الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The presence of MVD indicates poorer prognosis and a significantly higher mortality than single-vessel disease. In MVD, revascularization can be achieved by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
Invasive coronary angiography has been the gold standard diagnostic method to guide revascularization procedures since their introduction. As its limitations in some situations have been recognized, MSCT coronary angiography was introduced as a useful tool for the evaluation of coronary anatomy and provides information not currently available from invasive angiography.
The current study was concerned with evaluating the accuracy of computed tomography when compared with standard coronary angiography in evaluation of SYNTAX score to decide the revascularization strategy in MVD patients. The study included 46 patients who were referred for both invasive CA and CCTA; all patients had the MSCT conducted using 64 CT scanner. This was done utilizing dual-source CT system (Somatom Definition, Siemens). The study included a pre scan calcium scoring, followed by a contrast enhanced scan. Heart rate control was attempted in every patient using a beta blocker (bisoprolol) orally. Both the MSCT and invasive coronary angiography data were evaluated by operators blinded to the results of the other test. MSCT data were evaluated using the Trans axial images, as well as other reconstruction modalities; multiplanar reconstructions, MIP and curved MPR. Coronary segments were described according to braunwald coronary anatomic model which classify coronary segments into 18-segment and was used to evaluate the coronary tree by both methods. All segments were evaluated by both CCTA and CA and were labeled either with significant stenosis (≥ 50% luminal narrowing) or with no significant stenosis (< 50% luminal narrowing or less).
The current study revealed a good accuracy with CCTA in the diagnosis of significant (>50%) coronary stenosis, CCTA better than CA in visualization the occluded coronary segment morphology and length, CCTA and CA in detection calcifications which cannot be often well clarified by conventional ICA, finally In this study we found that there was significant difference between SYNTAX score calculated with MSCTA and that calculated with ICA. However there was a fair level of agreement between both modalities. This result is consistent with several other studies which have assessed the accuracy of the MSCT coronary angiography.
There was an additional role for CCTA regarding congenital coronary artery anomalies with variable origins and course not diagnosed by CA. Also CCTA can diagnose other associated non-coronary findings as in our study there were 3 patients had dilated ascending aorta ranging also one patient had left ventricular filling defect at the apex while another one had consolidated patches of pneumonia and lastly one patient had encysted pleural effusion. We can reach to a conclusion from this study that the Dual-Source 64- slice CT coronary angiography is a robust test that can be used confidently used in addition to CA in cases with MVD to revascularization strategy decision especially patients with total occlusions and calcifications.