Imaging coronary and extracoronary atherosclerosis: feasibility and impact of whole-body computed tomography angiography

• Published in: European radiology 2009-07, Vol.19 (7), p.1704-1714
• Main Authors: Napoli, Alessandro, Catalano, Carlo, Francone, Marco, Sciacca, Vincenzo, Carbone, Iacopo, Greco, Cesare, Anzidei, Michele, Calabrese, Francesca Antonella, Marincola, Beatrice Cavallo, Kirchin, Miles A., Vestri, Annarita, Arca, Marcello, Iuliano, Luigi, Passariello, Roberto
• Format: Article
• Language: English
• Subjects: Angiography - methods; Atherosclerosis - diagnostic imaging; Computed Tomography; Diagnostic Radiology; Feasibility Studies; Female; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Neuroradiology; Radiographic Image Enhancement - methods; Radiographic Image Interpretation, Computer-Assisted - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Ultrasound; Whole Body Imaging - methods
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-009-1342-5

A comprehensive whole-body approach to noninvasive evaluation of coronary and extracoronary vasculature is currently not available. The objective of our study was to assess the potential of 64-slice computed tomography angiography (64-CTA) for whole-body evaluation of atherosclerosis burden. Seventy-eight patients referred for coronary imaging underwent whole-body 64-CTA using an adjusted strategy for the administration of contrast medium with dose-saving algorithms involving ECG modulation and reduced tube voltage. Arterial segments (15 coronary, 32 systemic) were evaluated for significant (≥50%) steno-occlusive disease while arterovenous density was evaluated at seven extracoronary locations. Homogeneous attenuation (mean 321 ± 20 HU) was obtained throughout the systemic vasculature. Atherosclerosis was observed in 238/995 (24%) coronary and 368/2441 (15%) systemic segments. Significant stenoses/occlusions were present in 214 (21%)/24 (2.5%) coronary segments while asymptomatic clinically relevant stenoses were present in 49 systemic segments. Sensitivity, specificity, positive and negative predictive values of coronary 64-CTA among 52 patients who also underwent quantitative coronary angiography were 92%, 95%, 81% and 98%, respectively. ECG modulation decreased radiation exposure to 14.1–15.4 mSv per patient. Comprehensive, noninvasive assessment of atherosclerosis can be performed by whole-body 64-CTA and may have a positive impact on secondary prevention.