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Gupta B, Jacob D, Thompson R. Imaging in patients after cardiac transplantation and in patients with ventricular assist devices. J Nucl Cardiol 2015; 22:617-38. [PMID: 25832983 DOI: 10.1007/s12350-015-0115-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/29/2015] [Indexed: 02/06/2023]
Abstract
The field of cardiac imaging and the management of patients with severe heart failure have advanced substantially during the past 10 years. Cardiac transplantation offers the best long-term survival with high quality of life for the patients with end stage heart failure. However, acute cardiac rejection and cardiac allograft vasculopathy (CAV) can occur post cardiac transplantation and these problems necessitate regular surveillance. The short-term success of mechanical circulatory support devices (MCSD), such as ventricular assist devices (VADs), in improving survival and quality of life has led to a dramatic growth of the patient population with these devices. The development of optimal imaging techniques and algorithms to evaluate these advanced heart failure patients is evolving and multimodality non-invasive imaging approaches and invasive techniques are commonly employed. Most of the published studies done in the transplant and VAD population are small, and biased based on the strength of the particular program, and there is a relative lack of published protocols to evaluate these patient groups. Moreover, the techniques of echocardiography, computed tomography (CT), magnetic resonance imaging, and nuclear cardiology have all progressed rapidly in recent years. There is thus a knowledge gap for cardiologists, radiologists, and clinicians, especially regarding surveillance for CAV and ideal imaging approaches for patients with VADs. The purpose of this review article is to provide an overview of different noninvasive imaging modalities used to evaluate patients after cardiac transplantation and for patients with VADs. The review focuses on the role of echocardiography, CT, and nuclear imaging in surveillance for CAV and rejection and on the assessment of ventricular structure and function, myocardial remodeling and complications for VAD patients.
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Affiliation(s)
- Bhanu Gupta
- Department of Cardiology, St. Luke's Mid America Heart Institute, 4330 Wornall Rd, Suite 2000, Kansas City, MO, USA
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2
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Sharma A, Einstein AJ, Vallakati A, Arbab-Zadeh A, Mukherjee D, Lichstein E. Meta-analysis of global left ventricular function comparing multidetector computed tomography with cardiac magnetic resonance imaging. Am J Cardiol 2014; 113:731-8. [PMID: 24355312 DOI: 10.1016/j.amjcard.2013.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 11/17/2022]
Abstract
We compare the diagnostic accuracy of multidetector row computed tomography (MDCT) to cardiac magnetic resonance imaging (CMR) for evaluating global left ventricular function. We systematically searched PubMed, CINAHL, Cochrane CENTRAL, Scopus, and the Web of Science databases for studies published between 1966 to January 2013 that compared left ventricle (LV) volumes, ejection fraction (EF) and LV mass measured by MDCT and CMR. We performed meta-analyses and used random-effects model with inverse variance weighting test to determine the overall bias and limits of agreement of LV end-diastolic volume, end-systolic volume, stroke volume, and EF measured by MDCT and CMR. Furthermore, subgroup analyses were performed to compare 16-slice and 64-slice MDCT with CMR. Two study authors independently reviewed the 90 articles originally identified and selected 27 studies (n = 831) for analysis. Excellent correlation and a linear relation were seen between MDCT and CMR for LV end-diastolic volume (r = 0.93; p <0.001), LV end-systolic volume (r = 0.95; p <0.001), LV stroke volume (r = 0.85; p <0.001), LV ejection fraction (r = 0.93; p <0.001), and LV mass (r = 0.86; p <0.001). Subgroup analyses showed strong positive correlations for both 16- and 64-slice MDCT. In conclusion, although not the first-line test for LV function assessment in most patients, when appropriate, retrospectively gated MDCT provides an accurate and valid assessment of LV function compared with CMR.
