• The Journal of the Korea Contents Association
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• v.9 no.12
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• pp.339-347
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• 2009

Purpose : This study was to investigate the influence of heart rate and coronary calcification on diagnostic accuracy of 64-slice multidetector CT(MDCT) in coronary artery disease. Methods : 178 patients(84 men, 94 women) undergoing cardiac CT were included in this study. 3 coronary arteries(LAD, LCX, RCA) were assessed the presence of significant stenosis($\geq50%$) and the results compared with those of coronary angiography. Results : On a patient-based analysis, the diagnostic accuracy of 64-slice MDCT was 96.6%. The diagnostic accuracy on left anterior descending, left circumflex, right coronary artery were 86.5%, 84.3%, 92.1% respectively. Body mass index and blood pressure were not influenced on diagnostic accuracy of 64-slice MDCT. In less than 60/min of heart rate, accuracy was 90.1% and $\kappa$ value was 0.78. While in more than 70/min of heart rate, accuracy was 75.8% and $\kappa$ value was 0.52. In less than 100 of coronary calcification, accuracy was 91.3% and $\kappa$ value was 0.81. While in more than 400, accuracy was 68.6% and $\kappa$ value was 0.33. Conclusion : 64-slice MDCT shows similar diagnostic accuracy as coronary angiography. But in the context of more than 70/min of heart rate and 400 of coronary calcification, diagnostic accuracy was decreased. So there needs to identify heart rate and coronary calcification in cardiac CT, and if heart rate shows more than 70/min, use beta-blocker to regulate it.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.77-78
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• 2008

A 71-year-old woman was assigned to our department for Tc-99m myocardial perfusion SPECT(MPS) and coronary CT angiography. She admitted for substernal pain, via the ER, 2 days ago. The heart was scanned after intravenous injection of 925 MBq of $^{99m}Tc$-sestamibi adenosine-induced stress SPECT using dual head gamma camera (Hawkeye, GE healthcare. USA). The MPS shows decreased tracer uptake in the apical & mid area of anterior & lateral wall and mid & basal inferior wall. Coronary CT angiograph was obtained using Discovery VCT (GE healthcare). 3D angiography portrayed significant stenosis of ramus intermedius(RI) and posterolateral branch of right coronary artery(PLB) with fibrocalcified plaque. Two images were fused using Cardiac IQ fusion softwear package (Advantage workstation 4.4, GE healthcare) The fusion images explain the perfusion defect of anterior, lateral and inferior wall is due to stenosis of the RI and PLB. And 3 days later, coronary angiography was done and revealed the marked stenosis of RI and PLB. Then balloon angioplasty and stent was instituted in RI. Cardiac SPECT/CT fusion imaging provides additional information about hemodynamic relevance and facilitates lesion interpretation by allowing exact allocation of perfusion defects to its subtending coronary artery.

• Journal of the Korean Society of Radiology
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• v.83 no.1
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• pp.42-53
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• 2022

The clinical concept of coronary artery disease (CAD) has seen a paradigm shift over the last decade. CAD is mostly a progressive disease, and patients with CAD can develop acute coronary syndromes at any point in disease progression. In this clinical context, a new term, "chronic coronary syndrome," was published in the 2019 European Society of Cardiology guidelines, reflecting the importance of early diagnosis and active management. Recent advances have been made in the evaluation of CAD using coronary CT angiography (CCTA). The clinical usefulness of CCTA in patients with stable angina or chronic coronary syndrome begins with the detection of early asymptomatic CAD. The characterization of atherosclerotic plaque and its role in determining treatment strategies for CAD have been demonstrated for all stages of the disease. This review describes the pathophysiology of stable angina to aid in the understanding of the clinical applications of CCTA.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.3
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• pp.222-228
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• 2009

Risk stratification and assessment of prognosis in patients with known or suspected CAD is of crucial important for the practice of contemporary medicine. Noninvasive testing such as myocardial perfusion scintigraphy, coronary artery calcium scoring or CT coronary angiography is increasingly being used to determine the need for aggressive medical therapy and to select patients for catheterization. The integrated anatomic and functional information may provide more additional information for the cardiologist or other clinician by the improved risk stratification and diagnostic accuracy of integrated techniques. The development of SPECT/CT or PET/CT hybrid systems is therefore of important value for the nuclear cardiology.

• Korean Journal of Radiology
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• v.25 no.4
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• pp.331-342
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• 2024

The Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) is an instructional initiative of the ASCI School designed to enhance educational standards. In 2021, the ASCI-PT was convened with the goal of formulating a consensus statement on the assessment of coronary stenosis and coronary plaque using coronary CT angiography (CCTA). Nineteen experts from four countries conducted thorough reviews of current guidelines and deliberated on eight key issues to refine the process and improve the clarity of reporting CCTA findings. The experts engaged in both online and on-site sessions to establish a unified agreement. This document presents a summary of the ASCI-PT 2021 deliberations and offers a comprehensive consensus statement on the evaluation of coronary stenosis and coronary plaque in CCTA.

