Flat Panel Volume Computed Tomography of the Coronary Arteries

Knollmann, Friedrich D.; Wieltsch, Annika; Peters, Simone; Mahlke, Anika; Niederberger, Susanne; Kertesz, Tereza

doi:10.1016/j.acra.2009.05.015

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Volume 16, Issue 10 , Pages 1251-1262, October 2009

Flat Panel Volume Computed Tomography of the Coronary Arteries

Friedrich D. Knollmann, MD, PhD
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582
- Address correspondence to: F.D.K.
Annika Wieltsch, MD
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582
Simone Peters, MS
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582
Anika Mahlke, MS
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582
Susanne Niederberger, MS
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582
Tereza Kertesz, MD
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582

Received 1 January 2009; accepted 18 May 2009. published online 16 July 2009.

Rationale and Objectives

Multidetector-row computed tomography (MDCT) has evolved into a sensitive diagnostic tool for the noninvasive detection of coronary artery stenosis, but remains limited by spatial resolution. Flat panel volume computed tomography (fpVCT) offers a higher spatial resolution. In a postmortem investigation of autopsy specimens, the accuracies of fpVCT for measuring the severity of coronary artery stenosis and the size of atherosclerotic plaque components were determined.

Methods and Materials

In 25 autopsy cases, hearts were isolated, the left anterior descending coronary arteries filled with contrast agent, and depicted with a prototype fpVCT unit with a slice thickness of 0.25 mm. Transections of the left anterior descending coronary arteries were reconstructed and compared with histopathologic sections using light microscopy.

Results

FpVCT measurements of luminal stenosis (r = 0.81), total plaque area (r = 0.88), calcified plaque area (r = 0.92), noncalcified plaque area (r = 0.83), and lipid core size (r = 0.67; P < .02) correlated well with histopathology (P < .0001). The limits of agreement for measuring any plaque component were three times smaller than those reported for MDCT.

Conclusions

Postmortem coronary fpVCT provides an accurate and reproducible method for the quantitative assessment of both luminal stenosis and atherosclerotic plaque size. Because of its high spatial resolution, the method should be sufficiently accurate to reliably detect the lipid pools of vulnerable plaques.

Key Words: Computed tomography, coronary arteries, atherosclerosis