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KMID : 1149020180200010051
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Journal of Korean Society of Computed Tomographic Technology
2018 Volume.20 No. 1 p.51 ~ p.58
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Usefulness of Coronary venous classification using coronary CT angiography for Cardiac Resynchronization Therapy planning
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Nam Tae-Hyun
Gwon Sun-Ahn
Min Kwan-Hong
Chun Eun-Ju
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Abstract
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Purpose : Cardiac Resynchronization Therapy (CRT) is being used heart failure patients, category III and IV of NewYork Heart Association (NYHA). Multi-detector CT (MDCT) has allowed visualization of the 3-dimensional coronary venous anatomy. We aimed to evaluate the venous anatomy with coronary CT angiography using appropriate protocol and suggest the new classification for the coronary venous anatomy and anatomic variants.
Materials and Methods : 189 patients underwent 256-row MDCT (Brilliance iCT, Philips Healthcare, Cleveland, OH, USA) were retrospectively involved for this study. We used CT protocol for CRT which has two phases scan (late arterial and venous phases) and split contrast agent injection technique. A volume rendering image set and a curved multi-planar reconstruction image set by 3D reconstruction workstations were used for identifying and measuring coronary veins. Image quality is graded with the 0-5 points scale method by a radiologist. We categorized the venous anatomy according to the presence of main 3 veins (left marginal vein [L, 1], posterior vein of left ventricle [P, 2] and middle cardiac vein [M, 3]) for CRT and order of their dominance.
Results : The venous anatomy can be evaluated from all patients using this protocol. (135 excellent, 46 good and 8 fair). Depending on “Coronary Venous Anatomy Classification”, 142 out of 189 (75.1 %) patients had all 3 main veins (termed as “LPM” group), 18 patients (9.5 %) had P and M veins (termed as “PM” group), 23 patients (12.2 %) were “LM” group, 2 patients (1 %) were “LP” group. Only 4 out of 189 (2 %) patients were included in group “etc.” which cannot represent with this classification. According to the second category of dominant vein order, LPM_3_1_2 (M>L>P) is highest frequency (29.8 %), followed by LPM_3_2_1 (25.7 %), LM_3_1 (11.5 %) and LPM_3_1,2 (10.5 %).
Conclusions : MDCT using two phase protocol can visualize the venous anatomy and variants with good image quality. By using the coronary venous anatomical information depend upon MDCT, simply categorized “Coronary Venous Anatomy Classification” can be useful prior to CRT implantation, it may save the procedure time.
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KEYWORD
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cardiac resynchronization therapy, veins, coronary, multidetector computed tomography
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