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Subtraction coronary CT angiography using second-generation 320-detector row CT

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Abstract

The purpose of this study was to explore the feasibility of subtraction coronary computed tomography angiography (CCTA) by second-generation 320-detector row CT in patients with severe coronary artery calcification using invasive coronary angiography (ICA) as the gold standard. This study was approved by the institutional board, and all subjects provided written consent. Twenty patients with calcium scores of >400 underwent conventional CCTA and subtraction CCTA followed by ICA. A total of 82 segments were evaluated for image quality using a 4-point scale and the presence of significant (>50 %) luminal stenosis by two independent readers. The average image quality was 2.3 ± 0.8 with conventional CCTA and 3.2 ± 0.6 with subtraction CCTA (P < 0.001). The percentage of segments with non-diagnostic image quality was 43.9 % on conventional CCTA versus 8.5 % on subtraction CCTA (P = 0.004). The segment-based diagnostic accuracy for detecting significant stenosis according to ICA revealed an area under the receiver operating characteristics curve of 0.824 (95 % confidence interval [CI], 0.750–0.899) for conventional CCTA and 0.936 (95 % CI 0.889–0.936) for subtraction CCTA (P = 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value for conventional CCTA were 88.2, 62.5, 62.5, and 88.2 %, respectively, and for subtraction CCTA they were 94.1, 85.4, 82.1, and 95.3 %, respectively. As compared to conventional, subtraction CCTA using a second-generation 320-detector row CT showed improvement in diagnostic accuracy at segment base analysis in patients with severe calcifications.

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Acknowledgments

Dr. Joanne Schuijf and Mrs. Yukie Osawa from Toshiba Medical Systems gave support and suggestions in writing and technical subjects, especially for the dedicated subtraction algorithms. This work was supported by the Japan Society for the Promotion of Science (JSPS KAKENHI, Grant Number 26461803).

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Authors and Affiliations

  1. Division of Cardiovascular Radiology, Department of Radiology, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Kunihiro Yoshioka & Ryoichi Tanaka

  2. Center for Radiological Science, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Kenta Muranaka, Tadashi Sasaki, Takanori Ueda, Takuya Chiba, Kouta Takeda & Tsuyoshi Sugawara

Authors
  1. Kunihiro Yoshioka
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  2. Ryoichi Tanaka
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  3. Kenta Muranaka
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  4. Tadashi Sasaki
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  5. Takanori Ueda
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  6. Takuya Chiba
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  7. Kouta Takeda
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  8. Tsuyoshi Sugawara
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Correspondence to Kunihiro Yoshioka.

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Yoshioka, K., Tanaka, R., Muranaka, K. et al. Subtraction coronary CT angiography using second-generation 320-detector row CT. Int J Cardiovasc Imaging 31 (Suppl 1), 51–58 (2015). https://doi.org/10.1007/s10554-015-0630-1

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  • DOI: https://doi.org/10.1007/s10554-015-0630-1

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