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Affiliation(s)
- Abhishek Sharma
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Andrew J Einstein
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Ajay Vallakati
- Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Edgar Lichstein
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
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3
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [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: 12/22/2022]
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4
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Cardiac motion and strain detection using 4D CT images: comparison with tagged MRI, and echocardiography. Int J Cardiovasc Imaging 2013; 30:175-84. [DOI: 10.1007/s10554-013-0305-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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5
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van Ooijen PMA, de Jonge GJ, Oudkerk M. Informatics in radiology: postprocessing pitfalls in using CT for automatic and semiautomatic determination of global left ventricular function. Radiographics 2012; 32:589-99. [PMID: 22323618 DOI: 10.1148/rg.322115058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent advances in technical capabilities of computed tomographic (CT) scanners, including an increasing number of detector rows, improved spatial and temporal resolution, and the development of retrospective gating, have allowed the acquisition of four-dimensional (4D) datasets of the beating heart. As a result, the heart can be visualized in different phases and CT datasets can be used to assess cardiac function. Many software packages currently exist that allow automatic or semiautomatic evaluation of left ventricular function on the basis of 4D CT datasets. The level of automation varies from extensive, completely manual segmentation by the user to fully automatic evaluation of left ventricular function without any user interaction. Although the reproducibility of functional parameter assessment is reported to be high and intersoftware variability low for larger groups of patients, significant differences can exist among measurements obtained with different software tools from the same dataset. Thus, careful review of automatically or semiautomatically obtained results is required.
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Affiliation(s)
- Peter M A van Ooijen
- Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, EB44, 9713 GZ Groningen, the Netherlands.
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6
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Schroeder J, Peterschroeder A, Vaske B, Butz T, Barth P, Oldenburg O, Bitter T, Burchert W, Horstkotte D, Langer C. Cardiac volumetry in patients with heart failure and reduced ejection fraction: a comparative study correlating multi-slice computed tomography and magnetic resonance tomography. Reasons for intermodal disagreement. Clin Res Cardiol 2010; 98:739-47. [PMID: 19771459 DOI: 10.1007/s00392-009-0074-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 08/26/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND In humans with normal hearts multi-slice computed tomography (MSCT) based volumetry was shown to correlate well with the gold standard, cardiac magnetic resonance imaging (CMR). We correlated both techniques in patients with various degrees of heart failure and reduced ejection fraction (HFREF) resulting from cardiac dilatation. METHODS Twenty-four patients with a left ventricular enddiastolic volume (LV-EDV) of C 150 ml measured by angiography underwent MSCT and CMR scanning for left and right ventricular (LV, RV) volumetry. MSCT based short cardiac axis views were obtained beginning at the cardiac base advancing to the apex. These were reconstructed in 20 different time windows of the RR-interval (0-95%) serving for identification of enddiastole (ED) and end-systole (ES) and for planimetry. ED and ES volumes and the ejection fraction (EF) were calculated for LV and RV. MSCT based volumetry was compared with CMR. RESULTS MSCT based LV volumetry significantly correlates with CMR as follows: LV-EDV r = 0.94, LV-ESV r = 0.98 and LV-EF r = 0.93, but significantly overestimates LV-EDV and LV-ESV and underestimates EF (P \ 0.0001). MSCT based RV volumetry significantly correlates with CMR as follows: RV-EDV r = 0.79, RVESV r = 0.78 and RV-EF r = 0.73, but again significantly overestimates RV-EDV and RV-ESV and underestimates RV-EF (P \ 0.0001). CONCLUSION When compared with CMR a continuous overestimation of volumes and underestimation of EF needs to be considered when applying MSCT in HFREF patients.
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Affiliation(s)
- Janina Schroeder
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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7
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Sarwar A, Shapiro MD, Nasir K, Nieman K, Nomura CH, Brady TJ, Cury RC. Evaluating global and regional left ventricular function in patients with reperfused acute myocardial infarction by 64-slice multidetector CT: A comparison to magnetic resonance imaging. J Cardiovasc Comput Tomogr 2009; 3:170-7. [DOI: 10.1016/j.jcct.2009.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 04/05/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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8
