101
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Kurita Y, Kitagawa K, Kurobe Y, Nakamori S, Nakajima H, Dohi K, Ito M, Sakuma H. Estimation of myocardial extracellular volume fraction with cardiac CT in subjects without clinical coronary artery disease: A feasibility study. J Cardiovasc Comput Tomogr 2016; 10:237-41. [DOI: 10.1016/j.jcct.2016.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/02/2016] [Accepted: 02/21/2016] [Indexed: 01/13/2023]
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102
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Ishida M, Kitagawa K, Ichihara T, Natsume T, Nakayama R, Nagasawa N, Kubooka M, Ito T, Uno M, Goto Y, Nagata M, Sakuma H. Underestimation of myocardial blood flow by dynamic perfusion CT: Explanations by two-compartment model analysis and limited temporal sampling of dynamic CT. J Cardiovasc Comput Tomogr 2016; 10:207-14. [DOI: 10.1016/j.jcct.2016.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 12/04/2015] [Accepted: 01/11/2016] [Indexed: 11/24/2022]
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103
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Lee JH, Han D, Danad I, Hartaigh BÓ, Lin FY, Min JK. Multimodality Imaging in Coronary Artery Disease: Focus on Computed Tomography. J Cardiovasc Ultrasound 2016; 24:7-17. [PMID: 27081438 PMCID: PMC4828419 DOI: 10.4250/jcu.2016.24.1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 02/08/2023] Open
Abstract
Coronary artery disease (CAD) is the leading cause of mortality worldwide, and various cardiovascular imaging modalities have been introduced for the purpose of diagnosing and determining the severity of CAD. More recently, advances in computed tomography (CT) technology have contributed to the widespread clinical application of cardiac CT for accurate and noninvasive evaluation of CAD. In this review, we focus on imaging assessment of CAD based upon CT, which includes coronary artery calcium screening, coronary CT angiography, myocardial CT perfusion, and fractional flow reserve CT. Further, we provide a discussion regarding the potential implications, benefits and limitations, as well as the possible future directions according to each modality.
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Affiliation(s)
- Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Donghee Han
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Ibrahim Danad
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.; Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.; Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA
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104
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Semiautomated Global Quantification of Left Ventricular Myocardial Perfusion at Stress Dynamic CT:: Diagnostic Accuracy for Detection of Territorial Myocardial Perfusion Deficits Compared to Visual Assessment. Acad Radiol 2016; 23:429-37. [PMID: 26853969 DOI: 10.1016/j.acra.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/24/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic accuracy of semiautomated global quantification of left ventricular myocardial perfusion derived from stress dynamic computed tomography myocardial perfusion imaging (CTMPI) for detection of territorial perfusion deficits (PD). MATERIALS AND METHODS Dynamic CTMPI datasets of 71 patients were analyzed using semiautomated volume-based software to calculate global myocardial blood flow (MBF), myocardial blood volume, and volume transfer constant. Optimal cutoff values to assess the diagnostic accuracy of these parameters for detection of one- to three-vessel territories with PD in comparison to visual analysis were calculated. RESULTS Nonsignificant differences (P = 0.694) were found for average global MBF in patients without PD and single-territorial PD. Significant differences were found for mean global MBF in patients with PD in two (P < 0.0058) and three territories (P < 0.0003). Calculated optimal thresholds for global MBF and myocardial blood volume resulted in a sensitivity, specificity, and negative predictive value of 100% for detection of three-vessel territory PD. For detection of ≥2 territories with PD, global MBF was superior to other parameters (sensitivity 81.3%, specificity 90.9%, and negative predictive value 94.3%). CONCLUSIONS Semiautomated global quantification of left ventricular MBF during stress dynamic CTMPI shows high diagnostic accuracy for detection of ≥2 vessel territories with PD, facilitating identification of patients with multi-territorial myocardial PD.
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105
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Rest and stress transluminal attenuation gradient and contrast opacification difference for detection of hemodynamically significant stenoses in patients with suspected coronary artery disease. Int J Cardiovasc Imaging 2016; 32:1131-41. [DOI: 10.1007/s10554-016-0867-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
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106
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Mor-Avi V, Kachenoura N, Maffessanti F, Bhave NM, Port S, Lodato JA, Chandra S, Freed BH, Lang RM, Patel AR. Three-dimensional quantification of myocardial perfusion during regadenoson stress computed tomography. Eur J Radiol 2016; 85:885-92. [PMID: 27130047 DOI: 10.1016/j.ejrad.2016.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/15/2016] [Accepted: 02/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is no accepted methodology for CT-based vasodilator stress myocardial perfusion imaging and analysis. We developed a technique for quantitative 3D analysis of CT images, which provides several indices of myocardial perfusion. We sought to determine the ability of these indices during vasodilator stress to identify segments supplied by coronary arteries with obstructive disease and to test the accuracy of the detection of perfusion abnormalities against SPECT. METHODS We studied 93 patients referred for CT coronary angiography (CTCA) who underwent regadenoson stress. 3D analysis of stress CT images yielded segmental perfusion indices: mean X-ray attenuation, severity of defect and relative defect volume. Each index was averaged for myocardial segments, grouped by severity of stenosis: 0%, <50%, 50-70%, and >70%. Objective detection of perfusion abnormalities was optimized in 47 patients and then independently tested in the remaining 46 patients. RESULTS CTCA depicted normal coronary arteries or non-obstructive disease in 62 patients and stenosis of >50% in 31. With increasing stenosis, segmental attenuation showed a 7% decrease, defect severity increased 11%, but relative defect volume was 7-fold higher in segments with obstructive disease (p<0.001). In the test group, detection of perfusion abnormalities associated with stenosis >50% showed sensitivity 0.78, specificity 0.54, accuracy 0.59. When compared to SPECT in a subset of 21 patients (14 with abnormal SPECT), stress CT perfusion analysis showed sensitivity 0.79, specificity 0.71, accuracy 0.76. CONCLUSIONS 3D analysis of vasodilator stress CT images provides quantitative indices of myocardial perfusion, of which relative defect volume was most robust in identifying segments supplied by arteries with obstructive disease. This study may have implications on how CT stress perfusion imaging is performed and analyzed.
