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Devia-Rodriguez R, Derksen M, de Groot K, Vedder IR, Zeebregts CJ, Bokkers RPH, Pol RA, de Vries JPPM, Schuurmann RCL. Validation of a Length-Adjusted Abdominal Arterial Calcium Score Method for Contrast-Enhanced CT Scans. Diagnostics (Basel) 2023; 13:diagnostics13111934. [PMID: 37296786 DOI: 10.3390/diagnostics13111934] [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: 03/30/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The Agatston score on noncontrast computed tomography (CT) scans is the gold standard for calcium load determination. However, contrast-enhanced CT is commonly used for patients with atherosclerotic cardiovascular diseases (ASCVDs), such as peripheral arterial occlusive disease (PAOD) and abdominal aortic aneurysm (AAA). Currently, there is no validated method to determine calcium load in the aorta and peripheral arteries with a contrast-enhanced CT. This study validated a length-adjusted calcium score (LACS) method for contrast-enhanced CT scans. METHOD The LACS (calcium volume in mm3/arterial length in cm) in the abdominal aorta was calculated using four-phase liver CT scans of 30 patients treated between 2017 and 2021 at the University Medical Center Groningen (UMCG) with no aortic disease. Noncontrast CT scans were segmented with a 130 Hounsfield units (HU) threshold, and a patient-specific threshold was used for contrast-enhanced CTs. The LACS was calculated and compared from both segmentations. Secondly, the interobserver variability and the influence of slice thickness (0.75 mm vs. 2.0 mm) was determined. RESULTS There was a high correlation between the LACS from contrast-enhanced CT scans and the LACS of noncontrast CTs (R2 = 0.98). A correction factor of 1.9 was established to convert the LACS derived from contrast-enhanced CT to noncontrast CT scans. LACS interobserver agreement on contrast-enhanced CT was excellent (1.0, 95% confidence interval = 1.0-1.0). The 0.75 mm CT threshold was 541 (459-625) HU compared with 500 (419-568) HU on 2 mm CTs (p = 0.15). LACS calculated with both thresholds was not significantly different (p = 0.63). CONCLUSION The LACS seems to be a robust method for scoring calcium load on contrast-enhanced CT scans in arterial segments with various lengths.
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Affiliation(s)
- Raul Devia-Rodriguez
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Maikel Derksen
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Kristian de Groot
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Issi R Vedder
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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Choi H, Park EA, Ahn C, Kim JH, Lee W, Jeong B. Performance of 1-mm non-gated low-dose chest computed tomography using deep learning-based noise reduction for coronary artery calcium scoring. Eur Radiol 2022; 33:3839-3847. [PMID: 36520181 DOI: 10.1007/s00330-022-09300-6] [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: 03/11/2022] [Revised: 08/31/2022] [Accepted: 11/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate performance of 1-mm, sharp kernel, low-dose chest computed tomography (LDCT) for coronary artery calcium scoring (CACS) using deep learning (DL)-based denoising technique. METHODS This retrospective, intra-individual comparative study consisted of four image datasets of 131 participants who underwent LDCT and calcium CT on the same day between January and February 2020; 1-mm LDCT with DL, 1-mm LDCT with iterative reconstruction (IR), 3-mm LDCT, and calcium CT. CACS from calcium CT were considered as reference and CACS were categorized as 0, 1-10, 11-100, 101-400, and > 400. We compared CACS from LDCTs with that from calcium CT. RESULTS Mean CACS was 104.8 ± 249.1 and proportion of positive CACS was 45% (59/131). CACS from LDCT images tended to be underestimated than those from calcium CT: 1-mm LDCT with DL (93.5 ± 249.6, p = 0.002), 1-mm LDCT with IR (94.7 ± 249.9, p < 0.001), and 3-mm LDCT (90.3 ± 245.3, p = 0.004). All LDCT datasets showed excellent agreement with calcium CT: intraclass correlation coefficient (ICC) = 0.961 (95% confidence interval (CI), 0.945-0.972) for DL, 0.969 (95% CI, 0.956-0.978) for IR, and 0.952 (95% CI, 0.932-0.966) for 3-mm LDCT; weighted kappa for CACS classification, 0.930 (95% CI, 0.893-0.966) for 1-mm LDCT with DL, 0.908 (95% CI, 0.866-0.950) for 1-mm LDCT with IR, and 0.846 (95% CI, 0.780-0.912) for 3-mm LDCT. The accuracy of CACS classification of 1-mm LDCT with DL (90%) tended to be better than 1-mm LDCT with IR (87%) and 3-mm LDCT (84.7%) (p = 0.10). CONCLUSION DL-based noise reduction algorithm can offer reliable calcium scores in 1-mm LDCT reconstructed with sharp kernel. KEY POINTS • Deep learning (DL)-based noise reduction enables calcium scoring at 1-mm, sharp kernel reconstructed low-dose chest CT (LDCT). • Both iterative reconstruction and DL-based noise reduction underestimated calcium score, but agreement were excellent with those from calcium CT. • Accuracy of categorical classification of calcium scoring tended to be highest in 1-mm LDCT with DL compared to 1-mm LDCT with IR and 3-mm LDCT (90%, 87%, and 84.7%, p = 0.10).
