OBJECTIVES: We evaluated the technical and clinical utility of visual 5-point coronary stenosis grading on coronary computed tomographic angiography (CCTA). BACKGROUND: The binary approach used to assess coronary stenoses on CCTA does not adequately describe borderline obstructive lesions and limits full expression of clinically useful information. METHODS: From 84 patients who underwent CCTA and invasive angiography, we identified 278 native coronary segments with > or =25% stenosis on CCTA after excluding all <25% stenotic, stented, and uninterpretable segments. Fifty <25% stenotic segments were randomly selected as controls. Segmental stenosis severity on CCTA was consensually graded using a 0 to 5 scale (grade 0 = none, grade 1 = 1% to 24%, grade 2 = 25% to 49%, grade 3 = 50% to 69%, grade 4 = 70% to 89%, grade 5 = 90% to 100%) by 2 readers, using visual inspection and computed tomography-based quantification (CTQCA). Invasive angiography-based stenosis quantification (IQCA) was performed for all segments, using the same 0 to 5 scale to score stenosis severity. RESULTS: On CCTA, 185 (56%) segments had intermediate stenoses (grade 2 or grade 3). Stenosis severity by IQCA increased significantly with each step-up in CCTA grade (p < 0.001). CTQCA did not perform better than visual inspection. Visual CCTA stenosis grading differed from IQCA by >1 grade in only 4% of grade 2 to grade 5 segments (10 of 278; 2% of CCTA grade 2 segments, 4% of grade 3, 8% of grade 4, 2% of grade 5). Overall quantitative correlation was strong (r = 0.82) with high variability in agreement between CTQCA and IQCA for individual segments (95% of differences between 27.2% and 34.6%). CONCLUSIONS: With current CCTA technology, experienced readers should consider adopting a visually based, multitiered grading approach to evaluate coronary stenoses. A < or =49% lesion on CCTA can be considered virtually exclusive of > or =70% stenosis by invasive angiography.
OBJECTIVES: We evaluated the technical and clinical utility of visual 5-point coronary stenosis grading on coronary computed tomographic angiography (CCTA). BACKGROUND: The binary approach used to assess coronary stenoses on CCTA does not adequately describe borderline obstructive lesions and limits full expression of clinically useful information. METHODS: From 84 patients who underwent CCTA and invasive angiography, we identified 278 native coronary segments with > or =25% stenosis on CCTA after excluding all <25% stenotic, stented, and uninterpretable segments. Fifty <25% stenotic segments were randomly selected as controls. Segmental stenosis severity on CCTA was consensually graded using a 0 to 5 scale (grade 0 = none, grade 1 = 1% to 24%, grade 2 = 25% to 49%, grade 3 = 50% to 69%, grade 4 = 70% to 89%, grade 5 = 90% to 100%) by 2 readers, using visual inspection and computed tomography-based quantification (CTQCA). Invasive angiography-based stenosis quantification (IQCA) was performed for all segments, using the same 0 to 5 scale to score stenosis severity. RESULTS: On CCTA, 185 (56%) segments had intermediate stenoses (grade 2 or grade 3). Stenosis severity by IQCA increased significantly with each step-up in CCTA grade (p < 0.001). CTQCA did not perform better than visual inspection. Visual CCTAstenosis grading differed from IQCA by >1 grade in only 4% of grade 2 to grade 5 segments (10 of 278; 2% of CCTA grade 2 segments, 4% of grade 3, 8% of grade 4, 2% of grade 5). Overall quantitative correlation was strong (r = 0.82) with high variability in agreement between CTQCA and IQCA for individual segments (95% of differences between 27.2% and 34.6%). CONCLUSIONS: With current CCTA technology, experienced readers should consider adopting a visually based, multitiered grading approach to evaluate coronary stenoses. A < or =49% lesion on CCTA can be considered virtually exclusive of > or =70% stenosis by invasive angiography.
Authors: Haim Shmilovich; Victor Y Cheng; Balaji K Tamarappoo; Damini Dey; Ryo Nakazato; Heidi Gransar; Louise E J Thomson; Sean W Hayes; John D Friedman; Guido Germano; Piotr J Slomka; Daniel S Berman Journal: Atherosclerosis Date: 2011-08-07 Impact factor: 5.162
Authors: Ronak Rajani; Haim Shmilovich; Ryo Nakazato; Rine Nakanishi; Yuka Otaki; Victor Y Cheng; Sean W Hayes; Louise E J Thomson; John D Friedman; Piotr J Slomka; James K Min; Daniel S Berman; Damini Dey Journal: J Cardiovasc Comput Tomogr Date: 2013-03-15
Authors: Balaji K Tamarappoo; Ariel Gutstein; Victor Y Cheng; Ryo Nakazato; Heidi Gransar; Damini Dey; Louise E J Thomson; Sean W Hayes; John D Friedman; Guido Germano; Piotr J Slomka; Daniel S Berman Journal: J Nucl Cardiol Date: 2010-04-28 Impact factor: 5.952
Authors: Michiel A de Graaf; Heba M El-Naggar; Mark J Boogers; Caroline E Veltman; Alexander Broersen; Pieter H Kitslaar; Jouke Dijkstra; Lucia J Kroft; Imad Al Younis; Johan H Reiber; Jeroen J Bax; Victoria Delgado; Arthur J Scholte Journal: Eur J Nucl Med Mol Imaging Date: 2013-05-29 Impact factor: 9.236
Authors: Aryeh Shalev; Ryo Nakazato; Reza Arsanjani; Rine Nakanishi; Hyung-Bok Park; Yuka Otaki; Victor Y Cheng; Heidi Gransar; Troy M LaBounty; Sean W Hayes; Daniel S Berman; James K Min Journal: Acad Radiol Date: 2016-09-19 Impact factor: 3.173