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Affiliation(s)
- Victor Mor-Avi
- University of Chicago Medical Center, Chicago, IL, United States.
| | - Nadjia Kachenoura
- University of Chicago Medical Center, Chicago, IL, United States; Sorbonne Universités, UPMC University Paris 06, CNRS 7371, INSERM 1146, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France
| | | | - Nicole M Bhave
- University of Chicago Medical Center, Chicago, IL, United States
| | - Steven Port
- Aurora Health Care, Milwaukee, WI, United States
| | - Joseph A Lodato
- University of Chicago Medical Center, Chicago, IL, United States
| | - Sonal Chandra
- University of Chicago Medical Center, Chicago, IL, United States
| | - Benjamin H Freed
- University of Chicago Medical Center, Chicago, IL, United States
| | - Roberto M Lang
- University of Chicago Medical Center, Chicago, IL, United States
| | - Amit R Patel
- University of Chicago Medical Center, Chicago, IL, United States
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107
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Osawa K, Miyoshi T, Miki T, Koyama Y, Sato S, Kanazawa S, Ito H. Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard. PLoS One 2016; 11:e0149170. [PMID: 26894686 PMCID: PMC4764509 DOI: 10.1371/journal.pone.0149170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/06/2016] [Indexed: 01/17/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull’s eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73–0.90) and 0.70 (0.61–0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.
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Affiliation(s)
- Kazuhiro Osawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- * E-mail:
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasushi Koyama
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Shuhei Sato
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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108
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Técnica de imagen de perfusión miocárdica con tomografía computarizada de estrés: un nuevo tema en cardiología. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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109
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Stress Computed Tomography Myocardial Perfusion Imaging: A New Topic in Cardiology. ACTA ACUST UNITED AC 2016; 69:188-200. [PMID: 26774540 DOI: 10.1016/j.rec.2015.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023]
Abstract
Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed.
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110
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Delgado Sánchez-Gracián C, Oca Pernas R, Trinidad López C, Santos Armentia E, Vaamonde Liste A, Vázquez Caamaño M, Tardáguila de la Fuente G. Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience. Eur Radiol 2015; 26:3199-207. [PMID: 26699372 DOI: 10.1007/s00330-015-4128-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine whether the quantification of iodine with stress dual-energy computed tomography (DECT-S) allows for the discrimination between a normal and an ischemic or necrotic myocardium using magnetic resonance (MR) as a reference. METHODS This retrospective study was approved by the institutional review board, with waiver of informed consent. Thirty-six cardiac MR and DECT-S images from patients with suspected coronary artery disease were evaluated. Perfusion defects were visually determined, and myocardial iodine concentration was calculated by two observers using DECT colour-coded iodine maps. Iodine concentration differences were calculated using parametric tests. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the optimal iodine concentration threshold for discriminating pathologic myocardium. RESULTS In total, 576 cardiac segments were evaluated. There were differences in mean iodine concentration (p < 0.001) between normal (2.56 ± 0.66 mg/mL), ischemic (1.98 ± 0.36 mg/dL) and infarcted segments (1.35 ± 0.57 mg/mL). A myocardium iodine concentration of 2.1 mg/mL represented the optimal threshold to discriminate between normal and pathologic myocardium (sensitivity 75 %, specificity 73.6 %, area under the curve 0.806). Excellent agreement was found in measured myocardium iodine concentration (intraclass correlation coefficient 0.814). CONCLUSION Cardiac DECT-S with iodine quantification may be useful to differentiate healthy and ischemic or necrotic myocardium. KEY POINTS • DECT-S allows for determination of myocardial iodine concentration as a quantitative perfusion parameter. • A high interobserver correlation exists in measuring myocardial iodine concentration with DECT-S. • Myocardial iodine concentration may be useful in the assessment of patients with CAD.
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Affiliation(s)
| | - Roque Oca Pernas
- Radiology Department, Povisa Hospital, Salamanca, 36211, Vigo, Pontevedra, Spain.
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111
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Koo HJ, Yang DH, Kim YH, Kang JW, Kang SJ, Kweon J, Kim HJ, Lim TH. CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve. Int J Cardiovasc Imaging 2015; 32 Suppl 1:1-19. [DOI: 10.1007/s10554-015-0825-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
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112
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Schrauwen JTC, Coenen A, Kurata A, Wentzel JJ, van der Steen AFW, Nieman K, Gijsen FJH. Functional and anatomical measures for outflow boundary conditions in atherosclerotic coronary bifurcations. J Biomech 2015; 49:2127-2134. [PMID: 26654676 DOI: 10.1016/j.jbiomech.2015.11.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/07/2015] [Indexed: 11/25/2022]
Abstract
The aim of this research was finding the influence of anatomy-based and functional-based outflow boundary conditions for computational fluid dynamics (CFD) on fractional flow reserve (FFR) and wall shear stress (WSS) in mildly diseased coronary bifurcations. For 10 patient-specific bifurcations three simulations were set up with different outflow conditions, while the inflow was kept constant. First, the outflow conditions were based on the diameter of the outlets. Second, they were based on the volume estimates of the myocardium that depended on the outlets. Third, they were based on a myocardial flow measure derived from computed tomography perfusion imaging (CTP). The difference in outflow ratio between the perfusion-based and the diameter-based approach was -7 p.p. [-14 p.p.:7 p.p.] (median percentage point and interquartiles), and between the perfusion-based and volume-based this was -2 p.p. [-2 p.p.:1 p.p.]. Despite of these differences the computed FFRs matched very well. A quantitative analysis of the WSS results showed very high correlations between the methods with an r(2) ranging from 0.90 to 1.00. But despite the high correlations the diameter-based and volume-based approach generally underestimated the WSS compared to the perfusion-based approach. These differences disappeared after normalization. We demonstrated the potential of CTP for setting patient-specific boundary conditions for atherosclerotic coronary bifurcations. FFR and normalized WSS were unaffected by the variations in outflow ratios. In order to compute absolute WSS a functional measure to set the outflow ratio might be of added value in this type of vessels.