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Left Ventricular Functional Analysis With 16- and 64-Row Multidetector Computed Tomography. J Comput Assist Tomogr 2009; 33:8-14. [DOI: 10.1097/rct.0b013e3181624ad0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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DOĞAN H, VELDKAMP WJH, DIBBETS-SCHNEIDER P, SPIJKERBOER AM, MERTENS BJA, KROFT LJM, DE ROOS A, GELEIJNS J. Effects of heart rate, filling and slice thickness on the accuracy of left ventricular volume measurements in a dynamic cardiac phantom using ECG-gated MDCT. Br J Radiol 2008; 81:577-82. [DOI: 10.1259/bjr/92798700] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Sibley CT, Lima JA. Assessment of ventricular structure and function with multidetector CT and MRI. Curr Cardiol Rep 2008; 10:67-71. [DOI: 10.1007/s11886-008-0013-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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11
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Pelzel JM, Lesser JR, Knickelbine T, Flygenring B, Tadros G, Schwartz RS. Multidetector CT coronary angiography: Where we are, and where we are going…. Catheter Cardiovasc Interv 2007; 69:159-71. [PMID: 17173314 DOI: 10.1002/ccd.20956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jamie M Pelzel
- Division of Cardiovascular Disease, University of Minnesota, Minnesota, USA
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12
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Fischbach R, Juergens KU, Ozgun M, Maintz D, Grude M, Seifarth H, Heindel W, Wichter T. Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging. Eur Radiol 2006; 17:1009-17. [PMID: 17008985 DOI: 10.1007/s00330-006-0438-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 05/22/2006] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
This study compares quantitative and qualitative information on global and regional left ventricular (LV) function obtained with multidetector-row computed tomography (MDCT) with that obtained with magnetic resonance imaging (MRI) in patients with a high prevalence of LV wall motion abnormalities. Thirty patients (19 male, 63.7+/-15.1 years) with myocardial infarction (n=12), coronary artery disease (n=9), arrhythmogenic right ventricular cardiomyopathy (n=6), and dilation cardiomyopathy (n=3) were included. Segmental LV wall motion (LV-WM) was assessed using a 4-point scale. Wall thickness measurements were calculated in diastolic and systolic short axis images. Two hundred and fifty-two out of 266 (94.7%) normal and 189 out of 214 (88.3%) segments with decreased wall motion were correctly identified by MDCT, yielding a sensitivity of 88% and specificity of 95% for identification of wall motion abnormalities. LV-WM scores were identical in 86.7% of 480 segments (kappa=0.809). MDCT had a tendency to underestimate the degree of wall motion impairment. Interobserver agreement was lower in MDCT (66.5%) than in MRI (89.1%; p<0.01). Normokinetic segments are reliably identified with MDCT. Sensitivity for detection and accurate classification of LV wall motion abnormalities need to be improved. Better temporal resolution of the CT system seems to be the most important factor for enhancing MDCT performance.
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Affiliation(s)
- Roman Fischbach
- Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany
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13
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Dewey M, Müller M, Teige F, Schnapauff D, Schink T, Hamm B, Lembcke A. Multisegment and halfscan reconstruction of 16-slice computed tomography for assessment of regional and global left ventricular myocardial function. Invest Radiol 2006; 41:400-9. [PMID: 16523023 DOI: 10.1097/01.rli.0000201233.42994.9b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES We sought to prospectively compare multisegment and halfscan reconstruction of 16-slice computed tomography (CT) for the assessment of regional and global left ventricular myocardial function with magnetic resonance imaging (MRI) as the reference standard. MATERIALS AND METHODS Forty-two patients underwent CT with 16 x 0.5-mm detector collimation. Electrocardiogram-gated reconstructions were generated with multisegment reconstruction (using up to 4 segments correlated with the raw data of up to 4 heartbeats) and standard halfscan reconstruction. Steady-state free-precession cine MRI was acquired within 24 hours. RESULTS More normal myocardial segments were identified correctly with multisegment (95%, 620/656) compared with halfscan reconstruction (88%, 582/656) of CT (P < 0.001). Also, the accuracy (92% [657/714] vs. 87% [620/714]) and rate of nondiagnostic segments (0% vs. 5% [33/714]) were significantly better when using multisegment reconstruction (P < 0.001). The image quality with multisegment reconstruction was significantly superior to that achieved with halfscan reconstruction (P < 0.001). In the assessment of global left ventricular function, multisegment and halfscan reconstruction of CT showed high correlations for all parameters with MRI, whereas Bland-Altman analysis revealed smaller limits of agreement for assessment of myocardial mass with multisegment reconstruction (P = 0.025), but no significant differences between both reconstruction techniques in the measurement of left ventricular volumes as compared with MRI. CONCLUSIONS Multisegment reconstruction of 16-detector row CT improves image quality and assessment of regional wall motion compared with standard halfscan reconstruction.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Freie Universität and Humboldt-Universität zu Berlin, Germany.
