Cardiac CT & MRI Literature

Assessment of the radial artery and hand circulation by computed tomography angiography: a pilot study.

This is a pilot study on the use of CT angiography in the assessment of patients who are to go for a cardiac bypass surgery using the radial artery. Color Doppler currently is the modality of choice, but it is likely that CTA could become a modality of choice, due to its inherent superiority in demonstrating the anatomy and calcification as well as other pathologies.

Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT

You know that a modality is coming of age, when it is used to differentiate different clinical issues. In this study by Dietrich M et al in the European Journal of Cardiothoracic Surgery, ultra-fast CT was used to look for early restenosis in two different groups of patients going in for saphenous vein graft bypass surgery, one group having regular handsewn anastomosis and the other group having a new automatic clamper with a nitinol implant. More and more now we can use MRI and CT being used as gold standards or methods for assessing and answering clinical issues...this is a "coming of age phenomenon"

Cardiac CT in assessing chronic total occlusions for stent placement

Continuing from yesterday with understanding possible indications of cardiac CT, is an article from Mollet NR et al from Erasmus University, Rotterdam, published in the January issue of the American Journal of Cardiology.

This article is an initial study on 15 patients, studying the factors that affect the outcome of stent placement in chronic total occlusions. "Multivariate analysis identified a blunt stump (by conventional angiography), occlusion length >15 mm, and severe calcification (by multislice computed tomographic coronary angiography) as independent predictors of procedural failure."

This should be one more potential indication for cardiac CT. Patients with chronic total occlusions identified on coronary angiography, prior to stent placement could get a CT done to assess the length of the stenosis and the extent of calcification.

Noninvasive evaluation of type 2 diabetes patients with MSCT

Schuijf et al from Leiden have another article similar to the one published yesterday on this blog, in Diabetes Care, describing the use of 16-slice CT in patients with type 2 diabetes. The results obtained are a shade inferior to those in the patients with hypertension.

They had a sensitivity and specificity of 95% but with 86% interpretable segments. With the inclusion of non-interpretable segments, the sensitivity and specificity drop to the low 80s.

Noninvasive evaluation of hypertensive patients with MSCT

This is an interesting article by Schuijf et al from Leiden, in Hypertension, describing a study performed on a 16-slice Toshiba, without beta-blockers, assessing the usefulness of cardiac CT in triaging patients with hypertension.

31 patients were studied and 243 coronary artery segments could be evaluated. The sensitivity and specificity was 93% and 96% respectively, with an accuracy of 90% (24/31) on a per patient basis. The evaluation of ejection fraction and wall motion abnormality as compared to 2D-echocardiography was also accurate.

The authors suggest that in hypertensives, who have some form of atherosclerotic disease, using cardiac CT as an initial modality to evaluate function and the coronary arteries may be feasible proposition.