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Affiliation(s)
- Jelle T C Schrauwen
- Department of Biomedical Engineering, Thorax center, Erasmus Medical Center, Gravendijkwal 230, Faculty Building, Ee 2302, 3000 CA Rotterdam, The Netherlands.
| | - Adriaan Coenen
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Akira Kurata
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Biomedical Engineering, Thorax center, Erasmus Medical Center, Gravendijkwal 230, Faculty Building, Ee 2302, 3000 CA Rotterdam, The Netherlands
| | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thorax center, Erasmus Medical Center, Gravendijkwal 230, Faculty Building, Ee 2302, 3000 CA Rotterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Koen Nieman
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thorax center, Erasmus Medical Center, Gravendijkwal 230, Faculty Building, Ee 2302, 3000 CA Rotterdam, The Netherlands
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113
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Simultaneous achievement of accurate CT number and image quality improvement for myocardial perfusion CT at 320-MDCT volume scanning. Phys Med 2015; 31:702-7. [DOI: 10.1016/j.ejmp.2015.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/07/2015] [Accepted: 05/30/2015] [Indexed: 11/20/2022] Open
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114
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Computed tomography segmental calcium score (SCS) to predict stenosis severity of calcified coronary lesions. Int J Cardiovasc Imaging 2015; 31:1663-75. [DOI: 10.1007/s10554-015-0750-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
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115
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Rief M, Feger S, Martus P, Laule M, Dewey M, Schönenberger E. Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents--Intraindividual Comparison. PLoS One 2015; 10:e0136737. [PMID: 26327127 PMCID: PMC4556695 DOI: 10.1371/journal.pone.0136737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate how well patients with coronary stents accept combined coronary computed tomography angiography (CTA) and myocardial CT perfusion (CTP) compared with conventional coronary angiography (CCA). Background While combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined. Methods A total of 90 patients with coronary stents prospectively underwent CTA/CTP (both with contrast agent, CTP with adenosine) and CCA as part of the CARS-320 study. In this group, an intraindividual comparison of patient acceptance of CTA, CTP, and CCA was performed. Results CTP was experienced to be significantly more painful than CTA (p<0.001) and was associated with a higher frequency of dyspnea (p<0.001). Comparison of CTA/CTP with CCA revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377). Concern before CTA/CTP and CCA and overall satisfaction were likewise not significantly different (p = 0.097 and p = 0.123, respectively). Nevertheless, about two thirds (n = 60, 68%) preferred CTA/CTP to CCA (p<0.001). Moreover, patients felt less helpless during CTA/CTP than during CCA (p = 0.026). Lack of invasiveness and absence of pain were the most frequently mentioned advantages of CTA/CTP over CCA in our patient population. Conclusions CCA and combined CTA/CTP are equally well accepted by patients; however, more patients prefer CTA/CTP. CTP was associated with more intense pain than CTA and more frequently caused dyspnea than CTA alone. Trial Registration ClinicalTrials.gov NCT00967876
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Affiliation(s)
- Matthias Rief
- Department of Radiology, Charité, Medical School, Berlin, Germany
| | - Sarah Feger
- Department of Radiology, Charité, Medical School, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard Karls University Tübingen, Germany
| | - Michael Laule
- Department of Cardiology, Charité, Medical School, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité, Medical School, Berlin, Germany
- * E-mail:
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116
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Yang DH, Kim YH, Roh JH, Kang JW, Han D, Jung J, Kim N, Lee JB, Ahn JM, Lee JY, Park DW, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ, Lim TH. Stress Myocardial Perfusion CT in Patients Suspected of Having Coronary Artery Disease: Visual and Quantitative Analysis—Validation by Using Fractional Flow Reserve. Radiology 2015; 276:715-23. [DOI: 10.1148/radiol.2015141126] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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117
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Ziemer BP, Hubbard L, Lipinski J, Molloi S. Dynamic CT perfusion measurement in a cardiac phantom. Int J Cardiovasc Imaging 2015; 31:1451-9. [PMID: 26156231 DOI: 10.1007/s10554-015-0700-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/01/2015] [Indexed: 12/22/2022]
Abstract
Widespread clinical implementation of dynamic CT myocardial perfusion has been hampered by its limited accuracy and high radiation dose. The purpose of this study was to evaluate the accuracy and radiation dose reduction of a dynamic CT myocardial perfusion technique based on first pass analysis (FPA). To test the FPA technique, a pulsatile pump was used to generate known perfusion rates in a range of 0.96-2.49 mL/min/g. All the known perfusion rates were determined using an ultrasonic flow probe and the known mass of the perfusion volume. FPA and maximum slope model (MSM) perfusion rates were measured using volume scans acquired from a 320-slice CT scanner, and then compared to the known perfusion rates. The measured perfusion using FPA (P(FPA)), with two volume scans, and the maximum slope model (P(MSM)) were related to known perfusion (P(K)) by P(FPA) = 0.91P(K) + 0.06 (r = 0.98) and P(MSM) = 0.25P(K) - 0.02 (r = 0.96), respectively. The standard error of estimate for the FPA technique, using two volume scans, and the MSM was 0.14 and 0.30 mL/min/g, respectively. The estimated radiation dose required for the FPA technique with two volume scans and the MSM was 2.6 and 11.7-17.5 mSv, respectively. Therefore, the FPA technique can yield accurate perfusion measurements using as few as two volume scans, corresponding to approximately a factor of four reductions in radiation dose as compared with the currently available MSM. In conclusion, the results of the study indicate that the FPA technique can make accurate dynamic CT perfusion measurements over a range of clinically relevant perfusion rates, while substantially reducing radiation dose, as compared to currently available dynamic CT perfusion techniques.
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Affiliation(s)
- Benjamin P Ziemer
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA
| | - Logan Hubbard
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA
| | - Jerry Lipinski
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, Medical Sciences I, B-140, University of California, Irvine, CA, 92697, USA.