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14
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Orakzai SH, Orakzai RH, Nasir K, Budoff MJ. Assessment of Cardiac Function Using Multidetector Row Computed Tomography. J Comput Assist Tomogr 2006; 30:555-63. [PMID: 16845283 DOI: 10.1097/00004728-200607000-00001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with suspected or documented heart disease, a precise quantitative and qualitative assessment of cardiac function is critical for clinical diagnosis, risk stratification, management and prognosis. Cardiac CT is increasingly being used in diagnosis of coronary artery disease. Initially multi-detector row computed tomography (MDCT) was used chiefly for detecting coronary artery stenosis and assessment of cardiac morphology. Electron beam computed tomography has been shown to provide a highly accurate ejection fraction (+/-1%), with 50 ms image acquisition per image. Retrospective electrocardiographic gating allows for image reconstruction in any phase of the cardiac cycle. Thus, end systolic and end diastolic images can be produced to assess ventricular volumes and function. Despite lower temporal resolution than electron beam computed tomography, the ability of MDCT to assess ejection fraction is preserved. In the assessment of cardiac function, MDCT has been shown to be in good agreement with echocardiography, cineventriculography, single photon emission computed tomography and magnetic resonance imaging. The fast technical development of scanner hardware along with multisegmental image reconstruction has led to rapid improvement of spatial and temporal resolution and significantly faster cardiac scans. The same data that is acquired for MDCT angiography can also be used for evaluation of cardiac function. Considering contrast media application, radiation exposure, and limited temporal resolution, MDCT solely for analysis of cardiac function parameters seems not reasonable at the present time. However, because the data is already obtained during coronary evaluation, the combination of noninvasive coronary artery imaging and assessment of cardiac function with MDCT is a suitable approach to a conclusive cardiac workup in patients with suspected coronary artery disease. MDCT seems suitable for assessment of cardiac function by MDCT when results are held in comparison to magnetic resonance imaging as the reference standard. Given the radiation dose and contrast requirement, referring a patient to MDCT only for evaluation of function is not warranted, but rather adds important clinical information to the already acquired data during retrospective triggering for MDCT angiography.
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Affiliation(s)
- Sarwar H Orakzai
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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15
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Juergens KU, Seifarth H, Maintz D, Grude M, Ozgun M, Wichter T, Heindel W, Fischbach R. MDCT Determination of Volume and Function of the Left Ventricle: Are Short-Axis Image Reformations Necessary? AJR Am J Roentgenol 2006; 186:S371-8. [PMID: 16714611 DOI: 10.2214/ajr.04.1764] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Determination of left ventricular (LV) volumes and global function parameters from MDCT data sets is usually based on short-axis reformations from primarily reconstructed axial images, which prolong postprocessing time. The aim of this study was to evaluate the feasibility of LV volumetry and global LV function assessment from axial images in comparison with short-axis image reformations. SUBJECTS AND METHODS This study consisted of 20 patients with either coronary artery disease or dilated cardiomyopathy. We evaluated MDCT results using cine MRI as the reference technique. RESULTS LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were significantly overestimated by the axial MDCT approach in comparison with volume measurements from short-axis CT image reformations. The mean LV ejection fraction (LVEF) was not significantly different (41.2% vs 42.7%). Short-axis and axial MDCT determination of LVEF revealed a systematic underestimation by a mean +/- SD of -2.1% +/- 3.6% versus -3.6% +/- 8.2%, respectively, when compared with LVEF values based on cine MRI. The interobserver variability for volume and function measurements from axial images (LVEDV = 8.5%, LVESV = 10.8%, LVEF = 9.6%) was slightly higher than those measurements from short-axis reformations (LVEDV = 7.2%, LVESV = 9.5%, LVEF = 8.7%). The mean total evaluation time was significantly shorter using axial images (14.1 +/- 3.9 min) compared with short-axis reformations (16.9 +/- 5.2 min) (p < 0.05). CONCLUSION Determination of LV volumes and assessment of global LV function from axial MDCT image reformations is feasible and time efficient. This approach might be a clinically useful alternative to established short-axis-based measurements in patients with normal or near-normal LV function. A progressive underestimation of LVEF with increasing LV volumes may limit the clinical applicability of the axial approach in patients with dilated cardiomyopathy.
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Affiliation(s)
- Kai U Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany.
