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Abu-Omar A, Murray N, Ali IT, Khosa F, Barrett S, Sheikh A, Nicolaou S, Tamburrini S, Iacobellis F, Sica G, Granata V, Saba L, Masala S, Scaglione M. Utility of Dual-Energy Computed Tomography in Clinical Conundra. Diagnostics (Basel) 2024; 14:775. [PMID: 38611688 PMCID: PMC11012177 DOI: 10.3390/diagnostics14070775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing various applications to assist radiologists in reaching certain diagnoses SECT is rather unable to identify. DECT may also complement the role of SECT by supporting radiologists to confidently make diagnoses in certain clinically challenging scenarios. In this review article, we briefly describe the principles of X-ray attenuation. We detail principles for DECT and describe multiple systems associated with this technology. We describe various DECT techniques and algorithms including virtual monoenergetic imaging (VMI), virtual non-contrast (VNC) imaging, Iodine quantification techniques including Iodine overlay map (IOM), and two- and three-material decomposition algorithms that can be utilized to demonstrate a multitude of pathologies. Lastly, we provide our readers commentary on examples pertaining to the practical implementation of DECT's diverse techniques in the Gastrointestinal, Genitourinary, Biliary, Musculoskeletal, and Neuroradiology systems.
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Affiliation(s)
- Ahmad Abu-Omar
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Nicolas Murray
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Ismail T. Ali
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Faisal Khosa
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Sarah Barrett
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Adnan Sheikh
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Savvas Nicolaou
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS Di Napoli, 80131 Naples, Italy
| | - Luca Saba
- Medical Oncology Department, AOU Cagliari, Policlinico Di Monserrato (CA), 09042 Monserrato, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
- Department of Radiology, Pineta Grande Hospital, 81030 Castel Volturno, Italy
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Marques JB, Renha SK, Mendonça Pereira H, Lima TVM, Simões RFP. Effects of convolution filter with beam hardening correction on computed tomography image quality. Phys Med 2023; 110:102599. [PMID: 37167777 DOI: 10.1016/j.ejmp.2023.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/28/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To quantify the effects of convolution filters (FC) with beam hardening correction (BHC) compared to FC without BHC on the computed tomography (CT) image quality. METHODS This study was conducted on a Canon® Aquilion Lightning scanner. The exposure protocol includes acquisitions at 120 and 100 kVp. Sixteen FCs (8 with and 8 without BHC) were investigated using a Catphan®504 phantom. Uniformity, slice thickness, spatial resolution, Hounsfield unit and noise were analysed using the SPICE-CT ImageJ plugin and the noise power spectrum was analysed using the Imquest software. RESULTS It was observed that the BHC did not significantly influence the uniformity, slice thickness, noise and noise power spectrum. Comparisons of 10% MTF between FC01 and FC11 showed relative differences of -29% and -5% at 120 and 100 kVp, respectively, while those between FC09 and FC19 were -55% and -25%. The Hounsfield unit of the Catphan's region of highest electron density was reduced by -7.29% at 120 kVp for FC with BHC. In both cases (FC with and without BHC), the noise values agreed with CT operating manual. At 120 kVp, FC11 and FC09 presented the maximum and minimum noise values, respectively. CONCLUSION In CT procedures that quantitatively evaluate the bone or calcium Hounsfield unit, FC with BHC should be avoided due to its effects on Hounsfield units, in special at higher voltage, such as 120 kVp.
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Affiliation(s)
| | - Simone Kodlulovich Renha
- Institute of Radioprotection and Dosimetry, National Nuclear Energy Commission, Rio de Janeiro, Brazil
| | - Hélcio Mendonça Pereira
- Department of Medical Imaging, Brazilian National Institute of Orthopedics and Traumatology, Rio de Janeiro, Brazil; Department of Medical Imaging, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Thiago Viana Miranda Lima
- Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucern, Switzerland; Department of Health Science and Medicine, University of Lucerne, Luzern, Switzerland
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Dell’Aversana S, Ascione R, De Giorgi M, De Lucia DR, Cuocolo R, Boccalatte M, Sibilio G, Napolitano G, Muscogiuri G, Sironi S, Di Costanzo G, Cavaglià E, Imbriaco M, Ponsiglione A. Dual-Energy CT of the Heart: A Review. J Imaging 2022; 8:jimaging8090236. [PMID: 36135402 PMCID: PMC9503750 DOI: 10.3390/jimaging8090236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Dual-energy computed tomography (DECT) represents an emerging imaging technique which consists of the acquisition of two separate datasets utilizing two different X-ray spectra energies. Several cardiac DECT applications have been assessed, such as virtual monoenergetic images, virtual non-contrast reconstructions, and iodine myocardial perfusion maps, which are demonstrated to improve diagnostic accuracy and image quality while reducing both radiation and contrast media administration. This review will summarize the technical basis of DECT and review the principal cardiac applications currently adopted in clinical practice, exploring possible future applications.
