Electron-beam computed tomographic detection of coronary calcification in patients undergoing percutaneous transluminal coronary angioplasty: predictability of restenosis. A preliminary report.

Coronary artery calcification is a recognized marker for coronary atherosclerosis; however, the relationship between calcification and the success of balloon angioplasty at a calcification site has not been determined. The purpose of this study was to evaluate whether the presence of coronary artery calcification, as detected by electron bean computed tomography (EBCT), was predictive of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Site- specific coronary calcification was determined by EBCT in 20 patients with 24 lesions before, immediately after, and 2 to 18 month after PTCA. Calcification was scored using >130 Hounsfield units and >1.02-mm2 area criteria. Coronary calcium at the PTCA site was significantly greater in restenosed versus nonrestenosed patients (109.16 +/- 198.16 mm2 v 4.39 +/- 9.50 mm2) (P < .025). The amount of coronary calcium did not change as a result of the PTCA procedure (+2.72 +/- 22.31 mm2 v -4.81 +/- 7.82 mm2) (P = NS). The rate of progression of calcification was not greater in restenosed versus nonrestenosed patients (1.78 +/- 3.32 mm2/month v 0.09 +/- 0.19 mm2/mo) (P = NS). Site-specific coronary calcification as determined by EBCT appeared to be predictive of patients with an increased likelihood to restenose after PTCA. Further studies are needed to verify these observations in a considerably larger patient population.

Contrast-enhanced thin slice ultrafast computed tomography for the detection of small pulmonary emboli. Studies using autologous emboli in the pig.

RATIONALE AND OBJECTIVES: Ultrafast computed tomography (UFCT) has proven useful, but is of limited practical application in the diagnosis of central pulmonary embolism; however, its ability to detect more peripheral emboli has not been established. In this study, the use of contrast-enhanced UFCT images for the detection of autologous peripheral pulmonary emboli in the pig is evaluated. METHODS: A single autologous embolus measuring 0.7 x 1.5 cm was introduced into the superior vena cava of eight pigs. Contiguous, 3-mm axial UFCT images from the lung apex to the base were obtained before and after the introduction of the embolus. After scanning, the pigs were killed, and the thorax was removed intact and was frozen in a dry ice-alcohol mixture. Later, the thorax was sliced at 10-mm thicknesses, and the locations of the emboli were determined by a pulmonary pathologist blinded to the imaging results. Concomitantly, the locations of the emboli were determined by consensus of three chest radiologists blinded to the autopsy results. RESULTS: In 6 of 8 animals with emboli, the embolus location correlated exactly with the autopsy findings. In one, the embolus was on the same side, but 1.6 cm further distal. In the other, a marking suture was identified, but no clot was identified on the pathologic or UFCT examination. In the eight animals scanned before the introduction of the embolus, no embolus was found. Interobserver agreement was 100%. CONCLUSIONS: Ultrafast computed tomography has the potential to detect autologous emboli in second- to fourth-division pulmonary vessels. Further studies are needed to determine if in vivo emboli can be similarly visualized.