Multislice computed tomography angiography in the diagnosis of cardiovascular disease: 3D visualizations

Abstract

Multislice computed tomography (CT) has been widely used in clinical practice for the diagnosis of cardiovascular disease due to its reduced invasiveness and high spatial and temporal resolution. As a reliable alternative to conventional angiography, multislice CT angiography has been recognized as the method of choice for detecting and diagnosing head and neck vascular disease, abdominal aortic aneurysm, aortic dissection, and pulmonary embolism. In patients with suspected coronary artery disease, although invasive coronary angiography still remains as the gold standard technique, multislice CT angiography demonstrates high diagnostic accuracy; in selected patients, it is considered as the first-line technique. The imaging diagnosis of cardiovascular disease is based on a combination of two-dimensional (2D) and three-dimensional (3D) visualization tools to enhance the diagnostic value. This is facilitated by reconstructed visualizations which provide additional information about the extent of the disease, an accurate assessment of the spatial relationship between normal structures and pathological changes, and pre-operative planning and post-procedure follow-up. The aim of the present article is to present an overview of the diagnostic performance of various 2D and 3D CT visualizations in cardiovascular disease, including multiplanar reformation, maximum intensity projection, volume rendering, and virtual intravascular endoscopy. The recognition of the potential value of these visualizations will assist clinicians in efficiently using the multislice CT imaging modality for the diagnostic management of patients with cardiovascular disease.

Key words： cardiovascular disease; multislice computed tomography; three-dimensional reconstruction; diagnosis; visualization

References

1 Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 2010; 121(7): 948-954

PMID

2 Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol 2010; 35(2): 72-115

PMID

3 Liu L. Cardiovascular diseases in China. Biochem Cell Biol 2007; 85(2): 157-163

PMID

4 Boerma T, Shibuya K. World Health Statistics. 2007. http://www.who.int/whostat2007/en/index.html(accessed on 22 July 2011)

5 Adams MR, Celermajer DS. Detection of presymptomatic atherosclerosis: a current perspective. Clin Sci (Lond) 1999; 97(5): 615-624

PMID

6 Dormandy J, Heeck L, Vig S. The natural history of claudication: risk to life and limb. Semin Vasc Surg 1999; 12(2): 123-137

PMID

7 Goyen M, Herborn CU, Kröger K, Lauenstein TC, Debatin JF, Ruehm SG. Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three-dimensional MR angiography—initial experience. Radiology 2003; 227(1): 277-282

PMID

8 Noto TJ Jr, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR Jr, Vetrovec GW. Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). Cathet Cardiovasc Diagn 1991; 24(2): 75-83

PMID

9 Sun Z, Ng KH, Brennan P. Medical imaging of the heart and cardiovascular system. In: Acharya UR, Molinari F, Tamura T, Naidu DS, Suri JS. Distribution diagnosis and home healthcare (D2H2, Vol. 3). Stevenson Ranch, California : American Scientific Publishers, 2011 (in press)

10 McCollough CH, Zink FE. Performance evaluation of a multi-slice CT system. Med Phys 1999; 26(11): 2223-2230

PMID

11 Nieman K, Oudkerk M, Rensing BJ, van Ooijen P, Munne A, van Geuns RJ, de Feyter PJ. Coronary angiography with multi-slice computed tomography. Lancet 2001; 357(9256): 599-603

PMID

12 Sun Z, Cao Y, Li H. Multislice computed tomography angiography in the diagnosis of coronary artery disease. J Geriatric Cardiol 2011; 8(2): 1-10

13 Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges. Br J Radiol 2011 Mar 8. [Epub ahead of print]

14 Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Süss C, Grasruck M, Stierstorfer K, Krauss B, Raupach R, Primak AN, Küttner A, Achenbach S, Becker C, Kopp A, Ohnesorge BM. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 2006; 16(2): 256-268

PMID

15 Rybicki FJ, Otero HJ, Steigner ML, Vorobiof G, Nallamshetty L, Mitsouras D, Ersoy H, Mather RT, Judy PF, Cai T, Coyner K, Schultz K, Whitmore AG, Di Carli MF. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 2008; 24(5): 535-546

PMID

16 Hollingworth W, Nathens AB, Kanne JP, Crandall ML, Crummy TA, Hallam DK, Wang MC, Jarvik JG. The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. Eur J Radiol 2003; 48(1): 88-102

PMID

17 Josephson SA, Bryant SO, Mak HK, Johnston SC, Dillon WP, Smith WS. Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology 2004; 63(3): 457-460

