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We describe a case of a 52-year-old-woman with aortic coarctation demonstrated by means of 40-slice MSCT angiography. Based on the information extracted from MSCT it was possible to display the anatomical configuration of the disease, the thoraco-abdominal collateral pathways. The best therapeutic approach was established on the basis of MSCT findings. MSCT is a reliable and comprehensive tool for the assessment of adult patients with aortic coarctation. (www.actabiomedica.it).

The aim of this article is to illustrate the main technical improvements in the last generation of 64-row CT scanners and the possible applications in coronary angiography. In particular, we describe the new physical components (X-ray tube-detectors system) and the general scan and reconstruction parameters. We then define the scan protocols for coronary angiography with the new generation of 64-row CT scanners to enable radiologists to perform a CT study on the basis of the diagnostic possibilities.

The aim of the study was to assess the prognostic value of multidetector-row CT coronary angiography (MDCT-CA) in patients with suspected coronary artery disease (CAD) in a routine clinical context.A total of 125 patients (82 men, age 57.4±10.3 years) with suspected CAD underwent MDCT-CA. All patients were assessed for cardiovascular risk factors, symptoms and coronary calcium score. A 2-year follow-up study for the occurrence of major adverse cardiac events was performed.According to the Morise pretest score, 76 patients (60.8%) were at intermediate risk. Patients with suspected CAD presented the following prognostic outcome (p0.0001): in 41 patients with normal coronary arteries at MDCT-CA, the event rate was 0%; five of 49 patients with nonobstructive CAD had major cardiac events; two of 35 patients with obstructive CAD suffered cardiac death and 19 underwent revascularisation. At multivariate analysis, the presence of obstructive CAD is the only significant independent prognostic variable (hazard ratio, 10.1393; 95% confidence interval 3.2189-31.9379; p0.0001).Routine clinical MDCT-CA provides an excellent prognostic value at 2-year follow-up in patients with normal coronary arteries. The cardiac event rate increases with CAD severity.

PURPOSE: To assess the variability in attenuation of coronary plaques with multislice CT-angiography (MSCT-CA) in an ex-vivo model with varying convolution kernels. MATERIALS AND METHODS: MSCT-CA (Sensation 16, Siemens) was performed in three ex-vivo left coronary arteries after instillation of contrast material solution (Iomeprol 400 mgI/ml, dilution: 1/80). The specimens were placed in oil to simulate epicardial fat. Scan parameters: slices 16/0.75 mm, rotation time 375 ms, feed/rotation 3.0 mm, mAs 500, slice thickness 1 mm, and FOV 50 mm. Datasets were reconstructed using 4 different kernels (B30f-smooth, B36f-medium smooth, B46f-medium, and B60f-sharp). Each scan was scored for the presence of plaques. Once a plaque was detected, the operator performed attenuation measurements (HU) in coronary lumen, oil, calcified and soft plaque tissue using the same settings in all datasets. The results were compared with T-test and correlated with Pearson's test. RESULTS: Overall, 464 measurements were performed. Significant differences (p

PURPOSE: To assess the effect of intravascular enhancement, heart rate, and calcium score on diagnostic accuracy in the detection of significant coronary artery stenosis using 16-row multislice computed tomography (MSCT). MATERIALS AND METHODS: One hundred patients (88 males; 59+/-11 years) with suspected coronary artery disease who had undergone conventional coronary angiography (CA) and MSCT-CA were retrospectively enrolled for the study. Patients underwent a MSCT-CA, with the following protocol: collimation 16x0.75 mm, gantry rotation time 420 ms, feed/rotation 2.8 mm, kV 120, mAs 400-500. The protocol for contrast material administration was 100 ml of Iodixanol 320 mgI/ml at 4 ml/s and the scan delay was defined with a bolus tracking technique. In all patients vascular enhancement was measured in the aortic root, and in the left and right coronary arteries. The average vascular enhancement was used to divide the population in two groups of 50 patients each, one with lower enhancement (Low), and one with higher enhancement (High). In the two groups diagnostic accuracy (per coronary segment) for the detection of significant stenosis (= or >50% lumen reduction) was evaluated in vessels = or >2 mm in diameter using quantitative CA as the reference standard. The differences in diagnostic accuracy were compared with a Chi-square test and a p2 mm lumen diameter), 173 presented significant stenosis. The sensitivity and specificity for the assessment of significant stenosis were 89.4% and 93.3% vs 94.3% and 97.4% in the presence of increasing intravascular enhancement, 92.8% and 96.7% vs 91.1% and 93.9% in the presence of increasing heart rate, and 89.7% and 97.6% vs 93.3% and 92,8% in the presence of an increasing calcium score. CONCLUSIONS: Increasing intravascular enhancement significantly improves diagnostic accuracy in MSCT-CA. A higher heart rate lowers the specificity in the detection of significant obstructing lesions of the coronary artery. An increasing calcium score determines a lower specificity and a higher sensitivity.