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Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
- Correspondence:
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Fischer AM, Decker JA, Schoepf J, Varga-Szemes A, Flohr T, Schmidt B, Gutjahr R, Sahbaee P, Giovagnoli DA, Emrich T, Martinez JD, Lari KB, Bayer RR, Martin SS. Optimization of contrast material administration for coronary CT angiography using a software-based test-bolus evaluation algorithm. Br J Radiol 2022; 95:20201456. [PMID: 35084228 PMCID: PMC10993975 DOI: 10.1259/bjr.20201456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the benefit of a prototype circulation time-based test bolus evaluation algorithm for the individualized optimal timing of contrast media (CM) delivery in patients undergoing coronary CT angiography (CCTA). METHODS Thirty-two patients (62 ± 16 years) underwent CCTA using a prototype bolus evaluation tool to determine the optimal time-delay for CM administration. Contrast attenuation, signal-to-noise ratio (SNR), objective, and subjective image quality were evaluated by two independent radiologists. Results were compared to a control cohort (matched for age, sex, body mass index, and tube voltage) of patients who underwent CCTA using the generic test bolus peak attenuation +4 s protocol as scan delay. RESULTS In the study group, the mean time delay to CCTA acquisition was significantly longer (26.0 ± 2.9 s) compared to the control group (23.1 ± 3.5 s; p < 0.01). In the study group, SNR improvement was seen in the right coronary artery (17.5 vs 13; p = 0.028), the left main (15.3 vs 12.3; p = 0.027), and the left anterior descending artery (18.5 vs 14.1; p = 0.048). Subjective image quality was rated higher in the study group (4.75 ± 0.7 vs 3.64 ± 0.5; p < 0.001). CONCLUSIONS The prototype test bolus evaluation algorithm provided a reliable patient-specific scan delay for CCTA that ensured homogenous vascular attenuation, improvement in objective and subjective image quality, and avoidance of beam hardening artifacts. ADVANCES IN KNOWLEDGE The prototype contrast bolus evaluation and optimization tool estimated circulation time-based time-delay improves the overall quality of CCTA.
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Affiliation(s)
- Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- University Department of Geriatric Medicine FELIX PLATTER and
University of Basel, Basel,
Switzerland
| | - Josua A. Decker
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg,
Augsburg, Germany
| | - Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | | | | | | | | | - Dante A Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Medical Center, Mainz,
Germany
- German Center for Cardiovascular Research (DZHK), Partner Site
Rhine Main, Mainz,
Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Kia B Lari
- University of South Carolina School of Medicine
Greenville, Greenville, South
Carolina, USA
| | - Robert R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, South
Carolina, USA
| | - Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Frankfurt,
Frankfurt, Germany
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Tarkowski P, Czekajska-Chehab E. Dual-Energy Heart CT: Beyond Better Angiography-Review. J Clin Med 2021; 10:jcm10215193. [PMID: 34768713 PMCID: PMC8584316 DOI: 10.3390/jcm10215193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/30/2022] Open
Abstract
Heart CT has undergone substantial development from the use of calcium scores performed on electron beam CT to modern 256+-row CT scanners. The latest big step in its evolution was the invention of dual-energy scanners with much greater capabilities than just performing better ECG-gated angio-CT. In this review, we present the unique features of dual-energy CT in heart diagnostics.
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Schmidt B, Flohr T. Principles and applications of dual source CT. Phys Med 2020; 79:36-46. [PMID: 33115699 DOI: 10.1016/j.ejmp.2020.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 01/03/2023] Open
Abstract
This article describes the technical principles and clinical applications of dual source CT. A dual source CT (DSCT) is a CT system with two x-ray tubes and two detectors at an angle of approximately 90°. Both measurement systems acquire CT scan data simultaneously at the same anatomical level of the patient (same z-position). DSCT provides temporal resolution of approximately a quarter of the gantry rotation time for cardiac, cardio-thoracic and pediatric imaging. Successful imaging of the heart and the coronary arteries at high and variable heart rates has been demonstrated. DSCT systems can be operated at twice the spiral pitch of single source CT systems (up to pitch 3.2). The resulting high table speed is beneficial for pediatric applications and fast CT angiographic scans, e. g. of the aorta or the extremities. Operating both X-ray tubes at different tube potential (kV) enables the acquisition of dual energy data and the corresponding applications such as monoenergetic imaging and computation of material maps. Spectral separation can be improved by different filtration of the X-ray beams of both X-ray tubes. As a downside, DSCT systems have to cope with some challenges, among them the limited size of the second measurement system, and cross-scattered radiation.