PMID

18 Sun Z. Helical CT angiography of abdominal aortic aneurysms treated with suprarenal stent grafting. Cardiovasc Intervent Radiol 2003; 26(3): 290-295

PMID

19 Rydberg J, Kopecky KK, Lalka SG, Johnson MS, Dalsing MC, Persohn SA. Stent grafting of abdominal aortic aneurysms: pre- and postoperative evaluation with multislice helical CT. J Comput Assist Tomogr 2001; 25(4): 580-586

PMID

20 Sun Z, Mwipatayi BP, Allen YB, Hartley DE, Lawrence-Brown MMD. Multislice CT angiography of fenestrated endovascular stent grafting for treating abdominal aortic aneurysms: a pictorial review of the 2D/3D visualizations. Korean J Radiol 2009; 10(3): 285-293

PMID

21 Sun Z, Cao Y. Multislice CT virtual intravascular endoscopy of aortic dissection: a pictorial essay. World J Radiol 2010; 2(11): 440-448

PMID

22 Castañer E, Andreu M, Gallardo X, Mata JM, Cabezuelo MA, Pallardó Y. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. Radiographics 2003; 23: S93-S110

PMID

23 Sebastià C, Pallisa E, Quiroga S, Alvarez-Castells A, Dominguez R, Evangelista A. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics 1999; 19(1): 45-60, quiz 149-150

PMID

24 Schoepf UJ, Goldhaber SZ, Costello P. Spiral computed tomography for acute pulmonary embolism. Circulation 2004; 109(18): 2160-2167

PMID

25 Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL, Furber A, Revel MP, Howarth N, Davido A, Bounameaux H. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 2005; 352(17): 1760-1768

PMID

26 Sun Z, Dosari SA, Ng C, al-Muntashari A, Almaliky S. Multislice CT virtual intravascular endoscopy for assessing pulmonary embolisms: a pictorial review. Korean J Radiol 2010; 11(2): 222-230

PMID

27 Sun Z, Jiang W. Diagnostic value of multislice CT angiography in coronary artery disease: a meta-analysis. Eur J Radiol 2006; 60: 279-286

PMID

28 Sun Z, Lin CH, Davidson R, Dong C, Liao Y. Diagnostic value of 64-slice CT angiography in coronary artery disease: a systematic review. Eur J Radiol 2008; 67(1): 78-84

PMID

29 Sun Z, Ng KH. Multislice CT angiography in cardiac imaging. Part II: clinical applications in coronary artery disease. Singapore Med J 2010; 51(4): 282-289

PMID

30 Kalender WA, Seissler W, Klotz E, Vock P. Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation. Radiology 1990; 176(1): 181-183

PMID

31 Kohl G. The evolution and state-of-the-art principles of multislice computed tomography. Proc Am Thorac Soc 2005; 2(6): 470-476, 499-500

PMID

32 Leber AW, Johnson T, Becker A, von Ziegler F, Tittus J, Nikolaou K, Reiser M, Steinbeck G, Becker CR, Knez A. Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 2007; 28(19): 2354-2360

PMID

33 Brodoefel H, Burgstahler C, Tsiflikas I, Reimann A, Schroeder S, Claussen CD, Heuschmid M, Kopp AF. Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology 2008; 247(2): 346-355

PMID

34 Johnson TR, Nikolaou K, Busch S, Leber AW, Becker A, Wintersperger BJ, Rist C, Knez A, Reiser MF, Becker CR. Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 2007; 42(10): 684-691

PMID

35 Schwarz F, Ruzsics B, Schoepf UJ, Bastarrika G, Chiaramida SA, Abro JA, Brothers RL, Vogt S, Schmidt B, Costello P, Zwerner PL. Dual-energy CT of the heart—principles and protocols. Eur J Radiol 2008; 68(3): 423-433

PMID

36 Korn A, Bender B, Thomas C, Danz S, Fenchel M, Nägele T, Heuschmid M, Ernemann U, Hauser TK. Dual energy CTA of the carotid bifurcation: advantage of plaque subtraction for assessment of grade of the stenosis and morphology. Eur J Radiol 2010 Sep 10. [Epub ahead of print]

PMID

37 Thomas C, Korn A, Krauss B, Ketelsen D, Tsiflikas I, Reimann A, Brodoefel H, Claussen CD, Kopp AF, Ernemann U, Heuschmid M. Automatic bone and plaque removal using dual energy CT for head and neck angiography: feasibility and initial performance evaluation. Eur J Radiol 2010; 76(1): 61-67