Multislice computed tomography is a rapidly emerging technique for the non-invasive visualization of coronary arteries. Over the past 5 years several scanner generation were introduced with a progressive improvement in the diagnostic accuracy in the detection of coronary artery stenosis in selected patients populations. The introduction of 64-slice technology has further improved the diagnostic performance. This technique is at the edge of clinical implementation and, even though large clinical trials are still missing, an increased demand for these type of studies is observed all over the world. We describe our experience of more than 1 year with 64-slice CT coronary angiography providing clues on reasonable clinical applications.

PURPOSE: To evaluate the diagnostic accuracy of 16-row multislice spiral computed tomography coronary angiography (16-MSCT-CA) for the non-invasive assessment of significant coronary artery stenosis. MATERIALS AND METHODS: We enrolled 40 patients (36 male, aged 59+/-11 yrs) with suspected obstructive coronary artery disease and a heart rate 2 mm in diameter were evaluated by two independent observers for the presence of significant coronary artery stenosis (= or >50%). Consensus reading was compared to quantitative coronary angiography. RESULTS: The average heart rate was 55+/-6 bpm. Of the 428 segments of = or >2.0 mm diameter 92 were significantly diseased. Without exclusion of any branches (428), the sensitivity, specificity, positive, and negative predictive values to identify = or >50% obstructed segments were 95.7% (88/92), 95.8% (322/336), 86.3% (88/102), and 98.8% (322/326), respectively. No occluded left main, left anterior descending, circumflex or right coronary artery segments remained undetected. CONCLUSIONS: 16-MSCT-CA in a selected low-heart-rate patient population provides high diagnostic accuracy in the evaluation of significant coronary artery stenosis.

Digital pathology for the routine assessment of cases for primary diagnosis has been implemented by few laboratories worldwide. The Gravina Hospital in Caltagirone (Sicily, Italy), which collects cases from 7 different hospitals distributed in the Catania area, converted the entire workflow to digital starting from 2019. Before the transition, the Caltagirone pathology laboratory was characterized by a non-tracked workflow, based on paper requests, hand-written blocks and slides, as well as manual assembling and delivering of the cases and glass slides to the pathologists. Moreover, the arrangement of the spaces and offices in the department was illogical and under-productive for the linearity of the workflow. For these reasons, an adequate 2D barcode system for tracking purposes, the redistribution of the spaces inside the laboratory and the implementation of the whole-slide imaging (WSI) technology based on a laboratory information system (LIS)-centric approach were adopted as a needed prerequisite to switch to a digital workflow. The adoption of a dedicated connection for transfer of clinical and administrative data between different software and interfaces using an internationally recognised standard (Health Level 7, HL7) in the pathology department further facilitated the transition, helping in the integration of the LIS with WSI scanners. As per previous reports, the components and devices chosen for the pathologists’ workstations did not significantly impact on the WSI-based reporting phase in primary histological diagnosis. An analysis of all the steps of this transition has been made retrospectively to provide a useful “handy” guide to lead the digital transition of “analog”, non-tracked pathology laboratories following the experience of the Caltagirone pathology department. Following the step-by-step instructions, the implementation of a paperless routine with more standardized and safe processes, the possibility to manage the priority of the cases and to implement artificial intelligence (AI) tools are no more an utopia for every “analog” pathology department.

The goal of this article is to illustrate the main invasive and noninvasive diagnostic modalities to image the vulnerable coronary plaque, which is responsible for acute coronary syndrome. The main epidemiologic and histological issues are briefly discussed in order to provide an adequate background. Comprehensive coronary atherosclerosis imaging should involve visualization of the entire coronary artery tree and plaque characterization, including three-dimensional morphology, relationship with the lumen, composition, vascular remodelling and presence of inflammation. No single technique provides such a comprehensive description, and no available modality extensively identifies the vulnerable plaque. In particular, we describe multislice computed tomography, which at present seems to be the most promising noninvasive tool for an exhaustive image-based quantification of coronary atherosclerosis.

Three-dimensional reconstructions represent a visual-based tool for illustrating the basis of three-dimensional post-processing such as interpolation, ray-casting, segmentation, percentage classification, gradient calculation, shading and illumination. The knowledge of the optimal scanning and reconstruction parameters facilitates the use of three-dimensional reconstruction techniques in clinical practise. The aim of this article is to explain the principles of multidimensional image processing in a pictorial way and the advantages and limitations of the different possibilities of 3D visualisation.

