Feasibility of gadolinium-diethylene triamine pentaacetic acid enhanced multidetector computed tomography for the evaluation of coronary artery disease

Carrascosa, Patricia; Capuñay, Carlos; Bettinotti, Marcelo; Goldsmit, Alejandro; Deviggiano, Alejandro; Carrascosa, Jorge; García, Mario J.

doi:10.1016/j.jcct.2007.06.003

« Previous Next »Journal of Cardiovascular Computed Tomography
Volume 1, Issue 2 , Pages 86-94, October 2007

Feasibility of gadolinium-diethylene triamine pentaacetic acid enhanced multidetector computed tomography for the evaluation of coronary artery disease

Patricia Carrascosa, MD, PhD
- Department of Radiology, Diagnóstico Maipú, Av. Maipú 1668 (A1602ABQ) Vicente López, Buenos Aires, Argentina
- Corresponding author.
Carlos Capuñay, MD
- Department of Radiology, Diagnóstico Maipú, Av. Maipú 1668 (A1602ABQ) Vicente López, Buenos Aires, Argentina
Marcelo Bettinotti, MD
- Department of Cardiology, Sanatorio Güemes, Buenos Aires, Argentina
Alejandro Goldsmit, MD
- Department of Cardiology, Sanatorio Güemes, Buenos Aires, Argentina
Alejandro Deviggiano, MD
- Department of Radiology, Diagnóstico Maipú, Av. Maipú 1668 (A1602ABQ) Vicente López, Buenos Aires, Argentina
Jorge Carrascosa, MD
- Department of Radiology, Diagnóstico Maipú, Av. Maipú 1668 (A1602ABQ) Vicente López, Buenos Aires, Argentina
Mario J. García, MD
- Cardiovascular Medicine Institute, Mount Sinai Hospital, New York, NY, USA

Received 14 March 2007; accepted 24 June 2007. published online 13 August 2007.

Abstract

Background

Multidetector computed tomography (MDCT) has been proposed as a noninvasive method for the diagnosis of obstructive coronary artery disease (CAD). In patients with high risk of iodinated contrast adverse effects such as acute allergic-type reactions, the use of gadolinium could be an alternative.

Objective

We sought to evaluate the feasibility of gadolinium-enhanced MDCT for the diagnosis of obstructive CAD.

Methods

Twenty patients (mean age, 61 years; range, 50–73 years) referred for X-ray coronary angiography were studied by both gadolinium and iodine-enhanced 16-row MDCT coronary angiography. The degree of enhancement and the accuracy for detection of obstructive CAD (>50% diameter reduction) were evaluated with X-ray coronary angiography as the standard. Renal nephrotoxicity was strictly monitored.

Results

Gadolinium- and iodine-enhanced MDCT showed adequate visualization of the coronary arteries in 310 of the 312 coronary artery segments that were available by X-ray angiography, respectively. The average density of the coronary arteries in both iodine and gadolinium CT scans was 253.65 Hounsfield unit (HU) and 135.20 HU, respectively. In a per-coronary segment analysis, gadolinium- and iodine-enhanced MDCT showed sensitivities of 89% vs 84%, specificities of 96% vs 95%, and negative predictive values of 97% vs 96%, respectively. In a per-patient analysis, both gadolinium- and iodine-enhanced MDCT showed sensitivities of 92.85% vs specificities of 83.33%. Intermethod agreement between gadolinium- and iodine-enhanced MDCT (κ) was 0.95 (P < 0.0001).

Conclusion

Our preliminary results indicate lower attenuation with gadolinium but similar diagnostic accuracy for the detection of obstructive CAD when compared with iodine-enhanced MDCT. Therefore, gadolinium is a feasible alternative contrast agent for patients with iodine contrast allergy referred for MDCT coronary angiography.

Keywords: Contrast agents, Coronary artery disease, CT angiography, gadolinium, Multidetector computed tomography