PMID

38 North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325(7): 445-453

PMID

39 European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351(9113): 1379-1387

PMID

40 Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273(18): 1421-1428

PMID

41 Al Shuhaimi A, Ababtain K, Sun Z. Diagnostic value of non-invasive imaging techniques in the detection of carotid artery stenosis: a systematic review. Radiographer 2009; 56: 14-18

42 Chen CJ, Lee TH, Hsu HL, Tseng YC, Lin SK, Wang LJ, Wong YC. Multi-slice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke 2004; 35(1): 83-85

PMID

43 Agid R, Lee SK, Willinsky RA, Farb RI, terBrugge KG. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology 2006; 48(11): 787-794

PMID

44 Pozzi-Mucelli F, Bruni S, Doddi M, Calgaro A, Braini M, Cova M. Detection of intracranial aneurysms with 64 channel multidetector row computed tomography: comparison with digital subtraction angiography. Eur J Radiol 2007; 64(1): 15-26

PMID

45 McKinney AM, Palmer CS, Truwit CL, Karagulle A, Teksam M. Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography. Am J Neuroradiol 2008; 29(3): 594-602

PMID

46 Luo Z, Wang D, Sun X, Zhang T, Liu F, Dong D, Chan NK, Shen B. Comparison of the accuracy of subtraction CT angiography performed on 320-detector row volume CT with conventional CT angiography for diagnosis of intracranial aneurysms. Eur J Radiol 2011 May 30. [Epub ahead of print]

PMID

47 Tomandl BF, Hammen T, Klotz E, Ditt H, Stemper B, Lell M. Bone-subtraction CT angiography for the evaluation of intracranial aneurysms. Am J Neuroradiol 2006; 27(1): 55-59

PMID

48 Sakamoto S, Kiura Y, Shibukawa M, Ohba S, Arita K, Kurisu K. Subtracted 3D CT angiography for evaluation of internal carotid artery aneurysms: comparison with conventional digital subtraction angiography. Am J Neuroradiol 2006; 27(6): 1332-1337

PMID

49 Duan SY, Lv SM, Ye F, Lin QC. Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. Eur Spine J 2009; 18(8): 1102-1108

PMID

50 Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008; 359(22): 2324-2336

PMID

51 Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008; 52(21): 1724-1732

PMID

52 Meijboom WB, Meijs MFL, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, Nieman K, van Werkhoven JM, Pundziute G, Weustink AC, de Vos AM, Pugliese F, Rensing B, Jukema JW, Bax JJ, Prokop M, Doevendans PA, Hunink MG, Krestin GP, de Feyter PJ. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 2008; 52(25): 2135-2144

PMID

53 Sun Z, Dimpudus FJ, Nugroho J, Adipranoto JD. CT virtual intravascular endoscopy assessment of coronary artery plaques: a preliminary study. Eur J Radiol 2010; 75(1): e112-e119

PMID

54 Habets J, Symersky P, van Herwerden LA, de Mol BAJM, Spijkerboer AM, Mali WP, Budde RPJ. Prosthetic heart valve assessment with multidetector-row CT: imaging characteristics of 91 valves in 83 patients. Eur Radiol 2011; 21(7): 1390-1396

PMID

55 Girard SE, Miller FA Jr, Orszulak TA, Mullany CJ, Montgomery S, Edwards WD, Tazelaar HD, Malouf JF, Tajik AJ. Reoperation for prosthetic aortic valve obstruction in the era of echocardiography: trends in diagnostic testing and comparison with surgical findings. J Am Coll Cardiol 2001; 37(2): 579-584

PMID

56 Konen E, Goitein O, Feinberg MS, Eshet Y, Raanani E, Rimon U, Di-Segni E. The role of ECG-gated MDCT in the evaluation of aortic and mitral mechanical valves: initial experience. Am J Roentgenol 2008; 191(1): 26-31

PMID

57 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5(6): 491-499

PMID

58 Woodburn KR, May J, White GH. Endoluminal abdominal aortic aneurysm surgery. Br J Surg 1998; 85(4): 435-443

PMID

59 Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, Buskens E, Grobbee DE, Blankensteijn JD, Dutch Randomized Endovascular Aneurysm Management (DREAM)Trial Group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351(16): 1607-1618

PMID

60 Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR Trial Participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364(9437): 843-848

PMID

61 O’Donnell ME, Sun Z, Winder RJ, Ellis PK, Lau LL, Blair PH. Suprarenal fixation of endovascular aortic stent grafts: assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology. J Vasc Surg 2007; 45(4): 694-700