The aim of our study was to evaluate the atherosclerotic pattern of patients with coronary myocardial bridging (MB) by means of CT Coronary Angiography (CT-CA). 254 consecutive patients (166 male, mean age 58.6 +/- A 10.3) who underwent 64-slice CT-CA according to current clinical indications were reviewed for the presence of MB and concomitant segmental atherosclerotic pattern. Coronary plaques were assessed in all patients enrolled. 73 patients (29%) presented single (90%) or multiple (10%) MB, frequently (93%) localized in the mid-distal left anterior descending artery. The MB segment was always free of atherosclerosis. Segments proximal to the MB presented: no atherosclerotic disease (n = 37), positive remodeling (n = 23), < 50% (n = 14), or > 50% stenoses (n = 7). Distal segments presented a different atherosclerosis pattern (P < 0.0001): absence of disease (n = 73), no significant lesions (n = 8). No significant differences were found between segments proximal to MB and proximal coronary segments apart from left main trunk. Pattern of atherosclerotic lesions located in segments 6 and 7 significantly differs between patients with MB and patients without MB (P < 0.05). CT-CA is a reliable method to non-invasively demonstrate MB and related atherosclerotic pattern. CT-CA provides new insight regarding atherosclerosis distribution in segments close to MB.

Purpose. This study was undertaken to describe the correlation between the distribution of coronary artery disease (CAD) in a symptomatic population with suspected ischaemic heart disease, cardiovascular risk factors (RF) and clinical presentation. Materials and methods. We studied 163 patients (mean age 65.5 years; 101 men and 62 women) referred for multidetector computed tomography coronary angiography (MDCT-CA) to rule out CAD. The patients had no prior history of revascularisation or myocardial infarction. We analysed how the characteristics of CAD (severity and type of plaque) can change with the increase in RF and how they are related to different clinical presentations. Results. Patients were divided into three groups according to the number of RF: zero or one, two or three, and four or more. The percentage of coronary arteries with no plaque, nonsignificant disease and significant disease was 55%, 41% and 4%, respectively, in patients with zero or one RF; 27%, 51% and 22%, respectively, in patients with two or three RF; and 19%, 38% and 44%, respectively, in patients with four or more RF. Plaque in patients with nonsignificant disease was mixed in 65%, soft in 18% and calcified in 17%. The percentage of coronaries with no plaque in the three RF groups was 50%, 20% and 0% in patients with typical chest pain and 46%, 24% and 12% in those with atypical pain. The percentage of significant disease in patients with typical pain was 0%, 47% and 86% and in those with atypical pain 4%, 20% and 29%. Conclusions. MDCT plays an important role in the identification of CAD in patients with suspected ischaemic heart disease. Severity and type of disease is highly correlated with RF number and assumes different characteristics according to clinical presentation.

The aim of this study was to assess the feasibility of three-dimensional (3D) reconstructions and quantitative analysis of the volume of each component of the lung with cystic fibrosis (CF).Twenty-two patients with CF (mean age 17+/-8 years) were included in the study. The patients underwent an unenhanced single-slice spiral computed tomography (CT) chest scan with the following parameters: collimation 3 mm, table feed 6 mm x rot(-1), reconstruction interval 1 mm, soft tissue reconstruction kernel. Four image data sets were obtained: native axial slices, cine-mode display, virtual bronchographic volume-rendered images with algorithm for tissue transition display and virtual endoluminal views. The lungs were segmented manually from the hilum to the visceral pleura on the axial images, and the entire lung volume was calculated. A histogram was generated representing the fractional volume of tissues, the density of which was within a preset range. A curve was then obtained from the histogram.Native axial images and cine-mode display allowed complete evaluation of lung volumes. Virtual bronchography allowed a better assessment of the distribution of bronchiectasis. Virtual bronchoscopy was limited by the fact that it visualised only the surface, without differentiating mucus from the bronchial wall. Manual segmentation and generation of density-volume curves required 41+/-7 min for each lung. Three curve patterns were identified depending on disease severity.Volume-density analysis of lungs with CF is feasible. Its main advantage is that image analysis is not analogical, as the assessment is not performed using scoring systems or similar ordinal scales. This technique cannot differentiate acute from chronic findings, and the predictive value of the curve should be assessed.