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118
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Badano LP, Miglioranza MH, Edvardsen T, Colafranceschi AS, Muraru D, Bacal F, Nieman K, Zoppellaro G, Marcondes Braga FG, Binder T, Habib G, Lancellotti P, Sicari R, Cosyns B, Donal E, Lombardi M, Sarvari S. European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation. ACTA ACUST UNITED AC 2015; 16:919-48. [DOI: 10.1093/ehjci/jev139] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/02/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Luigi P. Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy
| | - Fernando Bacal
- Heart Transplant Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Koen Nieman
- Intensive Cardiac Care Unit and Cardiac CT Research, Erasmus MC, Rotterdam, The Netherlands
| | - Giacomo Zoppellaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Thomas Binder
- Department of Cardiology, University of Vienna, Wien, Austria
| | - Gilbert Habib
- Service de Cardiologie, Hôpital La Timone, Marseille, France
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
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Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease. AJR Am J Roentgenol 2015; 205:W67-72. [DOI: 10.2214/ajr.14.14087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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120
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Development of an Ex Vivo, Beating Heart Model for CT Myocardial Perfusion. BIOMED RESEARCH INTERNATIONAL 2015; 2015:412716. [PMID: 26185756 PMCID: PMC4491382 DOI: 10.1155/2015/412716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To test the feasibility of a CT-compatible, ex vivo, perfused porcine heart model for myocardial perfusion CT imaging. METHODS One porcine heart was perfused according to Langendorff. Dynamic perfusion scanning was performed with a second-generation dual source CT scanner. Circulatory parameters like blood flow, aortic pressure, and heart rate were monitored throughout the experiment. Stenosis was induced in the circumflex artery, controlled by a fractional flow reserve (FFR) pressure wire. CT-derived myocardial perfusion parameters were analysed at FFR of 1 to 0.10/0.0. RESULTS CT images did not show major artefacts due to interference of the model setup. The pacemaker-induced heart rhythm was generally stable at 70 beats per minute. During most of the experiment, blood flow was 0.9-1.0 L/min, and arterial pressure varied between 80 and 95 mm/Hg. Blood flow decreased and arterial pressure increased by approximately 10% after inducing a stenosis with FFR ≤ 0.50. Dynamic perfusion scanning was possible across the range of stenosis grades. Perfusion parameters of circumflex-perfused myocardial segments were affected at increasing stenosis grades. CONCLUSION An adapted Langendorff porcine heart model is feasible in a CT environment. This model provides control over physiological parameters and may allow in-depth validation of quantitative CT perfusion techniques.
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121
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Measuring myocardial perfusion: the role of PET, MRI and CT. Clin Radiol 2015; 70:576-84. [DOI: 10.1016/j.crad.2014.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
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Carrascosa PM, Cury RC, Deviggiano A, Capunay C, Campisi R, López de Munain M, Vallejos J, Tajer C, Rodriguez-Granillo GA. Comparison of myocardial perfusion evaluation with single versus dual-energy CT and effect of beam-hardening artifacts. Acad Radiol 2015; 22:591-9. [PMID: 25680523 DOI: 10.1016/j.acra.2014.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES We sought to explore the feasibility and diagnostic performance of dual-energy computed tomography (DECT) versus single-energy computed tomography (SECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease. MATERIALS AND METHODS The present prospective study involved patients with known or suspected coronary artery disease referred for myocardial perfusion imaging by single-photon emission computed tomography. Forty patients were included in the study protocol and scanned using DECT imaging (n = 20) or SECT imaging (n = 20). The same pharmacologic stress was used for DECT, SECT, and single-photon emission computed tomography scans. RESULTS A total of 1360 left ventricular segments were evaluated by DECT and SECT. The contrast-to-noise ratio was similar between groups (DECT 8.8 ± 2.9 vs. SECT 7.7 ± 4.2; P = .22). The diagnostic performance of DECT was greater than that of SECT in identifying perfusion defects (area under the receiver operating characteristic curve of DECT 0.90 [0.86-0.94] vs SECT 0.80 [0.76-0.84]; P = .0004) and remained unaffected when including only segments affected by beam-hardening artifacts (area under the receiver operating characteristic curve = DECT 0.90 [0.84-0.96) vs. SECT 0.77 [0.69-0.84]; P = .007). CONCLUSIONS Our results suggest that myocardial perfusion by DECT imaging is feasible and might have improved diagnostic performance compared to SECT imaging for the assessment of myocardial CT perfusion. Furthermore, the diagnostic performance of DECT remained unaffected by the presence of beam-hardening artifacts.
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Affiliation(s)
- Patricia M Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina.
| | - Ricardo C Cury
- Baptist Hospital of Miami, Miami, Florida; Baptist Cardiac and Vascular Institute, Miami, Florida
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Roxana Campisi
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Marina López de Munain
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Javier Vallejos
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Carlos Tajer
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
| | - Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López, B1602ABQ, Buenos Aires, Argentina
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Carrascosa PM, Deviggiano A, Capunay C, Campisi R, de Munain ML, Vallejos J, Tajer C, Rodriguez-Granillo GA. Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease. Eur J Radiol 2015; 84:637-42. [DOI: 10.1016/j.ejrad.2014.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/04/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
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Ko SM, Hwang HK, Kim SM, Cho IH. Multi-modality imaging for the assessment of myocardial perfusion with emphasis on stress perfusion CT and MR imaging. Int J Cardiovasc Imaging 2015; 31 Suppl 1:1-21. [PMID: 25809387 DOI: 10.1007/s10554-015-0645-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 01/29/2023]
Abstract
High-quality and non-invasive diagnostic tools for assessing myocardial ischemia are necessary for therapeutic decisions regarding coronary artery disease. Myocardial perfusion has been studied using myocardial contrast echo perfusion, single-photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and, more recently, computed tomography. The addition of coronary computed tomography angiography to myocardial perfusion imaging improves the specificity and overall diagnostic accuracy of detecting the hemodynamic significance of coronary artery stenosis. This study reviews the benefits, limitations, and imaging findings of various imaging modalities for assessing myocardial perfusion, with particular emphasis on stress perfusion computed tomography and cardiovascular magnetic resonance imaging.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea,
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Abstract
OBJECTIVE. The purpose of this study was to comprehensively study estimated radiation doses for subjects included in the main analysis of the Combined Non-invasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography (CORE320) study ( ClinicalTrials.gov identifier NCT00934037), a clinical trial comparing combined CT angiography (CTA) and perfusion CT with the reference standard catheter angiography plus myocardial perfusion SPECT. SUBJECTS AND METHODS. Prospectively acquired data on 381 CORE320 subjects were analyzed in four groups of testing related to radiation exposure. Radiation dose estimates were compared between modalities for combined CTA and perfusion CT with respect to covariates known to influence radiation exposure and for the main clinical outcomes defined by the trial. The final analysis assessed variations in radiation dose with respect to several factors inherent to the trial. RESULTS. The mean radiation dose estimate for the combined CTA and perfusion CT protocol (8.63 mSv) was significantly (p < 0.0001 for both) less than the average dose delivered from SPECT (10.48 mSv) and the average dose from diagnostic catheter angiography (11.63 mSv). There was no significant difference in estimated CTA-perfusion CT radiation dose for subjects who had false-positive or false-negative results in the CORE320 main analyses in a comparison with subjects for whom the CTA-perfusion CT findings were in accordance with the reference standard SPECT plus catheter angiographic findings. CONCLUSION. Radiation dose estimates from CORE320 support clinical implementation of a combined CT protocol for assessing coronary anatomy and myocardial perfusion.
