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A angiografia coronariana por tomografia computadorizada (ACTC) e um exame bem estabelecido no diagnostico da doenca arterial coronariana. Entretanto, segmentos coronarianos submetidos a implante de stent podem apresentar limitacao na avaliacao luminal. O objetivo deste estudo e avaliar o valor adicional da perfusao miocardica por tomografia computadorizada (PMTC) a avaliacao anatomica isolada pela ACTC em portadores de stent, tendo o cateterismo (CATE) como referencia. Quarenta e seis pacientes (56,9±7,2 anos, 28 homens) com indicacao clinica de CATE em ate 60 dias foram submetidos a avaliacao combinada de ACTC e PMTC, por meio de tomografo de 64 detectores (Aquillion 64, Toshiba). A aquisicao foi iniciada com a fase de estresse (PMTC) usando-se dipiridamol a 0,56mg/kg/4min e 60ml de contraste a 3ml/s, seguido de reversao com aminofilina 240mg e metoprolol (ate 20mg). Em seguida, realizou-se a ACTC com 80-90ml de constraste a 5ml/s. Os dados da PMTC, da ACTC, e do CATE foram analisados por dois observadores independentes, sem informacoes clinicas dos pacientes. Primariamente analisou-se a ACTC, seguida da avaliacao da PMTC. Concluida esta fase, os observadores tinham a possibilidade de reclassificar os segmentos coronarianos submetidos a stent cuja avaliacao estivesse limitada ou inadequada por artefatos. A dose total media de radiacao foi 15,83±4,93 mSv e todos os exames foram adequados. Um total de 129 segmentos coronarianos foi avaliado na ACTC, bem como os respectivos territorios miocardicos pela PMTC. Destes, 54 territorios (42%) eram relacionados a presenca de stents, sendo 19 com stents de avaliacao adequada e 23 com avaliacao luminal limitada, porem possivel, e 12 segmentos de avaliacao inadequada (sem possibilidade de avaliacao luminal). Os valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuracia para a ACTC isolada nos territorios com stents foram de, respectivamente: 85%, 76%, 85%, 76% e 81%, e... Coronary computed tomography angiography (coronary CTA) is a well established examination in the diagnosis of coronary artery disease (CAD). However, the segments with prior coronary stent implantation may have limited luminal evaluation. The aim of this study is to assess the incremental value of myocardial computed tomography perfusion (myocardial CTP) to the anatomical assessment by coronary CTA alone in patients with stents, using catheterization (CAT) as a reference method. Forty-six patients (56.9 ± 7.2 years, 28 men) referred to CAT by clinical indication within 60 days, were evaluated with combined evaluation of coronary CTA and myocardial CTP through 64-detector CT scanner (Aquillion 64, Toshiba). The acquisition protocol began with the stress phase (myocardial CTP), using dipyridamole to 0.56 mg/kg/4min and 60ml of contrast (3ml/s), followed by a bolus of aminophylline 240 mg and metoprolol (up to 20mg). After, it was performed the coronary CTA wih 80-90ml of contrast (5 ml/s). Data from the myocardial CTP, coronary CTA and CAT were analyzed by two independent observers, with no knowledge to clinical information. The observers reviewed the coronary CTA findings, and in a second time performed the evaluation of myocardial CTP. So, they had the possibility to reclassify segments with coronary stent that were considered with limited or inadequate assessment due to artifacts. Mean total dose of radiation was 15.83 ± 4.93 mSv, and all examinations were interpretable. A total of 129 coronary segments were evaluated by coronary CTA, and also were their correspondent myocardial territories by myocardial CTP. Of these, 54 territories (42%) were related to the presence of stents, 19 stents with adequate evaluation, 23 with limited evaluation, but possible, and 12 with inadequate evaluation (no luminal assessment possible). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the coronary CTA in territories...

Angiografia coronariana e perfusão miocárdica de estresse por tomografia computadorizada de 64 colunas de detectores na avaliação luminal intra-stent