PMID

62 Lau LL, Hakaim AG, Oldenburg WA, Neuhauser B, McKinney JM, Paz-Fumagalli R, Stockland A. Effect of suprarenal versus infrarenal aortic endograft fixation on renal function and renal artery patency: a comparative study with intermediate follow-up. J Vasc Surg 2003; 37(6): 1162-1168

PMID

63 Greenberg RK, Chuter TA, Lawrence-Brown M, Haulon S, Nolte L, Zenith Investigators. Analysis of renal function after aneurysm repair with a device using suprarenal fixation (Zenith AAA Endovascular Graft) in contrast to open surgical repair. J Vasc Surg 2004; 39(6): 1219-1228

PMID

64 Muhs BE, Verhoeven EL, Zeebregts CJ, Tielliu IF, Prins TR, Verhagen HJ, van den Dungen JJ. Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts. J Vasc Surg 2006; 44(1): 9-15

PMID

65 Rydberg J, Kopecky KK, Johnson MS, Patel NH, Persohn SA, Lalka SG. Endovascular repair of abdominal aortic aneurysms: assessment with multislice CT.Am J Roentgenol 2001; 177(3): 607-614

PMID

66 Sun Z, Winder RJ, Kelly BE, Ellis PK, Kennedy PT, Hirst DG. Diagnostic value of CT virtual intravascular endoscopy in aortic stent-grafting. J Endovasc Ther 2004; 11(1): 13-25

PMID

67 Sun Z, Winder RJ, Kelly BE, Ellis PK, Hirst DG. CT virtual intravascular endoscopy of abdominal aortic aneurysms treated with suprarenal endovascular stent grafting. Abdom Imaging 2003; 28(4): 580-587

PMID

68 Sun Z, O’Donnell ME, Winder RJ, Ellis PK, Blair PH. Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: assessment of morphological changes by virtual intravascular endoscopy. J Endovasc Ther 2007; 14(5): 650-660

PMID

69 Sun Z, Allen YB, Nadkarni S, Knight R, Hartley DE, Lawrence-Brown MM. CT virtual intravascular endoscopy in the visualization of fenestrated stent-grafts. J Endovasc Ther 2008; 15(1): 42-51

PMID

70 Verhoeven EL, Prins TR, Tielliu IF, van den Dungen JJ, Zeebregts CJ, Hulsebos RG, van Andringa de Kempenaer MG, Oudkerk M, van Schilfgaarde R. Treatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts: short-term results. Eur J Vasc Endovasc Surg 2004; 27(5): 477-483

PMID

71 Scaglione M, Salvolini L, Casciani E, Giovagnoni A, Mazzei MA, Volterrani L. The many faces of aortic dissections: beware of unusual presentations. Eur J Radiol 2008; 65(3): 359-364

PMID

72 Berger FH, van Lienden KP, Smithuis R, Nicolaou S, van Delden OM. Acute aortic syndrome and blunt traumatic aortic injury: pictorial review of MDCT imaging. Eur J Radiol 2010; 74(1): 24-39

PMID

73 Nikolaou K, Thieme S, Sommer W, Johnson T, Reiser MF. Diagnosing pulmonary embolism: new computed tomography applications. J Thorac Imaging 2010; 25(2): 151-160

PMID

74 Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV Jr, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD, PIOPED II Investigators. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology 2007; 242(1): 15-21

PMID

75 Schoepf UJ, Holzknecht N, Helmberger TK, Crispin A, Hong C, Becker CR, Reiser MF. Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT. Radiology 2002; 222(2): 483-490

PMID

76 Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, Costello P, Zwerner PL. Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am J Cardiol 2009; 104(3): 318-326

PMID

77 Nagao M, Kido T, Watanabe K, Saeki H, Okayama H, Kurata A, Hosokawa K, Higashino H, Mochizuki T. Functional assessment of coronary artery flow using adenosine stress dual-energy CT: a preliminary study. Int J Cardiovasc Imaging 2011; 27(3): 471-481

PMID

78 Weininger M, Schoepf UJ, Ramachandra A, Fink C, Rowe GW, Costello P, Henzler T. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results. Eur J Radiol 2010 Dec 29. [Epub ahead of print]

PMID

79 Meyer M, Nance JW Jr, Schoepf UJ, Moscariello A, Weininger M, Rowe GW, Ruzsics B, Kang DK, Chiaramida SA, Schoenberg SO, Fink C, Henzler T. Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of coronary artery disease. Eur J Radiol 2011 Jan 27. [Epub ahead of print]

PMID