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

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

^* Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
Department of Internal Medicine II (Cardiology), University of Erlangen, Erlangen, Germany
Institute of Diagnostic Radiology, University of Erlangen, Erlangen, Germany

View larger version (165K): [in a new window]   Figure 1 Visualization of coronary plaque and assessment of remodeling by multidetector spiral computed tomography (MDCT). (A–D) Patient with a not significantly stenotic lesion in the proximal left anterior descending coronary artery. (A) X-ray coronary angiogram (arrow = site of the lesion); (B) axial MDCT image (1-mm slice thickness) at the level of the lesion (arrow); (C) MDCT reconstruction orthogonal to the vessel at the site of maximum luminal obstruction showing circumferential plaque (cross-sectional vessel area 41 mm2); (D) MDCT reconstruction orthogonal to the vessel in the reference segment (cross-sectional vessel area 35 mm2). Remodeling Index 1.2. (E–H) Patient with a high-grade stenosis of the left anterior descending coronary artery. (E) X-ray coronary angiogram (arrow = left anterior descending coronary artery stenosis); (F) axial MDCT image (1.0 mm slice thickness) at the level of the partly calcified lesion (arrow); (G) MDCT reconstruction orthogonal to the vessel at the site of maximum luminal obstruction (cross-sectional vessel area 22 mm2); (H) MDCT reconstruction orthogonal to the vessel in the reference segment (cross-sectional vessel area 22 mm2). Remodeling Index 1.

View larger version (115K): [in a new window]   Figure 2 (A) Multidetector spiral computed tomography (MDCT) cross-sections of the reference segment (left) and lesion (right) in a patient with a nonsignificant stenosis of the left anterior descending coronary artery. Eccentric plaque can be appreciated in the lesion (arrow). (B) Measurement of cross-sectional vessel areas in MDCT. Remodeling Index 1.1. (C) Measurement of cross-sectional vessel areas in IVUS (image orientation does not correspond to MDCT). Remodeling Index 1.1.

View larger version (15K): [in a new window]   Figure 3 Remodeling Indices as determined by multidetector spiral computed tomography in 23 nonstenotic (mean: 1.3 ± 0.2) and 21 stenotic lesions (mean: 1.0 ± 0.2, p < 0.001). Large bars = mean value; thin bars = mean value ± SD.

View larger version (22K): [in a new window]   Figure 4 (A) Correlation of cross-sectional vessel areas in intravascular ultrasound (IVUS) and multidetector spiral computed tomography (MDCT) (n = 26, r2 = 0.77); (B) Bland-Altman analysis of the differences in cross-sectional vessel areas measured in MDCT and IVUS (mean difference: 1.2 ± 3.7 mm2). The dashed lines correspond to the mean difference ± 2 SD (–6.10 to –8.5 mm2); (C) correlation of Remodeling Indices (RI) in IVUS and MDCT (n = 13, r2 = 0.82).