Purpose
Computed tomography angiography (CTA) of the coronary arteries is a useful non-invasive tool to rule out significant coronary artery disease (CAD) in many clinical situations
Recent guidelines of stable CAD (1) and non-ST segment elevation myocardial infarction (2) endorse the use of CTA in symptomatic patients with low to intermediate likelihood of the disease,
given the particularly high negative predictive value of the technique.
However,
in patients with high pretest likelihood of CAD the technique is not recommended.
One of the reasons is the high...
Methods and Materials
Subtraction coronary CT requires two scans,
one pre-contrast and one post-contrast
The subtraction of 3D CTA volumes is significantly more challenging than the 2D substraction performed in X-ray digital substraction angiography (DSA).
Subtraction in two dimensions only requires shifting of the mask image in two axes: x and y.
In 3D volumes,
not only manual shifting of the mask in three axes (x,y and z) but also rotational movement is required.
The fact that the two studies have to be performed consecutively implies that respiratory,...
Results
Fig 4: A visual quality scales was used ranging from 1 (non evaluable segment) to 4 (high confidence evaluable segment.
There was a significant improvement in the evaluation of coronary segment
Fig 5: Regarding stented segment,
there also was a significant improvement
Fig 6: The number of non evaluable and poorly evaluable segments descends from 35% to 13%
Conclusion
The SURESubtraction softwareis a promising tool to minimize calcium an metallic artifacts
Coronary calcium subtraction may improve the CTA diagnostic accuracy,
especially in those patients with extensive calcifications or small stents
More studies are needed to validate this diagnostic tool and find out what role can have on clinical daily practice
References
1.
Members TF,
Montalescot G,
Sechtem U,
Achenbach S,
Andreotti F,
Arden C,
et al.
2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology .
Eur Hear J 2013;34 (38):2949–3003.
2.
Hamm CW,
Bassand J-P,
Agewall S,
Bax J,
Boersma E,
Bueno H,
et al.
ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the...