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127
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Tao Y, Chen GH, Hacker TA, Raval AN, Van Lysel MS, Speidel MA. Low dose dynamic CT myocardial perfusion imaging using a statistical iterative reconstruction method. Med Phys 2015; 41:071914. [PMID: 24989392 DOI: 10.1118/1.4884023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Dynamic CT myocardial perfusion imaging has the potential to provide both functional and anatomical information regarding coronary artery stenosis. However, radiation dose can be potentially high due to repeated scanning of the same region. The purpose of this study is to investigate the use of statistical iterative reconstruction to improve parametric maps of myocardial perfusion derived from a low tube current dynamic CT acquisition. METHODS Four pigs underwent high (500 mA) and low (25 mA) dose dynamic CT myocardial perfusion scans with and without coronary occlusion. To delineate the affected myocardial territory, an N-13 ammonia PET perfusion scan was performed for each animal in each occlusion state. Filtered backprojection (FBP) reconstruction was first applied to all CT data sets. Then, a statistical iterative reconstruction (SIR) method was applied to data sets acquired at low dose. Image voxel noise was matched between the low dose SIR and high dose FBP reconstructions. CT perfusion maps were compared among the low dose FBP, low dose SIR and high dose FBP reconstructions. Numerical simulations of a dynamic CT scan at high and low dose (20:1 ratio) were performed to quantitatively evaluate SIR and FBP performance in terms of flow map accuracy, precision, dose efficiency, and spatial resolution. RESULTS Forin vivo studies, the 500 mA FBP maps gave -88.4%, -96.0%, -76.7%, and -65.8% flow change in the occluded anterior region compared to the open-coronary scans (four animals). The percent changes in the 25 mA SIR maps were in good agreement, measuring -94.7%, -81.6%, -84.0%, and -72.2%. The 25 mA FBP maps gave unreliable flow measurements due to streaks caused by photon starvation (percent changes of +137.4%, +71.0%, -11.8%, and -3.5%). Agreement between 25 mA SIR and 500 mA FBP global flow was -9.7%, 8.8%, -3.1%, and 26.4%. The average variability of flow measurements in a nonoccluded region was 16.3%, 24.1%, and 937.9% for the 500 mA FBP, 25 mA SIR, and 25 mA FBP, respectively. In numerical simulations, SIR mitigated streak artifacts in the low dose data and yielded flow maps with mean error <7% and standard deviation <9% of mean, for 30 × 30 pixel ROIs (12.9 × 12.9 mm(2)). In comparison, low dose FBP flow errors were -38% to +258%, and standard deviation was 6%-93%. Additionally, low dose SIR achieved 4.6 times improvement in flow map CNR(2) per unit input dose compared to low dose FBP. CONCLUSIONS SIR reconstruction can reduce image noise and mitigate streaking artifacts caused by photon starvation in dynamic CT myocardial perfusion data sets acquired at low dose (low tube current), and improve perfusion map quality in comparison to FBP reconstruction at the same dose.
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Affiliation(s)
- Yinghua Tao
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705
| | - Guang-Hong Chen
- Department of Medical Physics and Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin 53705
| | - Timothy A Hacker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792
| | - Amish N Raval
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792
| | - Michael S Van Lysel
- Department of Medical Physics and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705
| | - Michael A Speidel
- Department of Medical Physics and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705
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Cannaò PM, Schoepf UJ, Muscogiuri G, Wichmann JL, Fuller SR, Secchi F, Varga-Szemes A, De Cecco CN. Technical prerequisites and imaging protocols for dynamic and dual energy myocardial perfusion imaging. Eur J Radiol 2015; 84:2401-10. [PMID: 25779223 DOI: 10.1016/j.ejrad.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/15/2015] [Indexed: 12/14/2022]
Abstract
Coronary CT angiography (CCTA) is an established imaging technique used for the non-invasive morphological assessment of coronary artery disease. As in invasive coronary angiography, CCTA anatomical assessment of coronary stenosis does not adequately predict hemodynamic relevance. However, recent technical improvements provide the possibility of CT myocardial perfusion imaging (CTMPI). Two distinct CT techniques are currently available for myocardial perfusion assessment: static CT myocardial perfusion imaging (sCTMPI), with single- or dual-energy modality, and dynamic CT myocardial perfusion imaging (dCTMPI). The combination of CCTA morphological assessment and CTMPI functional evaluation holds promise for achieving a comprehensive assessment of coronary artery anatomy and myocardial perfusion using a single image modality.
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Affiliation(s)
- Paola M Cannaò
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Scuola di Specializzazione di Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Giuseppe Muscogiuri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Julian L Wichmann
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephen R Fuller
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Francesco Secchi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
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129
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Functional relevance of coronary artery disease by cardiac magnetic resonance and cardiac computed tomography: myocardial perfusion and fractional flow reserve. BIOMED RESEARCH INTERNATIONAL 2015; 2015:297696. [PMID: 25692133 PMCID: PMC4323071 DOI: 10.1155/2015/297696] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/31/2014] [Indexed: 01/17/2023]
Abstract
Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.
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130
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Noninvasive physiologic assessment of coronary stenoses using cardiac CT. BIOMED RESEARCH INTERNATIONAL 2015; 2015:435737. [PMID: 25685790 PMCID: PMC4320886 DOI: 10.1155/2015/435737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022]
Abstract
Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive "one-stop-shop" diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.