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Affiliation(s)
- Hyewon Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Chulkyun Ahn
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea
- ClariPi Research, Seoul, 03088, Republic of Korea
| | - Jong-Hyo Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea
- ClariPi Research, Seoul, 03088, Republic of Korea
- Center for Medical-IT Convergence Technology Research, Advanced Institutes of Convergence Technology, Suwon, 16229, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Baren Jeong
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Niu X. Interactive 3D reconstruction method of fuzzy static images in social media. JOURNAL OF INTELLIGENT SYSTEMS 2022. [DOI: 10.1515/jisys-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Because the traditional social media fuzzy static image interactive three-dimensional (3D) reconstruction method has the problem of poor reconstruction completeness and long reconstruction time, the social media fuzzy static image interactive 3D reconstruction method is proposed. For preprocessing the fuzzy static image of social media, the Harris corner detection method is used to extract the feature points of the preprocessed fuzzy static image of social media. According to the extraction results, the parameter estimation algorithm of contrast divergence is used to learn the restricted Boltzmann machine (RBM) network model, and the RBM network model is divided into input, output, and hidden layers. By combining the RBM-based joint dictionary learning method and a sparse representation model, an interactive 3D reconstruction of fuzzy static images in social media is achieved. Experimental results based on the CAD software show that the proposed method has a reconstruction completeness of above 95% and the reconstruction time is less than 15 s, improving the completeness and efficiency of the reconstruction, effectively reconstructing the fuzzy static images in social media, and increasing the sense of reality of social media images.
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Affiliation(s)
- Xiaomei Niu
- Sichuan Vocational College of Health and Rehabilitation , Zigong 643000 , China
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An S, Fan R, Zhao B, Yi Q, Yao S, Shi X, Zhu Y, Yi X, Liu S. Evaluating coronary artery calcification with low-dose chest CT reconstructed by different kernels. Clin Imaging 2022; 83:166-171. [DOI: 10.1016/j.clinimag.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022]
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van Praagh GD, Wang J, van der Werf NR, Greuter MJW, Mastrodicasa D, Nieman K, van Hamersvelt RW, Oostveen LJ, de Lange F, Slart RHJA, Leiner T, Fleischmann D, Willemink MJ. Coronary Artery Calcium Scoring: Toward a New Standard. Invest Radiol 2022; 57:13-22. [PMID: 34261083 PMCID: PMC10072789 DOI: 10.1097/rli.0000000000000808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although the Agatston score is a commonly used quantification method, rescan reproducibility is suboptimal, and different CT scanners result in different scores. In 2007, McCollough et al (Radiology 2007;243:527-538) proposed a standard for coronary artery calcium quantification. Advancements in CT technology over the last decade, however, allow for improved acquisition and reconstruction methods. This study aims to investigate the feasibility of a reproducible reduced dose alternative of the standardized approach for coronary artery calcium quantification on state-of-the-art CT systems from 4 major vendors. MATERIALS AND METHODS An anthropomorphic phantom containing 9 calcifications and 2 extension rings were used. Images were acquired with 4 state-of-the-art CT systems using routine protocols and a variety of tube voltages (80-120 kV), tube currents (100% to 25% dose levels), slice thicknesses (3/2.5 and 1/1.25 mm), and reconstruction techniques (filtered back projection and iterative reconstruction). Every protocol was scanned 5 times after repositioning the phantom to assess reproducibility. Calcifications were quantified as Agatston scores. RESULTS Reducing tube voltage to 100 kV, dose to 75%, and slice thickness to 1 or 1.25 mm combined with higher iterative reconstruction levels resulted in an on average 36% lower intrascanner variability (interquartile range) compared with the standard 120 kV protocol. Interscanner variability per phantom size decreased by 34% on average. With the standard protocol, on average, 6.2 ± 0.4 calcifications were detected, whereas 7.0 ± 0.4 were detected with the proposed protocol. Pairwise comparisons of Agatston scores between scanners within the same phantom size demonstrated 3 significantly different comparisons at the standard protocol (P < 0.05), whereas no significantly different comparisons arose at the proposed protocol (P > 0.05). CONCLUSIONS On state-of-the-art CT systems of 4 different vendors, a 25% reduced dose, thin-slice calcium scoring protocol led to improved intrascanner and interscanner reproducibility and increased detectability of small and low-density calcifications in this phantom. The protocol should be extensively validated before clinical use, but it could potentially improve clinical interscanner/interinstitutional reproducibility and enable more consistent risk assessment and treatment strategies.
