Pictorial review: computed tomography features of cardiovascular emergencies and associated imminent decompensation

Identification of Cardiac and Aortic Injuries in Trauma with Multi-detector Computed Tomography

Blunt and penetrating cardiovascular (CV) injuries are associated with a high morbidity and mortality. Rapid detection of these injuries in trauma is critical for patient survival. The advent of multi-detector computed tomography (MDCT) has led to increased detection of CV injuries during rapid comprehensive scanning of stabilized major trauma patients. MDCT has the ability to acquire images with a higher temporal and spatial resolution, as well as the capability to create multiplanar reformats. This pictorial review illustrates several common and life-threatening traumatic CV injuries from a regional trauma center.

Evaluation of novice reader diagnostic performance in coronary CT angiography using an advanced cardiac software package

Purpose

The purpose of this research was to evaluate whether a commercially available advanced cardiac software package for coronary CT angiography (CTA) interpretation may reliably assist inexperienced readers to screen for significant coronary artery stenoses.

Methods

Coronary CTA data sets of 61 consecutive patients with suspected coronary artery disease were evaluated by three novice readers with no experience in cardiac CT interpretation. In the first 15 patients, the novice readers were trained to use the advanced cardiac software package (includes automatic detection of coronary vessels, curved MPR and VRT reconstructions and a measurement too) knowing the results of an expert read. In the next 46 patients, the novice readers had to state whether there is a significant coronary artery stenosis (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$>$$\end{document}>50 %) and if they are confident with their diagnosis. The results of the novice readers were compared to the expert read.

Results

The 46 coronary CTA data sets contained 184 vessels with 15 stenoses in 9 patients. On a per-vessel analysis, novice reader 1/2/3 demonstrated 60 %/100 %/ 93% sensitivity, and 98 %/90 %/86 % specificity. Per patient, the readers diagnosed 36/28/29 cases correctly as free of stenoses, 6/9/8 correctly as having at least one stenosis, missed 3/0/1 cases with a stenosis and overdiagnosed 1/9/8 patients. Cohen’s kappa values for the three readers versus the expert were 0.60, 0.61 and 0.54. The three novice readers felt confident in the diagnosis of 36/33/30 patients. In these patients, they missed one significant stenosis, showed a sensitivity of 100 %/100 %/75 % and a specificity of 100 %/92 %/88 %.

Conclusions

The evaluated advanced cardiac software package successfully assists novice readers in interpreting coronary CTA data sets especially in ruling out significant coronary artery stenosis.

Diagnosis and treatment planning of acute aortic emergencies using a handheld DICOM viewer

Acute aortic syndromes and traumatic aortic injury are often diagnosed on CT angiography, possibly requiring emergent intervention. Advances in handheld computing have created the possibility of viewing full DICOM datasets from a remote location. We evaluated the ability to diagnose and characterize acute aortic pathologies on CT angiograms of the thorax using an iPhone-based DICOM viewer. This study was performed after Institutional Review Board approval. Fifteen CT angiograms of the thorax in suspected acute aortic syndromes were evaluated by three blinded radiologists on a handheld device using a DICOM viewer. Studies were evaluated for the ability to identify and classify aortic dissection, transection, or intramural hematoma, measure aortic dimensions, and identify mediastinal hematoma, arch variants, and pulmonary pathology. Studies were compared to blinded interpretations on a dedicated PACS workstation. The aortic pathology was correctly identified as aortic transection/pseudoaneurysm (n = 5), type A dissection (n = 2), and type A intramural hematoma (n = 1) by all reviewers, with no false-positive interpretations. This represents a sensitivity and specificity of 100 %. Mediastinal hematoma (n = 6), pneumothorax (five right, three left), and arch vessel involvement (n = 2) were identified in all cases. There was 88.5 % accuracy in identifying arch variants. Measurement of the size of the involved aortic segment was similar on handheld device and PACS workstation; however the adjacent normal aorta was 1.2 ± 1.0 mm larger on the handheld device (p = 0.03). Handheld DICOM viewers may be useful for emergent consultations and triage, and may expedite preprocedure planning to reduce the time interval between diagnostic scan and therapeutic intervention.