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131
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Myocardial blood flow quantification for evaluation of coronary artery disease by positron emission tomography, cardiac magnetic resonance imaging, and computed tomography. Curr Cardiol Rep 2014; 16:483. [PMID: 24718671 DOI: 10.1007/s11886-014-0483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The noninvasive detection of the presence and functional significance of coronary artery stenosis is important in the diagnosis, risk assessment, and management of patients with known or suspected coronary artery disease. Quantitative assessment of myocardial perfusion can provide an objective and reproducible estimate of myocardial ischemia and risk prediction. Positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography perfusion are modalities capable of measuring myocardial blood flow and coronary flow reserve. In this review, we will discuss the technical aspects of quantitative myocardial perfusion imaging with positron emission tomography, cardiac magnetic resonance imaging, and computed tomography, and its emerging clinical applications.
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132
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Beyond stenosis detection: computed tomography approaches for determining the functional relevance of coronary artery disease. Radiol Clin North Am 2014; 53:317-34. [PMID: 25726997 DOI: 10.1016/j.rcl.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary computed tomography angiography (CCTA) is an established imaging technique for the noninvasive assessment of coronary arteries. However, CCTA remains a morphologic technique with the same limitations as invasive coronary angiography in evaluating the hemodynamic significance of coronary stenosis. Different computed tomography (CT) techniques for the functional analysis of coronary lesions have recently emerged, including static and dynamic CT myocardial perfusion imaging and CT-based fractional flow reserve and transluminal attenuation gradient methods. These techniques hold promise for achieving a comprehensive appraisal of anatomic and functional aspects of coronary heart disease with a single modality.
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Munnur RK, Cameron JD, Ko BS, Meredith IT, Wong DTL. Cardiac CT: atherosclerosis to acute coronary syndrome. Cardiovasc Diagn Ther 2014; 4:430-48. [PMID: 25610801 PMCID: PMC4278045 DOI: 10.3978/j.issn.2223-3652.2014.11.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA.
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Relative Myocardial Blood Flow by Dynamic Computed Tomographic Perfusion Imaging Predicts Hemodynamic Significance of Coronary Stenosis Better Than Absolute Blood Flow. Invest Radiol 2014; 49:801-7. [DOI: 10.1097/rli.0000000000000087] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ho KT, Ong HY, Tan G, Yong QW. Dynamic CT myocardial perfusion measurements of resting and hyperaemic blood flow in low-risk subjects with 128-slice dual-source CT. Eur Heart J Cardiovasc Imaging 2014; 16:300-6. [PMID: 25378472 DOI: 10.1093/ehjci/jeu200] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of the study was to measure rest and stress myocardial blood flow (MBF) values prospectively in a low-risk population with 128-slice dual-source computed tomography (CT) and to compare MBF/coronary flow reserve (CFR) values to that of a second population with a documented coronary artery disease (CAD). METHODS AND RESULTS This study evaluates resting and hyperaemic MBF in 35 low-risk individuals identified by the modified Framingham Risk score and a calcium score of <100. The patients were scanned using 80 kV and quantitative blood flow values were generated using complete time-attenuation curves. Global resting and hyperaemic MBF was 74.08 ± 16.30 and 135.24 ± 28.89 mL/100 g/min, respectively, with CFR of 1.86 ± 0.38. Resting MBF was 76.98 ± 25.68, 66.98 ± 19.66, 81.34 ± 21.40, and 63.35 ± 16.35 mL/100 g/min in anterior, septal, lateral, and inferior walls, respectively, and corresponding hyperaemic MBF was 133.25 ± 29.80, 123.47 ± 31.03, 148.60 ± 32.69, and 124.21 ± 31.54 mL/100 g/min, respectively. In the population with CAD, global resting and hyperaemic MBF were 82.29 ± 16.87 and 81.98 ± 18.54 mL/100 g/min and 107.95 ± 25.25 and 106.93 ± 32.91 mL/100 g/min in the group with ischaemia only and infarction only, respectively, with corresponding CFR of 1.33 ± 0.27 and 1.33 ± 0.46, respectively (statistically different from the low-risk population). Radiation dose for CT myocardial perfusion imaging (CTMPI) was 6.72 ± 2.71 and 6.19 ± 2.19 mSv for stress and rest scans, respectively. This was 30% lower than a radiation dose in the scanning historical cohort at 100 kV. There was no significant difference in the signal-to-noise ratio and contrast-to-noise ratio between low-risk cohort and historical cohort scanned at 80 and 100 kV, respectively. CONCLUSIONS Baseline, hyperaemic MBF and CFR values in a low-risk cohort can be evaluated with dynamic myocardial perfusion imaging using 80 kV.
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Affiliation(s)
- Kheng-Thye Ho
- Mount Alvernia Hospital, Heart Consultants Pte Ltd, 820 Thomson Road, #02-25A, Singapore 574623
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Saraste A, Knuuti J. Dynamic perfusion CT: what is normal myocardial blood flow? Eur Heart J Cardiovasc Imaging 2014; 16:288-9. [DOI: 10.1093/ehjci/jeu211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Integrating Anatomical and Functional Assessment of Coronary Artery Disease: Can MDCT act as the lone Gatekeeper in the near Future? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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138
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Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GBJ, Nieman K, Pontone G, Raff GL. SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8:342-58. [PMID: 25301040 DOI: 10.1016/j.jcct.2014.07.003] [Citation(s) in RCA: 657] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/21/2014] [Indexed: 12/18/2022]
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Kim SM, Cho YK, Choe YH. Adenosine-stress dynamic myocardial perfusion imaging using 128-slice dual-source CT in patients with normal body mass indices: effect of tube voltage, tube current, and iodine concentration on image quality and radiation dose. Int J Cardiovasc Imaging 2014; 30 Suppl 2:95-103. [PMID: 25156692 DOI: 10.1007/s10554-014-0524-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to evaluate the image quality and radiation dose in adenosine-stress dynamic myocardial CT perfusion (CTP) imaging using different tube voltages, tube current settings, and contrast materials containing different iodine concentrations in subjects with normal body mass indices (BMI). We included 92 patients (BMI range, 18.5-24.8) who underwent dynamic CTP for the evaluation of coronary artery disease using a 128-slice dual-source computed tomography. The protocols employed the following dynamic scan parameters: protocol I with 100 kV, fixed tube current (FTC), and medium-concentration contrast material (MC, 350 mg iodine/mL); protocol II with 100 kV, automatic tube current modulation (ATCM), and MC; protocol III with 100 kV, ATCM, and high-concentration contrast material (HC, 400 mg iodine/mL); protocol IV with 80 kV, adopted FTC, and HC. Subjective image quality on a 1-3 point scale and objective image quality with respect to the contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were assessed. Protocol IV showed higher CNR and SNR than the other protocols (P < 0.01), while the CNR and SNR values did not significantly differ among the other three protocols. There was no significant difference in subjective image quality among the protocols. The radiation dose in protocol IV was the lowest among the protocols (P < 0.01), while protocol IV resulted in a 54% overall reduction in mean effective radiation dose compared with protocol I. Dynamic myocardial CTP performed at 80 kV with adapted FTC provided high CNR and SNR while preserving subjective image quality and reducing radiation exposure.
