Cardiac dual-source CT for the preoperative assessment of?patients undergoing bariatric surgery

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• 作者：A. Tognolini^a ; ^{ATognolini@mednet.ucla.edu} ; C.S. Arellano^a ; W. Marfori^a ; J.W. Sayre^a ; ^b ; J.L. Hollada^a ; J.G. Goldin^a ; E.P. Dutson^c ; S.G. Ruehm^a
• 刊名：Clinical Radiology
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：68
• 期：3
• 页码：e154-e163
• 全文大小：965 K

文摘

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Aim

To assess the diagnostic value of coronary dual-source computed tomography (DSCT) as a comprehensive, non-invasive tool in the preoperative cardiac evaluation of patients undergoing bariatric surgery.

Materials and methods

Thirty consecutive obese [average body mass index (BMI): 45?¡À?7.6, range: 35-59] patients (24 women; six men; median age: 52?¡À?15 years) were enrolled in this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant prospective study. Calcium scoring (CaS) and electrocardiography (ECG)-gated images of the coronary arteries were obtained with a large body habitus protocol (120?kV; 430?mAs; 100?ml iodinated contrast medium at 7?ml/s injection rate) on a DSCT machine. Qualitative (four-point: 1?=?excellent to 4?=?not delineable) coronary segmental analysis, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) measurements were performed. The presence and degree of vascular disease (four-grade scale: mild to severe) was correlated with CaS and cardiovascular (CV) risk stratification blood tests. In patients with severe stenosis (>70 % ), findings were compared with cardiac nuclear medicine imaging (single photon-emission computed tomography; SPECT) imaging.

Results

The average HR, enhancement, and quality score were 64?¡À?7 beats/min, 288?¡À?66?HU and 1.8?¡À?.5, respectively. Ninety-three percent (417/450) of the coronary segments were rated diagnostic. The SNRs and CNRs were 17?¡À?9 and 12?¡À?7 for the right coronary artery; 17?¡À?8 and 12?¡À?7 for the left main coronary artery; 16?¡À?9 and 11?¡À?7 for the left anterior descending coronary artery; and 15?¡À?7 and 10?¡À?6 for the left circumflex coronary artery. Ten of the 30 patients (33 % ) demonstrated coronary artery disease (CAD) of which two (6 % ) showed three-vessel disease. Four (13 % ) patients showed severe disease: in three of which the presence of significant stenosis was confirmed by SPECT and by catheter angiography in the fourth patient. Neither the CaS, nor the?CV?risk stratification tests showed significant correlation with presence or degree of CAD (p?>?0.05).

Conclusions

Coronary DSCT is a robust alternative imaging tool in the preoperative assessment of patients undergoing bariatric surgery.