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Affiliation(s)
| | - Jia Wang
- Department of Environmental Health and Safety, Stanford University, Stanford CA
| | | | | | | | | | | | - Luuk J Oostveen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | - Frank de Lange
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | | | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht
| | | | - Martin J Willemink
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
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Impact of Image Reconstruction Parameters on Abdominal Aortic Calcification Measurement Using Abdominal Computed Tomography. J Comput Assist Tomogr 2021; 45:849-855. [PMID: 34581705 DOI: 10.1097/rct.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Abdominal aortic calcification (AAC) is correlated with cardiovascular outcomes independent of traditional risk factors. Quantification of AAC on computed tomography (CT) has not been standardized. Reconstruction parameters have been shown to impact coronary calcium scores. The aim of our study was to assess the impact of abdominal CT reconstruction parameters, slice thickness (ST), and display field of view (DFOV) on AAC quantitative scoring on abdominal CT examinations. METHODS We retrospectively measured AAC on noncontrast CT of 46 patients (mean age, 64.1 years; 35 males) using 5 different reconstruction protocols with a range of ST and DFOV: protocol A, 2.5 mm ST, 35 cm DFOV; protocol B, 2.5 mm ST, 50 cm DFOV; protocol C, 2.5 mm ST, 25 cm DFOV; protocol D, 5 mm ST, 35 cm DFOV; and protocol E: 0.625 mm ST, 35 cm DFOV. The AAC scores from each protocol were compared using concordance correlation coefficient and Bland-Altman agreement analyses. RESULTS The AAC mean (SD) scores for each protocol were as follows: A, 2022 (2418); B, 2022 (2412); C, 1939 (2310); D, 2220 (2695); and E, 1862 (2234). The AAC mean score differences between protocols and reference protocol A were -0.47, 82.01, -198.94, and 160 for protocols B, C, D, and E, respectively, with differences between protocols C to E statistically significantly different (P < 0.05). The different protocols showed overall excellent correlation (concordance correlation coefficient, >0.9) between AAC scores. CONCLUSIONS Slice thickness and DFOV can impact AAC score measurement. A description of reconstruction parameters is important to allow comparisons across different cohorts.
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Terlouw LG, van Noord D, van Walsum T, Bruno MJ, Moelker A. Mesenteric artery calcium scoring: a potential screening method for chronic mesenteric ischemia. Eur Radiol 2020; 31:4212-4220. [PMID: 33263162 PMCID: PMC8128738 DOI: 10.1007/s00330-020-07530-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023]
Abstract
Objective A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS). Methods This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment. Results The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs. Conclusion MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted. Key Points • A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool. • Interobserver agreement of the mesenteric artery calcium score is excellent. • Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters.
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Affiliation(s)
- Luke G Terlouw
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Seitun S, Clemente A, De Lorenzi C, Benenati S, Chiappino D, Mantini C, Sakellarios AI, Cademartiri F, Bezante GP, Porto I. Cardiac CT perfusion and FFR CTA: pathophysiological features in ischemic heart disease. Cardiovasc Diagn Ther 2020; 10:1954-1978. [PMID: 33381437 DOI: 10.21037/cdt-20-414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiac computed tomography (CCT) has rapidly evolved, becoming a powerful integrated tool for the evaluation of coronary artery disease (CAD), and being superior to other noninvasive methods due to its high accuracy and ability to simultaneously assess both lumen stenosis and atherosclerotic plaque burden. Furthermore, CCT is regarded as an effective gatekeeper for coronary angiography, and carries independent important prognostic information. In the last decade, the introduction of new functional CCT applications, namely CCT perfusion (CCTP) imaging and CT-derived fractional flow reserve (FFRCTA), has opened the door for accurate assessment of the haemodynamic significance of stenoses. These new CCT technologies, thus, share the unique advantage of assessing both myocardial ischemia and patient-specific coronary artery anatomy, providing an integrated anatomical/functional analysis. In the present review, starting from the pathophysiology of myocardial ischemia, we evaluate the existing evidence for functional CCT imaging and its value in relation to alternative, well-established, non-invasive imaging modalities and invasive indices of ischemia (currently the gold-standard). The knowledge of clinical applications, benefits, and limitations of these new CCT technologies will allow efficient and optimal use in clinical practice in the near future.