• Korean Journal of Radiology
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• v.22 no.1
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• pp.97-105
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• 2021

Objective: The present study aimed to investigate the association between myocardial blood flow (MBF) quantified by dynamic CT myocardial perfusion imaging (CT-MPI) and the increments in heart rate (HR) after stress in patients without obstructive coronary artery disease. Materials and Methods: We retrospectively included 204 subjects who underwent both dynamic CT-MPI and coronary CT angiography (CCTA). Patients with more than minimal coronary stenosis (diameter ≥ 25%), history of myocardial infarction/revascularization, cardiomyopathy, and microvascular dysfunction were excluded. Global MBF at stress was measured using hybrid deconvolution and maximum slope model. Furthermore, the HR increments after stress were recorded. Results: The median radiation dose of dynamic CT-MPI plus CCTA was 5.5 (4.5-6.8) mSv. The median global MBF of all subjects was 156.4 (139.8-180.4) mL/100 mL/min. In subjects with HR increment between 10 to 19 beats per minute (bpm), the global MBF was significantly lower than that of subjects with increment between 20 to 29 bpm (153.3 mL/100 mL/min vs. 171.3 mL/100 mL/min, p = 0.027). This difference became insignificant when the HR increment further increased to ≥ 30 bpm. Conclusion: The global MBF value was associated with the extent of increase in HR after stress. Significantly higher global MBF was seen in subjects with HR increment of ≥ 20 bpm.

• Journal of the Korean Society of Radiology
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• v.83 no.1
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• pp.84-101
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• 2022

Cardiac CT is the most accurate tool for diagnosing and evaluating coronary artery anomalies. Coronary anomalies can often be observed as the number of cardiac CT scans increases. In this review article, we described the CT findings and clinical significance of coronary anomalies that radiologists should know. In particular, we described the dangerous anatomical findings of coronary anomalies on CT images in detail.

• Korean Journal of Radiology
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• v.25 no.6
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• pp.518-539
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• 2024

Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool for diagnosing and risk-stratifying patients with suspected coronary artery disease (CAD). Recent advancements in image analysis and artificial intelligence (AI) techniques have enabled the comprehensive quantitative analysis of coronary atherosclerosis. Fully quantitative assessments of coronary stenosis and lumen attenuation have improved the accuracy of assessing stenosis severity and predicting hemodynamically significant lesions. In addition to stenosis evaluation, quantitative plaque analysis plays a crucial role in predicting and monitoring CAD progression. Studies have demonstrated that the quantitative assessment of plaque subtypes based on CT attenuation provides a nuanced understanding of plaque characteristics and their association with cardiovascular events. Quantitative analysis of serial CCTA scans offers a unique perspective on the impact of medical therapies on plaque modification. However, challenges such as time-intensive analyses and variability in software platforms still need to be addressed for broader clinical implementation. The paradigm of CCTA has shifted towards comprehensive quantitative plaque analysis facilitated by technological advancements. As these methods continue to evolve, their integration into routine clinical practice has the potential to enhance risk assessment and guide individualized patient management. This article reviews the evolving landscape of quantitative plaque analysis in CCTA and explores its applications and limitations.

• Journal of Yeungnam Medical Science
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• v.29 no.1
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• pp.61-64
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• 2012

The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5-2.5% of individuals. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, the case of a 53-year-old woman with intermittent chest tightness and coughing is reported. Aberrant right subclavian artery (arteria lusoria) was diagnosed via aortogram during right transradial coronary angiography. Compression of the esophagus and trachea by the aberrant right subclavian artery was demonstrated by chest computed tomography (CT).

• Journal of the Korea Computer Graphics Society
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• v.23 no.1
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• pp.49-55
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• 2017

Computed tomographic angiography (CTA) is widely used in the diagnosis and treatment of coronary artery disease because it shows not only the whole anatomical structure of the cardiovascular three-dimensionally but also provides information on the lesion and type of plaque. However, due to the large size of the image, there is a limitation in manually extracting coronary arteries, and related researches are performed to automatically extract coronary arteries accurately. As the coronary artery originate from the ascending aorta, the ascending aorta and ostium should be detected to extract the coronary tree accurately. In this paper, we propose an automatic segmentation for the ostium as a starting structure of coronary artery in CTA. First, the region of the ascending aorta is initially detected by using Hough circle transform based on the relative position and size of the ascending aorta. Second, the volume of interest is defined to reduce the search range based on the initial area. Third, the refined ascending aorta is segmented by using a two-dimensional geodesic active contour. Finally, the two ostia are detected within the region of the refined ascending aorta. For the evaluation of our method, we measured the Euclidean distance between the result and the ground truths annotated manually by medical experts in 20 CTA images. The experimental results showed that the ostia were accurately detected.