Korean J Radiol.  2019 Jul;20(7):1146-1155. 10.3348/kjr.2018.0845.

Modified Subtraction Coronary CT Angiography with a Two-Breathhold Technique: Image Quality and Diagnostic Accuracy in Patients with Coronary Calcifications

Affiliations
  • 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. zengmengsu@outlook.com
  • 2Shanghai Institute of Medical Imaging, Shanghai, China.
  • 3Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
  • 4Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract


OBJECTIVE
To evaluate a modified subtraction coronary computed tomography angiography (CCTA) technique with a two-breathhold approach in terms of image quality and stenosis grading of calcified coronary segments and in the detection of significant coronary stenosis in segments with severe calcification.
MATERIALS AND METHODS
The institutional board approved this study, and all subjects provided written consent. A total of 128 patients were recruited into this trial, of which 32 underwent subtraction CCTA scans and invasive coronary angiography (ICA). The average Agatston score was 356 ± 145. In severely calcified coronary segments, the presence of significant (> 50%) stenosis was assessed on both conventional CCTA and subtraction CCTA images, and the results were finally compared with ICA findings as the gold standard.
RESULTS
For severely calcified segments, the image quality in conventional CCTA significantly improved from 2.51 ± 0.98 to 3.12 ± 0.94 in subtraction CCTA (p < 0.001). In target segments, specificity (70% vs. 87%; p = 0.005) and positive predictive value (61% vs. 79%, p < 0.01) were improved using subtraction CCTA in comparison with conventional CCTA, with no loss in the negative predictive value. The segment-based diagnostic accuracy for detecting significant stenosis was significantly better in subtraction CCTA than in conventional CCTA (area under the receiver operating characteristic curve, 0.94 vs. 0.85; p = 0.03).
CONCLUSION
This modified subtraction CCTA method showed lower misregistration and better image quality in patients with limited breathhold capability. In comparison with conventional CCTA, modified subtraction CCTA would allow stenosis regrading and improve the diagnostic accuracy in coronary segments with severe calcification.

Keyword

320-detector row CT; Coronary CT angiography; Plaque calcification; Subtraction

MeSH Terms

Angiography*
Constriction, Pathologic
Coronary Angiography
Coronary Stenosis
Humans
Methods
ROC Curve
Sensitivity and Specificity
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