Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Natural History of Untreated Coronary Total Occlusions Revealed with Follow-Up Semi-Automated Quantitative Coronary CT Angiography: The Morphological Characteristics of Initial CT Predict Occlusion Shortening

  • Wu, Qian (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Yu, Mengmeng (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Li, Yuehua (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Li, Wenbin (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Lu, Zhigang (Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Wei, Meng (Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Yan, Jing (Siemens Healthcare Ltd.) ;
  • Zhang, Jiayin (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital)
  • Received : 2017.06.25
  • Accepted : 2017.08.17
  • Published : 2018.04.01
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Abstract

Objective: To investigate the morphological changes of coronary chronic total occlusion (CTO) as determined by coronary computed tomography angiography (CCTA) follow-up using semi-automated quantitative analysis. Materials and Methods: Thirty patients with 31 CTO lesions confirmed by invasive coronary angiography and baseline/follow-up CCTA were retrospectively included. CTOs were quantitatively analyzed by a semi-automated coronary plaque analysis software (Coronary Plaque Analysis, version 2.0, Siemens) after manually determining the lesion border. Recanalized lumen was defined as the linear-like enhanced opacity traversing the non-opacified occluded segment. Other parameters, such as total occlusion length, total occlusion volume, volume with low attenuation component (< 30 Hounsfield unit [HU]), volume with middle to high attenuation component (30-190 HU) as well as the calcification volume, were also recorded. Results: Recanalized lumen was found within 48.4% (15/31) occlusions on the follow-up CCTA, compared to 45.2% (14/31) occlusions on the baseline CCTA. Eleven of 14 lesions (78.6%) with CT-visible recanalized lumen within CTOs had a shorter occlusion length on follow-up compared to only 3 of 17 lesions (17.6%) without CT-visible recanalized lumen (odds ratio, 17.1, p < 0.001). The percentage of low attenuation component of occlusions was smaller on follow-up CCTA compared to baseline value ($18.1{\pm}20.1%$ vs. $22.6{\pm}19.6%$, p = 0.033). Conclusion: Coronary computed tomography angiography enables non-invasive characterization of natural progression of untreated CTO lesions. Recanalized lumen within CTOs observed at baseline CCTA was associated with shortening of occlusion length on follow-up. Compared to their earlier stage, occlusions of later stage were presented with higher density of non-calcified components.

Keywords

Acknowledgement

Supported by : National Natural Science Foundation of China, Shanghai Municipal Education Commission-Gaofeng Clinical Medicine

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