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Affiliation(s)
- Sara Seitun
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa, Italy
| | - Cecilia De Lorenzi
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Stefano Benenati
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, "G. d'Annunzio" University, Chieti, Italy
| | - Antonis I Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Gian Paolo Bezante
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Italo Porto
- Clinic of Cardiovascular Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
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Best practice for the nuclear medicine technologist in CT-based attenuation correction and calcium score for nuclear cardiology. Eur J Hybrid Imaging 2020; 4:11. [PMID: 34191150 PMCID: PMC8218053 DOI: 10.1186/s41824-020-00080-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
The use of hybrid systems is increasingly growing in Europe and this is progressively important for the final result of diagnostic tests. As an integral part of the hybrid imaging system, computed tomography (CT) plays a crucial role in myocardial perfusion imaging diagnostics. Throughout Europe, a variety of equipment is available and also different university curricula of the nuclear medicine technologist are observed. Hence, the Technologist Committee of the European Association of Nuclear Medicine proposes to identify, through a bibliographic review, the recommendations for best practice in computed tomography applied to attenuation correction and calcium score in myocardial perfusion imaging, which courses in the set of knowledge, skills, and competencies for nuclear medicine technologists. This document aims at providing recommendations for CT acquisition protocols and CT image optimization in nuclear cardiology.
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Kawaguchi YO, Fujimoto S, Kumamaru KK, Kato E, Dohi T, Takamura K, Aoshima C, Kamo Y, Kato Y, Hiki M, Okai I, Okazaki S, Aoki S, Daida H. The predictive factors affecting false positive in on-site operated CT-fractional flow reserve based on fluid and structural interaction. IJC HEART & VASCULATURE 2019; 23:100372. [PMID: 31193109 PMCID: PMC6517572 DOI: 10.1016/j.ijcha.2019.100372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/05/2022]
Abstract
Background A novel algorithm has been developed for the on-site analysis of CT-fractional flow reserve (CT-FFR) using fluid structural interactions. There have been no reports on the factors affecting the diagnostic performance of CT-FFR using this algorithm. We evaluated the factors predictive of false-positive CT-FFR findings compared to invasive FFR as a reference standard. Methods The subjects were 66 consecutive cases (81 vessels) who underwent invasive FFR assessment within 90 days of the detection of 30–90% stenosis of one vessel of the major coronary artery, from among patients with suspected coronary arterial disease who underwent one-rotation scanning by 320-row coronary CT angiography (CCTA). The prospective CCTA mode was used for all patients, with the X-ray exposure set in a range of 70–99% of the RR interval. The FFR was calculated on-site from multiple cardiac phases. Factors associated with a false-positive finding of functional stenosis on CT-FFR, defined as an invasive FFR of ≤0.80, were evaluated using logistic regression analysis. Results Thirty-nine vessels (48.1%) had an invasive FFR of ≤0.80. CT-FFR and invasive FFR values disagreed in 13 vessels in 13 patients. The values were false positive in 12 of the vessels. In an analysis of patient characteristics, the body mass index (odds ratio, 1.33; 95%CI, 1.06–1.67; p = 0.01) and Image noise (odds ratio, 1.18; 95%CI, 1.01–1.40; p = 0.04) were predictive of false-positive findings. The presence of calcified plaque (odds ratio, 5.16; 95%CI, 1.06–20.85; p = 0.01) was the only significant predictive factor in a vessel-based analysis of lesion characteristics. Conclusions The presence of calcified plaque exerted a significant effect on the diagnostic performance of CT-FFR, and did so independently of the degree of calcification indicated by the Agatston score.
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Affiliation(s)
- Yuko O Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Etsuro Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Kamo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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