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Affiliation(s)
- Sung Mok Kim
- Department of Radiology and Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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141
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Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention. Cardiovasc Interv Ther 2014; 30:283-6. [PMID: 25081314 DOI: 10.1007/s12928-014-0288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
Abstract
Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.
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142
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Global Quantification of Left Ventricular Myocardial Perfusion at Dynamic CT: Feasibility in a Multicenter Patient Population. AJR Am J Roentgenol 2014; 203:W174-80. [DOI: 10.2214/ajr.13.12328] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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143
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Rubin GD, Leipsic J, Joseph Schoepf U, Fleischmann D, Napel S. CT angiography after 20 years: a transformation in cardiovascular disease characterization continues to advance. Radiology 2014; 271:633-52. [PMID: 24848958 DOI: 10.1148/radiol.14132232] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovations in CT and image processing, over the next 5-15 years, CT angiography toppled conventional angiography, the undisputed diagnostic reference standard for vascular disease for the prior 70 years, as the preferred modality for the diagnosis and characterization of most cardiovascular abnormalities. This review recounts the evolution of CT angiography from its development and early challenges to a maturing modality that has provided unique insights into cardiovascular disease characterization and management. Selected clinical challenges, which include acute aortic syndromes, peripheral vascular disease, aortic stent-graft and transcatheter aortic valve assessment, and coronary artery disease, are presented as contrasting examples of how CT angiography is changing our approach to cardiovascular disease diagnosis and management. Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiation dose reduction through iterative reconstruction are explored with consideration toward the continued refinement and advancement of CT angiography.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute, 2400 Pratt St, Box 17969, Durham, NC 27715 (G.D.R.); Department of Medical Imaging and Division of Cardiology, University of British Columbia, Vancouver, BC, Canada (J.L.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.F., S.N.)
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144
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Kurobe Y, Kitagawa K, Ito T, Kurita Y, Shiraishi Y, Nakamori S, Nakajima H, Nagata M, Ishida M, Dohi K, Ito M, Sakuma H. Myocardial delayed enhancement with dual-source CT: Advantages of targeted spatial frequency filtration and image averaging over half-scan reconstruction. J Cardiovasc Comput Tomogr 2014; 8:289-98. [DOI: 10.1016/j.jcct.2014.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/16/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
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Physiologic evaluation of ischemia using cardiac CT: current status of CT myocardial perfusion and CT fractional flow reserve. J Cardiovasc Comput Tomogr 2014; 8:272-81. [PMID: 25151919 DOI: 10.1016/j.jcct.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/07/2014] [Accepted: 06/13/2014] [Indexed: 01/09/2023]
Abstract
Cardiac CT, specifically coronary CT angiography (CTA), is an established technology which detects anatomically significant coronary artery disease with a high sensitivity and negative predictive value compared with invasive coronary angiography. However, the limited ability of CTA to determine the physiologic significance of intermediate coronary stenoses remains a shortcoming compared with other noninvasive methods such as single-photon emission CT, stress echocardiography, and stress cardiac magnetic resonance. Two methods have been investigated recently: (1) myocardial CT perfusion and (2) fractional flow reserve (FFR) computed from CT (FFRCT). Improving diagnostic accuracy by combining the anatomic aspects of coronary CTA with a physiologic assessment via CT perfusion or FFRCT may reduce the need for additional testing to evaluate for ischemia, reduce downstream costs and risks associated with an invasive procedure, and lead to improved patient outcomes. Given a rapidly expanding body of research in this field, this comparative review summarizes the present literature while contrasting the benefits, limitations, and future directions in myocardial CT perfusion and FFRCT imaging.
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146
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Meta-analysis: diagnostic accuracy of coronary CT angiography with prospective ECG gating based on step-and-shoot, Flash and volume modes for detection of coronary artery disease. Eur Radiol 2014; 24:2345-52. [PMID: 24865695 DOI: 10.1007/s00330-014-3221-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/28/2014] [Accepted: 05/06/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the diagnostic performance of coronary computed tomographic angiography (CCTA) with prospective electrocardiograph (ECG) gating based on step-and-shoot (SAS), Flash and volume imaging modes. METHODS We searched the electronic databases PubMed for all published studies regarding CCTA. We used an exact binomial rendition of the bivariate mixed-effects regression model developed for synthesis of diagnostic data. RESULTS A total of 21,852 segments, 4,851 vessels and 1,375 patients were identified using database searches. Patient-level pooled sensitivity was 0.99 (95 % confidence interval [CI], 0.98-1.00); specificity was 0.88 (CI, 0.85-0.91). The results showed that the sensitivity and specificity for detection of significant stenosis did not differ in the three protocols (P = 0.24). No heterogeneity was found at the patient level for sensitivity (Q = 26.23; P = 0.12; I (2) = 27.56 % [CI, 0.00-67.02 %]) and specificity (Q = 19.54; P = 0.42; I (2) = 2.78 % [CI, 0.00-66.26 %]). CONCLUSIONS CCTA with prospective ECG gating has similar high diagnostic value to rule out CAD in all three presented modes. KEY POINTS • The accuracy of CCTA with different prospective ECG gating is similar • CCTA with prospective ECG gating is effective to exclude coronary artery disease • The radiation dose of volume mode increases with higher heart rate.
