• Journal of Chest Surgery
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• v.37 no.7
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• pp.570-577
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• 2004

CT angiography is now available to evaluate the early graft patency after coronary bypass surgery. We investigated whether patency or occlusion of the bypass grafts can be visualized by CT angiography and what factors effect the visuality. Material and Method: Fifty patients underwent scanning with a 4-slice computed tomographic scanner (Somatom Volume ZoomTM; Siemens, Germany) before being discharged after coronary artery bypass grafting. To evaluate graft patency and relationship between the quality of graft image and the characteristics of the diseased coronary vessels, 50 internal thoracic artery grafts, 18 radial artery grafts, and 56 vein grafts were included in this study. Result: All vein grafts (24 grafts; 32 anastomoses) to left coronary artery system were well visualized, but 3 grafts (4.7%) of 30 vein grafts (35 anastomoses) to right coronary artery system were not visualized. The latter was also occluded in invasive coronary angiographic study. Thirty-nine (78%) internal thoracic artery grafts were well visualized, 8 (16%) faintly visualized, and 3 (6%) not visualized, but all the internal artery grafts were well patent in invasive coronary angiographic study. Conclusion: Unvisualized vein grafts in CT angiography means occlusion of the grafts, but unvisualized arterial grafts in CT angiography may not mean occlusion of the graft but result from competitive flow between the graft and coronary artery. To confirm patency of the unvisualized arterial grafts, invasive coronary angiography is needed.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.258-269
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• 2024

Treatment of patients with coronary artery disease commonly involves the use of balloon-expandable stent placements, currently recognized as the most prevalent approach for coronary artery revascularization. Nevertheless, the occurrence of restenosis remains a significant complication following percutaneous coronary interventions. The diagnostic role of coronary CT angiography (CCTA) in detecting stent restenosis has limitations primarily attributable to challenges in accurately discerning the lumen, due to issues such as blooming and motion artifacts. As a result, many cases often necessitate a transition to conventional coronary angiography. However, recent advancements in CT technology have led to notable improvements in both sensitivity and specificity, underscoring the growing significance of CCTA as a diagnostic tool. The consistent reporting of high negative predictive value is particularly noteworthy. This review aims to explore the historical context, current status, and recent trends in diagnosing coronary artery stent restenosis using CCTA.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.270-296
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• 2024

Coronary CT angiography (CCTA) is recognized for its role as a gatekeeper for invasive coronary angiography in patients suspected of coronary artery disease because it can detect significant coronary stenosis with high accuracy. However, heavy plaque in the coronary artery makes it difficult to visualize the lumen, which can lead to errors in the interpretation of the CCTA results. This is primarily due to the limited spatial resolution of CT scanners, resulting in blooming artifacts caused by calcium. However, coronary stenosis with high calcium scores often requires evaluation using CCTA. Technological methods to overcome these limitations include the introduction of high-resolution CT scanners, the development of reconstruction techniques, and the subtraction technique. Methods to improve reading ability, such as the setting of appropriate window width and height, and evaluation of the position of calcified plaque and residual visibility of the lumen in cross-sectional images, are also recommended.

• Journal of the Korean Society of Radiology
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• v.13 no.7
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• pp.1005-1014
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• 2019

The purpose of this study is to evaluate the usefulness of coronary computed tomography angiography of coronary artery disease for the purpose fo health screening according to gender and age. In addition the association between hematological factors (Glucose, total cholesterol, visceral fat, body mass index, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL)) and coronary artery disease is investigated. A retrospective analysis of coronary computed tomography angiography with 299 subjects showed that the detection rate of coronary artery disease was higher in men over 50 years of age and it was statistically significant. In particular, the prevalence rate of men (37.9%) was about 2 times higher than that of women (17.0%). Glucose and HDL as hematological factors associated with coronary artery disease were statistically significant. The prevention and management of coronary artery disease seems to require the control of glucose and high density lipoprotein (HDL). Although it is not statistically significant with other hematological factors, the need for management of coronary artery disease was identified. the coronary computed tomography angiography of coronary artery has higher radiation doses than other CT scans. Therefore, for the purpose of screening, coronary computed tomography angiography should be considered in consideration of the sex and age of the examinee, and detection of coronary artery disease through other non-invasive tests should be prioritized over coronary computed tomography angiography.

