Concomitant Atherosclerotic Disease Detected by Whole-Body MR Angiography in Relation to Coronary Artery Calcification in Patients with Coronary Artery Disease

Zusammenfassung

Ziel: Patienten mit einer koronaren Herzerkrankung (KHK) weisen häufig begleitende arteriosklerotische Gefäßwandveränderungen des peripheren Gefäßsystems (pAVK) auf. Eine pAVK scheint ein zusätzlicher Risikofaktor für das Auftreten kardialer Ereignisse zu sein. In unserer Untersuchung korrelierten wir das Auftreten von Gefäßwandveränderungen, die mittels Ganzkörper-MR-Angiografie detektiert wurden, mit dem Maß an Koronargefäßverkalkungen, die mittels EBCT oder MSCT gefunden wurden. Material and Methoden: 228 Patienten (161 Männer; 67 Frauen) mit Verdacht auf eine KHK bzw. mit einer bekannten KHK wurden mittels kontrastverstärkter Ganzkörper-MR-Angiografie und EBCT/MSCT untersucht. Für jeden Patienten wurde ein Arterioskleroseindex berechnet:

Index = ∑⁴⁰ _n=1w_i

(w_i Grad der Stenose in i^ten der 40 Gefäßsegmente [Grad: 0 – kein Plaque; 1 – Plaque – ≤ 50 % Stenose; 2 – > 50 % Stenose – ≤ 90 % Stenose; 3 – > 90 % Stenose – < 100 % Stenose; 4 – Gefäßverschluss]). Ergebnisse: Die Ganzkörper-MR-Angiografie und die koronare Koronarkalkbelastung korrelieren mäßig. Für einen Arterioskleroseindex 8 liegt der positiv prädiktive Wert für eine Koronarkalkbelastung 100 bei 63,3 %. Schlussfolgerung: Der hier benutzte Arterioskleroseindex korreliert nicht im vollen Umfang mit dem Ausmaß der KHK, so wie es mittels Koronarangiografie oder EBCT/MSCT detektiert werden kann, jedoch spiegelt er theoretisch das erhöhte Risiko für Patienten mit einer pAVK für eine KHK wider. Dieser Index könnte daher ein weiteres vielsprechendes Hilfsmittel für die Vorhersage von kardialen Ereignissen sein. Jedoch müssen weitere Studien dieses zeigen.

Abstract

Purpose: Patients with coronary artery disease (CAD) show a high prevalence for concomitant atherosclerotic peripheral arterial disease (PAD). On the other hand, PAD seems to be an additional risk factor for cardiac events. We evaluated the correlation between arterial pathologies as found in whole-body MR angiography and coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) and multislice CT (MSCT). Materials and Methods: Two hundred and twenty-eight patients (161 men; 67 women) with suspicion for CAD/known CAD underwent whole-body contrast-enhanced MR angiography (wb-ce-MRA) and EBCT/MSCT. An atherosclerosis index was calculated for each patient

Index = ∑⁴⁰ _n=1w_i

with w_i being the grading of the stenosis of the i^ten of 40 arteria segments (grade: 0 – no plaque; 1 – plaque – ≤ 50 % stenosis; 2 – > 50 % stenosis – ≤ 90 % stenosis; 3 – > 90 % stenosis – < 100 % stenosis; 4 – occlusion). Correlations between CAC and atherosclerosis index were performed. Results: Wb-ce MRA and CAC correlate only moderately in this population. An atherosclerosis index 8 renders a positive predictive value for a CAC 100 of 63.3 %. Conclusion: An atherosclerosis index as defined in this study does not fully correlate with the extent of CAD as revealed by catheter angiography or EBCT/MSCT, but it might theoretically mirror the increased risk by PAD. It thus might be a promising complementary parameter for the prediction of cardiac events. Future studies need to show its possible additional predictive impact.

vascular - MR angiography - CT electron beam

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