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George RT, Mehra VC, Chen MY, Kitagawa K, Arbab-Zadeh A, Miller JM, Matheson MB, Vavere AL, Kofoed KF, Rochitte CE, Dewey M, Yaw TS, Niinuma H, Brenner W, Cox C, Clouse ME, Lima JAC, Di Carli M. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study. Radiology 2014; 272:407-16. [PMID: 24865312 DOI: 10.1148/radiol.14140806] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. MATERIALS AND METHODS This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. RESULTS CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis ≥50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with Az values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single- and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. CONCLUSION The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.
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Affiliation(s)
- Richard T George
- From the School of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524D2, Baltimore, MD 21287 (R.T.G., V.C.M., A.A.Z., J.M.M., A.L.V., J.A.C.L.); Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.D.C.); Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (V.C.M., M.Y.C.); Department of Radiology, Iwate Medical University, Morioka, Japan (H.N.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.E.C.); Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Cardiology, National Heart Center, Singapore, Singapore (T.S.Y.); and Departments of Radiology (M.D.C.) and Nuclear Medicine (W.B.), Charité-University Medicine Berlin, Berlin, Germany
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Normal range and regional heterogeneity of myocardial perfusion in healthy human myocardium: assessment on dynamic perfusion CT using 128-slice dual-source CT. Int J Cardiovasc Imaging 2014; 30 Suppl 1:33-40. [PMID: 24794291 DOI: 10.1007/s10554-014-0432-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
Information about myocardial perfusion in healthy hearts is essential for evaluating patients with ischemic heart disease. The purpose of this study was to determine the range and regional variability of myocardial perfusion in normal volunteers on dynamic perfusion computed tomography (CT). Myocardial perfusion was assessed in 19 healthy volunteers (age 33-60 years; 11 men) at rest and during adenosine-induced hyperemia using a 128-slice dual-source CT scanner. Data were quantified as cc/cc/min for the transmural myocardium based on a 17-segment American Heart Association model. Mean myocardial blood flows (MBF) were 1.73 ± 0.33 cc/cc/min during adenosine-induced hyperemia, 0.83 ± 0.21 cc/cc/min at rest, and perfusion reserve was 2.20 ± 0.53. Regional variability was 17 ± 5% for hyperemic perfusion, 18 ± 7% for resting, and 21 ± 6 % for perfusion reserve. Although statistically insignificant, perfusion in the septum was lower at rest and during hyperemia than in other regions. Women tended to have lower perfusion during hyperemia (1.65 ± 0.40 vs. 1.79 ± 0.28 cc/cc/min, P = 0.40), and higher perfusion at rest than men (0.91 ± 0.27 vs. 0.77 ± 0.15 cc/cc/min, P = 0.23), resulting in lower perfusion reserve (1.86 ± 0.31 vs. 2.45 ± 0.53, P = 0.11). This small cohort of healthy volunteers study reveals normal myocardial perfusion parameter on dynamic perfusion CT as follows: mean MBF is 1.73 ± 0.33 cc/cc/min during hyperemia, 0.83 ± 0.21 cc/cc/min at rest, and perfusion reserve is 2.20 ± 0.53. And the study also demonstrates considerable regional heterogeneity of the myocardial perfusion.
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2014; 14:721-40. [PMID: 23847385 DOI: 10.1093/ehjci/jet123] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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Stuijfzand WJ, Danad I, Raijmakers PG, Marcu CB, Heymans MW, van Kuijk CC, van Rossum AC, Nieman K, Min JK, Leipsic J, van Royen N, Knaapen P. Additional value of transluminal attenuation gradient in CT angiography to predict hemodynamic significance of coronary artery stenosis. JACC Cardiovasc Imaging 2014; 7:374-86. [PMID: 24631509 DOI: 10.1016/j.jcmg.2013.12.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The current study evaluates the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (CCO), and TAG with exclusion of calcified coronary segments (ExC) over coronary computed tomography angiogram (CTA) alone using fractional flow reserve (FFR) as the gold standard. BACKGROUND TAG is defined as the contrast opacification gradient along the length of a coronary artery on a coronary CTA. Preliminary data suggest that TAG provides additional functional information. Interpretation of TAG is hampered by multiple heartbeat acquisition algorithms and coronary calcifications. Two correction models have been proposed based on either dephasing of contrast delivery by relating coronary density to corresponding descending aortic opacification (TAG-CCO) or excluding calcified coronary segments (TAG-ExC). METHODS Eighty-five patients with intermediate probability of coronary artery disease were prospectively included. All patients underwent step-and-shoot 256-slice coronary CTA. TAG, TAG-CCO, and TAG-ExC analyses were performed followed by invasive coronary angiography in conjunction with FFR measurements of all major coronary branches. RESULTS Thirty-four patients (40%) were diagnosed with hemodynamically-significant coronary artery disease (i.e., FFR ≤0.80). On a per-vessel basis (n = 253), 59 lesions (23%) were graded as hemodynamically significant, and the diagnostic accuracy of coronary CTA (diameter stenosis ≥50%) was 95%, 75%, 98%, and 54% for sensitivity, specificity, negative predictive value, and positive predictive value, respectively. TAG and TAG-ExC did not discriminate between vessels with or without hemodynamically significant lesions (-13.5 ± 17.1 HU [Hounsfield units] × 10 mm(-1) vs. -11.6 ± 13.3 HU × 10 mm(-1), p = 0.36; and 13.1 ± 15.9 HU × 10 mm(-1) vs. -11.4 ± 11.7 HU × 10 mm(-1), p = 0.77, respectively). TAG-CCO was lower in vessels with a hemodynamically-significant lesion (-0.050 ± 0.051 10 mm(-1) vs. -0.036 ± 0.034 10 mm(-1), p = 0.03) and TAG-ExC resulted in a slight improvement of the net reclassification index (0.021, p < 0.05). CONCLUSIONS TAG did not provide incremental diagnostic value over 256-slice coronary CTA alone in assessing the hemodynamic consequences of a coronary stenosis. Correction for temporal nonuniformity of contrast delivery or exclusion of calcified coronary segments slightly enhanced the results.
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Affiliation(s)
- Wynand J Stuijfzand
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine, and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - C Bogdan Marcu
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Cornelis C van Kuijk
- Department of Radiology, Nuclear Medicine, and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Koen Nieman
- Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - James K Min
- Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
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