Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Korean J Radiol. 2018 Mar-Apr;19(2):256-264. doi: 10.3348/kjr.2018.19.2.256. Epub 2018 Feb 22.
To investigate the morphological changes of coronary chronic total occlusion (CTO) as determined by coronary computed tomography angiography (CCTA) follow-up using semi-automated quantitative analysis.
Thirty patients with 31 CTO lesions confirmed by invasive coronary angiography and baseline/follow-up CCTA were retrospectively included. CTOs were quantitatively analyzed by a semi-automated coronary plaque analysis software (Coronary Plaque Analysis, version 2.0, Siemens) after manually determining the lesion border. Recanalized lumen was defined as the linear-like enhanced opacity traversing the non-opacified occluded segment. Other parameters, such as total occlusion length, total occlusion volume, volume with low attenuation component (< 30 Hounsfield unit [HU]), volume with middle to high attenuation component (30-190 HU) as well as the calcification volume, were also recorded.
Recanalized lumen was found within 48.4% (15/31) occlusions on the follow-up CCTA, compared to 45.2% (14/31) occlusions on the baseline CCTA. Eleven of 14 lesions (78.6%) with CT-visible recanalized lumen within CTOs had a shorter occlusion length on follow-up compared to only 3 of 17 lesions (17.6%) without CT-visible recanalized lumen (odds ratio, 17.1, < 0.001). The percentage of low attenuation component of occlusions was smaller on follow-up CCTA compared to baseline value (18.1 ± 20.1% vs. 22.6 ± 19.6%, = 0.033).
Coronary computed tomography angiography enables non-invasive characterization of natural progression of untreated CTO lesions. Recanalized lumen within CTOs observed at baseline CCTA was associated with shortening of occlusion length on follow-up. Compared to their earlier stage, occlusions of later stage were presented with higher density of non-calcified components.
通过冠状动脉 CT 血管造影（CCTA）随访的半自动定量分析，研究冠状动脉慢性完全闭塞（CTO）的形态学变化。
回顾性纳入 30 例经冠状动脉造影证实的 31 例 CTO 病变患者，均行基线/随访 CCTA 检查。手动确定病变边界后，使用半自动冠状动脉斑块分析软件（Coronary Plaque Analysis，version 2.0，Siemens）对 CTO 进行定量分析。再通管腔定义为穿过未显影闭塞段的线性增强不透明度。还记录了总闭塞长度、总闭塞体积、低衰减成分体积（<30 亨氏单位[HU]）、中至高衰减成分体积（30-190 HU）以及钙化体积等其他参数。
在随访 CCTA 上发现 31 处闭塞中有 48.4%（15/31）存在再通管腔，而在基线 CCTA 上有 45.2%（14/31）存在再通管腔。14 处 CT 可见再通管腔的病变中有 11 处（78.6%）的闭塞长度在随访时较基线时缩短，而在 17 处无 CT 可见再通管腔的病变中仅有 3 处（17.6%）缩短（比值比，17.1，<0.001）。与基线值相比，闭塞的低衰减成分百分比在随访 CCTA 上较小（18.1±20.1% vs. 22.6±19.6%，=0.033）。
冠状动脉 CT 血管造影能够无创性地描述未经治疗的 CTO 病变的自然进展情况。在基线 CCTA 上观察到的 CTO 内再通管腔与随访时闭塞长度的缩短有关。与早期阶段相比，晚期阶段的闭塞表现为非钙化成分的密度更高。
