, Germany
Department of Internal Medicine, Division of Cardiology, Tuebingen, Germany
Institute for Medical Information Processing, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
Department of Cardiology, Herz- und Gefäß-Klinik, Bad Neustadt, Germany

View larger version (20K): [in a new window]   Figure 1 Coronary segments after a modified ACC/AHA classification. For the right coronary artery as well as the left anterior descending artery, the nomenclature remained unchanged. In the circumflex branch, the proximal segment was segment 11, the distal posterolateral branches was segment 12, and the first marginal branch was segment 13.

View larger version (96K): [in a new window]   Figure 2 (a) A 59-year-old patient with known single-vessel disease and prior right coronary artery-percutaneous transluminal coronary angioplasty. The entire coronary tree is well visualized in this volume-rendering image. (b) Same image with different window thresholds shows severe calcifications (Agatston score 970) impeded correct diagnosis. (c) Enlargement of (b) shows severe calcium deposits in the left main, left circumflex, and left anterior descending arteries.

View larger version (135K): [in a new window]   Figure 3 (a) A 57-year-old male patient with known two-vessel disease and prior multiple right circumflex and left anterior descending-percutaneous transluminal coronary angioplasties. With a favorable Agatston Score Equivalent (39) and a heart rate below 65, an excellent image quality was obtained, which is displayed in the 3D volume-rendering image. (b) Severe left anterior descending lesion and the absence of restenosis in the left circumflex are visualized. The enlarged images in (c) and (d) depict the corresponding segment as assessed by multidetector computed tomography. The small insets show the corresponding maximum intensity projections used for diagnosis.

View larger version (86K): [in a new window]   Figure 4 (a) A 58-year-old male patient with known single-vessel disease and prior right coronary artery occlusion and successful recanalization. The elevated body mass index of 27 and a heart rate of 66.3 beats/min caused reduced overall image quality. (b) Severest calcifications (Agatston score 2505) of the entire coronary tree impeded correct diagnosis visible in this volume rendering image with different window thresholds.

View larger version (84K): [in a new window]   Figure 5 (a) A 62-year-old male patient with two-vessel disease and prior multiple percutaneous transluminal coronary angioplasty of left anterior descending, and known 60% right coronary artery lesion. Patient presents now with recurrent chest pain. The multidetector computed tomography reveals a high-grade lesion of the proximal right coronary artery as well as wall changes throughout the vessel (see arrows). (b) In the axial image the lesion severity is estimated to be 80%. (c) The conventional angiogram in right anterior oblique projection confirms the proximal lesion (thick arrow) as well as the wall changes (thin arrow).