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Affiliation(s)
- Bernhard Schmidt
- Siemens Healthcare GmbH, Computed Tomography, Siemensstr. 3, 91301 Forchheim, Germany.
| | - Thomas Flohr
- Siemens Healthcare GmbH, Computed Tomography, Siemensstr. 3, 91301 Forchheim, Germany
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Dynamic Quantitative Iodine Myocardial Perfusion Imaging with Dual-Layer CT using a Porcine Model. Sci Rep 2019; 9:16046. [PMID: 31690759 PMCID: PMC6831609 DOI: 10.1038/s41598-019-52458-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/16/2019] [Indexed: 01/09/2023] Open
Abstract
Ischemic heart disease is the globally leading cause of death. When using coronary CT angiography, the functional hemodynamics within the myocardium remain uncertain. In this study myocardial CT perfusion imaging using iodine contrast agent demonstrated to strongly improve the assessment of myocardial disorders. However, a retrieval of such dynamics using Hounsfield units from conventional CT poses concerns with respect to beam-hardening effects and low contrast-to-noise ratio (CNR). Dual-energy CT offers novel approaches to overcome aforementioned limitations. Quantitative peak enhancement, perfusion, time to peak and iodine volume measurements inside the myocardium were determined resulting in 0.92 mg/ml, 0.085 mg/ml/s 17.12 s and 29.89 mg/ml*s, respectively. We report on the first extensive quantitative and iodine-based analysis of myocardial dynamics in a healthy porcine model using a dual-layer spectral CT. We further elucidate on the potential of reducing the radiation dose from 135 to 18 mGy and the contrast agent volume from 60 to 30 mL by presenting a two-shot acquisition approach and measuring iodine concentrations in the myocardium in-vivo down to 1 mg/ml, respectively. We believe that dynamic quantitative iodine perfusion imaging may be a highly sensitive tool for the precise functional assessment and monitoring of early myocardial ischemia.
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Scholtz JE, Hedgire S, Ghoshhajra BB. Technical Aspects, Interpretation, and Body of Evidence for Coronary Computed Tomography Angiography. Radiol Clin North Am 2019; 57:13-23. [DOI: 10.1016/j.rcl.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gu C, Zeng D, Lin J, Li S, He J, Zhang H, Bian Z, Niu S, Zhang Z, Huang J, Chen B, Zhao D, Chen W, Ma J. Promote quantitative ischemia imaging via myocardial perfusion CT iterative reconstruction with tensor total generalized variation regularization. ACTA ACUST UNITED AC 2018; 63:125009. [DOI: 10.1088/1361-6560/aac7bd] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Albrecht MH, Bickford MW, Schoepf UJ, Tesche C, De Santis D, Eid M, Jacobs BE, Duguay TM, Schmidt BT, Canstein C, Varga-Szemes A, Leithner D, Martin S, Vogl TJ, De Cecco CN. Beam-hardening in 70-kV Coronary CT angiography: Artifact reduction using an advanced post-processing algorithm. Eur J Radiol 2018; 101:111-117. [DOI: 10.1016/j.ejrad.2018.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 09/27/2017] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
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Scholtz JE, Ghoshhajra B. Advances in cardiac CT contrast injection and acquisition protocols. Cardiovasc Diagn Ther 2017; 7:439-451. [PMID: 29255688 DOI: 10.21037/cdt.2017.06.07] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cardiac computed tomography (CT) imaging has become an important part of modern cardiovascular care. Coronary CT angiography (CTA) is the first choice imaging modality for non-invasive visualization of coronary artery stenosis. In addition, cardiac CT does not only provide anatomical evaluation, but also functional and valvular assessment, and myocardial perfusion evaluation. In this article we outline the factors which influence contrast enhancement, give an overview of current contrast injection and acquisition protocols, with focus on current emerging topics such as pre-transcatheter aortic valve replacement (TAVR) planning, cardiac CT for congenital heart disease (CHD) patients, and myocardial CT perfusion (CTP). Further, we point out areas where we see potential for future improvements in cardiac CT imaging based on a closer interaction between CT scanner settings and contrast injection protocols to tailor injections to patient- and exam-specific factors.
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Affiliation(s)
- Jan-Erik Scholtz
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brian Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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