Journal of Cardiovascular Computed Tomography - Articles in Press

Right Aortic Arch and its Variants - Accepted Manuscript

Jeffrey P. Kanne, J. David Godwin — 2010-07-22

Abstract: A number of congenital anomalies of the aortic arch complex can occur, ranging from asymptomatic normal variations in arch vessel branch pattern to symptomatic vascular rings, stenoses, and arch interruptions with a frequency ranging from 0.5% to 3.0%. A right aortic arch is present in 0.1% of the population and can occur in isolation or be associated with congenital heart disease. Patients may present at any age with signs and symptoms of airway or esophageal compression, heart failure, or abnormal chest imaging studies. This pictorial essay will illustrate the computed tomography (CT) and appearances of congenital variations of the right aortic arch and use Edwards' hypothetical embryonic double aortic arch model to explain the etiology of some of these variants.

Keeping Score of Coronary Artery Disease Using Cardiac CT Angiography: Can Reasonable Experts Agree? - Accepted Manuscript

Todd C. Villines — 2010-07-21

Abstract: This is an editorial on the original research manuscript, “Inter-observer variations of Plaque Severity Score and Segment Stenosis Score in Coronary arteries using 64 slice Multidetector Computed Tomography: A sub study of the Accuracy Trial”.

Cardiac Imaging: A Multimodality Approach, first edition - Uncorrected Proof

Thanjavur Bragadeesh — 2010-07-20

The English edition published in 2009 is a revised translation of the German edition first published in 2007. The book encompasses 289 pages, 13 chapters, and 607 illustrations from 27 contributors, and it provides a comprehensive review of cardiac imaging. The contents of the book are divided into 2 sections: the first section is on imaging modalities, and the second section deals with imaging in specific cardiac disease states. The chapters are succinct, yet rich in detail with well laid-out figures and tables that are easy to read.

Ex vivo evaluation of coronary atherosclerotic plaques: Characterization with dual-source CT in comparison with histopathology - Uncorrected Proof

2010-06-07

Background: Identification and differentiation of coronary atherosclerotic plaques may improve risk stratification for incident coronary events.Objective: We investigated the ability of dual-source computed tomography (CT) to depict and characterize atherosclerotic coronary plaques.Methods: Contrast-enhanced CT was performed in 25 human heart specimens with a total of 322 histologically determined plaques. Coronary plaques were classified on CT as (1) noncalcified, mixed, or calcified and (2) by CT attenuation values. Atherosclerotic plaques were histopathologically characterized according to the Stary classification.Results: CT detected 79% (245/322) of all plaques. Lesions missed by CT were generally early lesions, type I (n = 31), type II (n = 38), or type III (n = 8), according to Stary. CT detected 29% of early (Stary I–III) and 100% of advanced (Stary IV–VIII) plaques. Plaque classification as noncalcified was sensitive (100%) and specific (72%) for early, whereas classification as mixed/calcified was sensitive (92%, 89%) and specific (100%) for advanced plaques. Calcified plaques on CT were detected with high sensitivity (80%) and specificity (95%). Other subtypes were not distinguishable with CT according to the presence or absence of calcification. CT density was significantly higher for advanced (306 ± 470 HU) than for early (42 ± 14 HU; P < 0.01) plaques. The mean CT density value of type VII plaques (512 ± 349 HU) was significantly higher than those of other plaques (34–101 HU; P < 0.001).Conclusions: CT reliably depicts advanced coronary plaques and allows for the differentiation between early and advanced plaques.

Coronary artery to main pulmonary artery fistulae via a Vieussens' arterial ring - Corrected Proof

Mohammad I. Hirzallah, Eric Horlick, Leon Zelovitzky — 2010-06-07

Abstract: Coronary artery fistulae are rare abnormal communications between a coronary artery and a cardiac chamber or a great vessel which may shunt blood flow away from the myocardial capillary network. Vieussens arterial ring is usually described as a collateral pathway between the left anterior descending and right coronary arteries, pathology of Vieussens arterial ring are exceedingly rare. We present a case of a complex coronary artery to pulmonary artery fistula via an aneurysmal Vieussens arterial ring, with emphasis on computerized tomography and invasive angiography findings and management.

Interobserver variations of plaque severity score and segment stenosis score in coronary arteries using 64 slice multidetector computed tomography: A substudy of the ACCURACY trial - Corrected Proof

2010-06-07

Background: Assessing the severity of coronary plaque for the risk stratification and management of coronary artery disease is important. Multidetector computed tomography has been shown to be a useful tool to measure coronary plaque; however, interreader variability is a concern.Objective: We measured interobserver variations of plaque severity score (PSS) and segment stenosis score (SSS) as measured by the total plaque severity score (TPS) and total segment stenosis score (TSS).Methods: Cardiac CT scans (n = 221) of the ACCURACY trial were interpreted by 3 different readers blinded to patient characteristics. PSS (mild, 1; moderate, 2; and severe, 3) and SSS (stenosis 1%–29%, 1; 30%–49%, 2; 50%–69%, 3; and ≥70%, 4) were calculated with the 15-segment American Heart Association model. TPS and TSS were determined by summing the segments for each interpreter. TPS and TSS were compared for correlation and variation among any 2 of the 3 readers.Results: A highly significant correlation was observed among any 2 of the 3 readers for both TPS and TSS. For TPS, the r = 0.91, 0.93, 0.94 (P < 0.001) for A vs B, B vs C, A vs C, respectively, and for TSS, r = 0.91, 0.92, 0.93 (P < 0.001) for A vs B, B vs C, A vs C, respectively. On Bland Altman plot, the mean difference between the scores of any 2 readers was 3.33 ± 3.93, 1.65 ± 2.88, and 1.68 ± 2.92 for TPS and 4.19 ± 4.73, 2.54 ± 4.02, and 1.65 ± 3.18 for TSS.Conclusion: Semiquantitative measures of coronary plaque burden, including the TPS and TSS, can be determined with a high degree of interobserver agreement, suggesting their potential role as tools to aid in the assessment of coronary heart disease.

Ventricular septal rupture and right ventricular intramyocardial dissection secondary to acute inferior myocardial infarction - Corrected Proof

Márcio Sommer Bittencourt, Martin Seltmann, Gerd Muschiol, Stephan Achenbach — 2010-06-07

Abstract: A 61-year-old female patient presented with sub acute myocardial infarction with an occluded right coronary artery on invasive evaluation and a ventricular septal rupture on echocardiogram. Cardiac computed tomography (CT) was performed to better define the septal anatomy. As the anatomy on cardiac CT was considered unfavorable for percutaneous intervention, the patient underwent successful surgical repair.

Tissue characterization of a papillary fibroelastoma on the aortic valve by contrast-enhanced 320-detector row computed tomography - Corrected Proof

2010-06-07

Abstract: A 56-year-old woman with a mass on the aortic valve as seen on echocardiogram underwent pre-operative contrast-enhanced cardiac computed tomography prior to removal. The mass was confirmed to be a papillary fibroelastoma histologically. Spatial co-registration between the contrast-enhanced CT cross-sectional images of the mass and the Movat's pentachrome staining revealed an association of elastic fibers with higher levels of attenuation and collagen fibers with lower levels of attenuation on CT.