Purpose. Our aim was to evaluate the diagnostic accuracy of 64- slice computed tomography coronary angiography (MSCT-CA) for detecting significant stenosis (≥50% lumen reduction) in a population of patients at low to intermediate risk. Materials and methods. We studied 72 patients (38 men, 34 women, mean age 53.9±8.0 years) with atypical or typical chest pain and stratified in the low- to intermediate risk category. MSCT-CA (Sensation 64 Cardiac, Siemens, Germany) was performed after IV administration of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). Two observers, blinded to the results of conventional coronary angiography (CAG), assessed the MSCT-CA scans in consensus. Diagnostic accuracy for detecting significant stenosis was calculated. Results. CAG demonstrated the absence of significant disease in 70.1% of patients (51/72). No patient was excluded from MSCTCA. There were 37 significant lesions on 1,098 available coronary segments. Sensitivity, specificity and positive and negative predictive value of MSCT-CA for detecting significant coronary artery on a per-segment basis were 100%, 98.6%, 71.2% and 100%, respectively. All patients with at least one significant lesion were correctly identified by MSCT-CA. MSCT-CA scored 15 false positives on a per-segment base, which affected only marginally the per-patient performance (only one false positive). Conclusions. We concluded that 64-slice CT-CA is a diagnostic modality with high sensitivity and negative predictive value in patients at low to intermediate risk.

PURPOSE: The aim of this study was to correlate left main (LM) coronary artery dimensions with the presence of atherosclerosis by multidetector-row computed tomography (MDCT) coronary angiography (CA) and to assess coronary atherosclerotic plaques with a semiquantitative method. MATERIALS AND METHODS: Sixty-two consecutive patients (41 men, mean age 60+/-11) with suspected coronary artery disease underwent 64-MDCT coronary angiography. LM dimensions (length, ostial and bifurcation diameters), quantitative [location, Hounsfield unit (HU) attenuation] and qualitative (composition, shape) analysis of plaques within the LM were performed. All patients underwent conventional CA. RESULTS: Thirty patients (mean age 55+/-10) without plaques in the LM presented the following average dimensions: length 10.6+/-6.1 mm, ostial diameter 5.5+/-0.7 mm, bifurcation diameter 4.9+/-0.9 mm. LM plaques (n=36) were detected in 32 patients (mean age 64+/-10) with the following LM average dimensions: length 11.3+/-4.0 mm, ostial diameter 6.0+/-1.2 mm and bifurcation diameter 6.0+/-1.2 mm. Plaques were calcified (40%, mean attenuation 742+/-191 HU), mixed (43%, mean attenuation 387+/-94 HU) or noncalcified (17%, mean attenuation 56+/-14 HU) and were frequently eccentric (77%). Age was significantly different in the two groups (p

Purpose. The aim of the study was to investigate the prevalence of the noncardiac collateral findings during multislice computed tomography coronary angiography (MSCT-CA). Materials and methods. Six hundred and seventy patients undergoing MSCT-CA with 16-slice and 64-slice CT scanners for suspected atherosclerotic disease of the coronary arteries were retrospectively reviewed. All data sets obtained with a large field of view (FOV) were analysed by two radiologists using standard mediastinal and lung window settings. Collateral findings were divided according to clinical importance into nonsignificant, remarkable and compulsory to be investigated. Results. Eighty-five percent of patients revealed coronary artery disease (CAD). Only 138/670 (20.6%) were without any additional finding. An additional 1,234 findings were recorded: nonsignificant 332 (26.9%), mild 821 (66.53%), compulsory for study 81 (6.56%). A total of 81 patients (12.08%) had significant noncardiac pathology requiring clinical or radiological follow-up. Among these, newly discovered pathologies were revealed in two patients (2.46%). Conclusions. A significant number of noncardiac findings might have been missed in MSCT-CA scans; the appropriate approach should be as a team trained in cardiology and radiology.

PURPOSE: Assess the effect of heart rate on diagnostic accuracy for the detection of significant coronary artery stenosis using 16-row multislice computed tomography (MSCT). MATERIAL AND METHODS: About 120 patients (105 males; 59+/-11 years) with suspected coronary artery disease who underwent conventional coronary angiography (CA) and MSCT-CA were retrospectively enrolled for the study. Patients underwent a MSCT-CA (Sensation 16, Siemens, Germany), with the following protocol: collimation 16 x 0.75 mm, gantry rotation time 420 ms, feed/rotation 3.0 mm, kV 120, mAs 400-500. The protocol for contrast material administration was 100 ml of Iodixanol (Visipaque 320 mg l/ml, Amersham, UK) at 4 ml/s and the delay was defined with a bolus tracking technique. In all patients the mean heart rate (HR) during the scan was used as a criteria to divide the population in two groups of 60 patients each. In one group (Low HR) the 60 patients with lower heart rates, and in the other group (High HR) the patients with higher heart rates. In the two groups diagnostic accuracy (per coronary segment) for the detection of significant stenosis (>or=50% lumen reduction) was evaluated in vessels >or=2 mm of diameter using quantitative CA as reference standard. The difference in diagnostic accuracy were compared with a Chi(2) test and a p