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125 ct based characterization

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125 ct based characterization

  1. 1. Editorial Slides VP Watch – December 18, 2002 - Volume 2, Issue 50 Is CT-Based Characterization Of CoronaryIs CT-Based Characterization Of Coronary Plaque/Artery Possible?Plaque/Artery Possible? Provided by: P.J. de Feijter, M.D. Department of Cardiology and Radiology, Erasmus University Rotterdam, The Netherlands
  2. 2. MS-CT : Goal Visualizing and characterizing the diseased coronary arterial wall in living patients. To evaluate: - progression / regression - risk factor modification - coronary plaque treatment - vulnerability to rupture - site and extent of coronary obstruction
  3. 3. Milestones in Coronary Plaque Imaging with (MS)-CT - First EBCT coronary angiography Achenbach NEJM 1998;339:1964 Rensing Circulation 1998; 98:2509 - First 4 slice MS-CT coronary angiography Nieman Lancet 2001; 357: 599 - First in vivo 4 slice MS-CT coronary plaque imaging Schroeder S. et al JACC 2001;37:1430-5 - First 16 slice MS-CT coronary angiography Nieman Circulation 2002; 106: 2051 - Preliminary results 16 slice MS-CT coronary plaque imaging
  4. 4. Coronary Plaque Imaging : the “extreme” challenge - small caliber vessels - small size of plaques - continuous cardiac and respiratory motion - calcification (obscures underlying structures) - modest attenuation variation between lipid-rich and fibrous tissue components
  5. 5. 16 Slice MS-CT Coronary Angiography Suspected CAD : 58 subjects (53 male; 58 ± 12 yrs) Average heart rate : 56 ± 6 b.p.m. (with additional ß-blocker) Detection of ≥ 50% stenosis in all coronary vessels > 2.0mm No exclusion of vessels (or segments) Sensitivity : 95% Pos.Pred.Value : 80% Specificity : 86% Neg.Pred.Value : 97% Nieman Circulation 2002;106:2051
  6. 6. MS-CT – coronary angiography
  7. 7. Diagnostic Accuracy MS-CT coronary angiography 4 slice MS-CT Achenbach Circulation 2001 4 slice MS-CT Nieman Heart 2002 16 slice MS-CT Nieman Circulation 2002 Detection of >50% diameter obstruction without exclusion of coronary vessels or segments due to suboptimal image quality Sensitivity 55% 65% 95%
  8. 8. MS-CT : Plaque Characterization - Morphology * presence, location, distribution * plaque size * vessel remodeling - Plaque composition * Lipid * fibrous tissue * calcium - Inflammation MS - CT + + Soft ( 0 – 30 HU ) Hard ( 31 – 130 HU ) Calcific ( >130 HU )
  9. 9. Coronary Plaque Imaging - Examples Normal Calcific spots Calcium & stenosis Severe stenosis Total occlusion
  10. 10. 70 300 150 500 600 300 200 30 MS-CT Coronary Plaque Imaging
  11. 11. 4slice MS-CT Coronary Plaque Evaluation Comparison of ICUS with MS-CT Plaques (n) 12 5 17 ICUS (echogenicity) Soft Intermediate Calcified MS-CT (Hounsfield Units) 14 ± 26 91 ± 21 419 ± 194 Schroeder et al JACC 2001;37:1430
  12. 12. 280HU 280HU80HU 30HU 450HU MS-CT Coronary Plaque Imaging
  13. 13. Work-Up High Risk Patients Clinical presentation < 60 yrs old Diabetes Acute coronary syndrome Biochemical markers Elevated C-PR Non-invasive MS-CT Localization of plaque Characterization of plaque Invasive techniques IVUS Palpography Thermography OCT
  14. 14.  As reported in this week’s VP Watch, Teichholz et al. showed quantitative assessment of atherosclerosis by EBT. Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography. Am J Cardiol. 2002 Dec 15;90(12):1416-9.
  15. 15.  They showed 3 new EBT parameters for a region of interest (ROI):  Mean value of Hounsfield Units (HU) within the ROI  Standard deviation (SD) of HU within the ROI  Percent of voxels with HU < 0 within the ROI Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography. Am J Cardiol. 2002 Dec 15;90(12):1416-9.
  16. 16.  The mean voxel intensity (HU) within the ROI in the proximal LAD was lower in patients with CAD compared to normals subjects.  The standard deviation of voxel intensities within the ROI in the proximal LAD was higher in patients with CAD as compared to normal subjects.  The percent of voxels with HU < 0 within the ROI in the proximal LAD was higher in patients with CAD. Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography. Am J Cardiol. 2002 Dec 15;90(12):1416-9.
  17. 17. 0 5 10 15 20 25 30 35 40 Normal CAD (p<0.005) HU Mean Voxel Intensity (HU) in LAD Teichholz LE, Petrillo S, Larson AJ, Klig V. Quantitative assessment of atherosclerosis by electron beam tomography. Am J Cardiol. 2002 Dec 15;90(12):1416-9.
  18. 18. • 16 MS-CT Coronary Imaging: – A reliable non-invasive technique to detect coronary obstructions if combined with intensive heart rate control to <65 b.p.m. – Can be used for identification of soft, intermediate and calcific plaques. – Offers great potential as an initial non-invasive technique to identify vulnerable plaque / artery in at risk population Conclusion:
  19. 19. Conclusion: • Growing body of evidence suggest that CT-based characterization of coronary plaques and/or artery is possible, and this technology may serve as the first line imaging tool for screening vulnerable patients. • Combination of CT with serum markers of vulnerability may provide a much more powerful predictive value.
  20. 20. Department of Cardiology1 and Radiology2 Erasmus University Rotterdam, The Netherlands P.J. de Feijter1, 2 K. Nieman1 2 N.R.A. Mollet1 2 R. Raaijmakers2 F. Cademartiri2 J. Ligthart1 P. Lemos1 P.Pattynama2 P.W. Serruys1 Most of the Editorial Slides of this week were provided by Dr de Feijter and his colleagues:

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