• Journal of the Korean Society of Radiology
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• v.83 no.1
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• pp.3-27
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• 2022

Cardiac CT has been proven to provide diagnostic and prognostic evaluation of coronary artery disease for cardiovascular risk stratification and treatment decision-making based on rapid technological development and various research evidence. Coronary CT angiography has emerged as a gateway test for coronary artery disease that can reduce invasive angiography due to its high negative predictive value, but the diagnostic specificity is relatively low. However, coronary CT angiography is likely to overcome its limitations through functional evaluation to identify the hemodynamic significance of coronary artery disease by analyzing myocardial perfusion and fractional flow reserve through cardiac CT. Recently, studies have been actively conducted to incorporate artificial intelligence to make this more objective and reproducible. In this review, functional imaging techniques of cardiac computerized tomography are explored.

• Korean Journal of Radiology
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• v.22 no.11
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• pp.1749-1763
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• 2021

Coronary computed tomography angiography (CCTA) is routinely used for anatomical assessment of coronary artery disease (CAD). However, invasive measurement of fractional flow reserve (FFR) is the current gold standard for the diagnosis of hemodynamically significant CAD. CT-derived FFRCT and CT perfusion are two emerging techniques that can provide a functional assessment of CAD for risk stratification and clinical decision making. Several clinical studies have shown that the diagnostic performance of concomitant CCTA and functional CT assessment for detecting hemodynamically significant CAD is at least non-inferior to that of other routinely used imaging modalities. This article aims to review the current clinical evidence and recent developments in functional CT techniques.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.297-307
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• 2024

Coronary artery disease (CAD) narrows vessel lumens at the sites of atherosclerosis, increasing the risk of myocardial ischemia or infarction. Early and accurate diagnosis of CAD is crucial to significantly improve prognosis and management. CT angiography (CTA) is a noninvasive imaging technique that enables assessment of vascular structure and stenosis with high resolution and contrast. Coronary CTA is useful in the diagnosis of CAD. Recently, the CAD-reporting and data system (CAD-RADS), a diagnostic classification system based on coronary CTA, has been developed to improve intervention efficacy in patients suspected of CAD. While the CADRAD is based on CTA, it includes borderline categories where interpreting the coronary artery status solely based on CTA findings may be challenging. This review introduces CTA findings that fall within the CAD-RADS categories that necessitate additional tests to decide to perform invasive coronary angiography and discusses appropriate management strategies.

• 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.

• The Journal of the Korea Contents Association
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• v.10 no.6
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• pp.336-343
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• 2010

Coronary artery CT angiography has short scanning length, the exposure dose is high. Therefore, it is required to study on the organ dose when using MDCT. We compared the differences between the absorbed dose and effective dose in the major organs assessing the absorbed dose in the major organs by 16-MDCT and 64-MDCT in the subjects with coronary artery CT angiography, the same protocol by 16-MDCT and 64-MDCT. As a result, the great orders of absorbed dose when conducting coronary artery CT angiography had been shown as heart, stomach, liver, pancreas, kidney, spleen, large intestine, lung, small intestine, thyroid gland, ovary, bladder, and orbit with the absorbed dose distribution of $0.538{\pm}0.026(Mean{\pm}SD,\;p<0.05)mGy{\sim}71.316{\pm}4.316mGy$ in 16-MDCT, and heart, stomach, pancreas, spleen, liver, kidney, small intestine, large intestine, lung, thyroid gland, ovary, bladder, and orbit with the absorbed dose distribution of $0.87{\pm}0.01mGy{\sim}115.26{\pm}1.59mGy$ in 64-MDCT, demonstrating some different distributions. The exposed doses to the patient per one time scanning with coronary artery CT angiography were $71.316{\pm}4.316mGy$ in 16-MDCT as the absorbed dose based on the heart and $115.26{\pm}1.59mGy$ in 64-MDCT. The effective doses were 7.41 mSv and 12.11 mSv in 16 and 64-MDCT, respectively. Taking into account the results of brain CT with 2.8 mSv that has comparatively large scanning length and size, facial CT 0.8 mSv, chest CT 5.7 mSv, pelvic CT 7.2 mSv, and abdominal and pelvic CT 14.4 mSv, it is very high considering the scanning length of 13 cm limited to the heart for the scanning range.