RESUMEN
This case highlights an impressive manifestation of a diagnosis that affects many people around the world.
RESUMEN
BACKGROUND: Coronary artery calcium (CAC) scanning is commonly performed before coronary CT angiography (CTA) based partly on its potential to influence CTA scan parameters. Encompassing the whole heart and performed at high tube potential (120 âkVp), standard (Agatston) CAC scanning adds to patient radiation exposure. Most CAC exists in the proximal and mid coronary segments and is easily visualized at low kVp. METHODS: We tested the impact of a modified calcium scan on coronary CTA acquisition decision-making and image quality in a randomized clinical trial. Providers documented planned CTA acquisition parameters prior to CAC scanning in a blinded manner. Standard Agatston CAC scans proceeded in typical fashion whereas modified scans utilized 80 âkVp and reduced z-axis length focused on the proximal-to-mid coronary arteries. CTA providers reviewed the CAC burden then documented final acquisition parameters. RESULTS: The study included 172 patients (48% female; mean age 59 â± â6.7). As planned, the calcium scan effective dose was significantly lower in the modified CAC scan group (0.14 vs. 0.74 âmSv using a 0.014 k-factor or 0.26 vs. 1.38 âmSv using a 0.026 k-factor; both p â< â0.001). Initially selected CTA parameters were changed at an identical rate following visual CAC assessment (59%). There was no significant difference in coronary CTA image quality (median quality score â= â4 in both groups, p â= â0.26), noise (31.0 vs 31.4 HU; p â= â0.81), or signal/noise ratio (17.9 vs 16.8; p â= â0.26). CONCLUSIONS: A low-kVp scan with focused field-of-view provides actionable information regarding the presence and severity of CAC prior to coronary CTA. Coronary CTA parameters based on patient variables are frequently modified after assessing CAC burden in the CTA suite. CLINICALTRIALS. GOV REGISTRATION NUMBER: NCT02972242.
Asunto(s)
Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Maryland , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Dosis de Radiación , Exposición a la Radiación , Índice de Severidad de la EnfermedadAsunto(s)
Aneurisma Infectado/terapia , Aneurisma Coronario/terapia , Intervención Coronaria Percutánea/instrumentación , Infecciones Estafilocócicas/terapia , Stents , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Antibacterianos/uso terapéutico , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/microbiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/microbiología , Resultado del TratamientoAsunto(s)
Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Cardiopatías/diagnóstico por imagen , Posicionamiento del Paciente/métodos , Posición Prona , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Cardiopatías/etiología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Venas Pulmonares/cirugía , Trombosis/etiologíaRESUMEN
This case demonstrates the complementary benefit of utilizing multimodality cardiac imaging in the assessment of myocardial infarction with nonobstructive coronary artery disease especially when a culprit lesion is not discovered upon initial coronary catheterization. Use of cardiac magnetic resonance imaging, optical coherence tomography, and invasive coronary angiography together solidified the diagnosis of unstable, complex coronary artery disease in this case.