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16
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CT Angiography. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Heuschmid M, Rothfuss JK, Schroeder S, Fenchel M, Stauder N, Burgstahler C, Franow A, Kuzo RS, Kuettner A, Miller S, Claussen CD, Kopp AF. Assessment of left ventricular myocardial function using 16-slice multidetector-row computed tomography: comparison with magnetic resonance imaging and echocardiography. Eur Radiol 2005; 16:551-9. [PMID: 16215736 DOI: 10.1007/s00330-005-0015-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2005] [Revised: 07/07/2005] [Accepted: 08/18/2005] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess functional parameters using multidetector-row computed tomography (MDCT) and echocardiography and to compare the results with magnetic resonance imaging (MRI). MATERIALS AND METHODS End-diastolic-volume (EDV), end-systolic-volume (ESV), stroke-volume (SV), ejection-fraction (EF), and myocardial mass (MM) were calculated based on CT data sets from 52 patients. Echocardiography was performed in 24 of the 52 patients. The results from MDCT and echocardiography were compared with MRI. RESULTS A strong correlation between MDCT and MRI (r=0.66-0.90) was found for all parameters. Echocardiography revealed a low or moderate correlation (0.05-0.59). Compared to MRI the average differences with MDCT were for EDV 15.1 ml, ESV 10.6 ml, SV 4.5 ml, EF 1.8%, and MM 8.2 g, for EDV determined by echocardiography 36.2 ml, ESV 6.8 ml, and EF 13.9%. Bland-Altman analysis revealed acceptable limits of agreement between MRI and MDCT. CONCLUSIONS MDCT enables reliable quantification of left ventricular function. Echocardiography was found to have only a moderate agreement of functional parameters with MRI.
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Affiliation(s)
- Martin Heuschmid
- Department of Diagnostic Radiology, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72070, Tübingen, Germany.
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Juergens KU, Fischbach R. Left ventricular function studied with MDCT. Eur Radiol 2005; 16:342-57. [PMID: 16132917 DOI: 10.1007/s00330-005-2888-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 07/29/2005] [Indexed: 11/24/2022]
Abstract
Accurate determination of left ventricular (LV) myocardial function is fundamental for clinical diagnosis, risk stratification, and estimation of prognosis in patients with ischemic and nonischemic cardiomyopathy. Primarily, multi-detector-row spiral CT (MDCT) of the heart aimed at detecting coronary artery obstruction and cardiac morphology. Multiple studies have demonstrated that retrospectively, ECG-gated MDCT determination of LV volumes and consequently global LV function parameters is feasible in good agreement with established imaging modalities such as cineventriculography, echocardiography, and cine magnetic resonance imaging (CMR). Post-processing tools allow fast and semi-automatic determination of LV function parameters from MDCT data in analogy to known CMR evaluation approaches. Although MDCT is not considered to be first-line modality for LV function assessment, this technique provides accessory dynamic information in patients undergoing MDCT coronary angiography, contributing to combined assessment of cardiac morphology and function without need of additional radiation exposure. MDCT regional LV wall motion analysis at rest is feasible, but further improvement in temporal resolution seems mandatory to match results obtained from competing modalities. This paper will discuss the diagnostic potential of MDCT for assessment of LV function with regards to accuracy and clinical applications, as well as limitations, particularly in comparison with CMR as modality of reference.
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Affiliation(s)
- Kai Uwe Juergens
- Department of Clinical Radiology, University of Muenster, Germany.
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19
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Dewey M, Müller M, Teige F, Hamm B. Evaluation of a semiautomatic software tool for left ventricular function analysis with 16-slice computed tomography. Eur Radiol 2005; 16:25-31. [PMID: 15965660 DOI: 10.1007/s00330-005-2817-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 05/04/2005] [Accepted: 05/09/2005] [Indexed: 12/20/2022]
Abstract
The purpose of the study was to evaluate a semiautomatic analysis tool for assessing global left ventricular myocardial function with multislice computed tomography (MSCT). We examined 33 patients with MSCT using 16x0.5 mm detector collimation and magnetic resonance imaging (MRI) on a 1.5-T scanner. MSCT data were analyzed using semiautomatic volumetric analysis software (ANET, CSCF-001A, Toshiba). This software tool automatically creates endo- and epicardial contours that can be manually corrected on all short-axis slices at all reconstructed time points within the cardiac cycle, based on a contour-detection and density-threshold algorithm. All global left ventricular function parameters assessed with the semiautomatic MSCT software were highly correlated with the results of MRI. Bland-Altman analysis showed minor systematic overestimation of end-diastolic (10.7 ml) and end-systolic volumes (5.6 ml) and underestimation of ejection fraction (2.1%) with MSCT as compared with MRI. The post-processing time was moderately but significantly longer with the MSCT software (15.9+/-2.8 min) than necessary for MRI (14.0+/-2.5 min, P<0.01), mainly as a result of the longer time required for uploading of the MSCT datasets, which were on average 54 times larger (1.3 GByte). In conclusion, it appears feasible to accurately assess global left ventricular function with MSCT in a reasonable post-processing time using a semiautomatic software tool.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité, Medical School, Humboldt-Universität zu Berlin, Schumannstr. 20/21, 10117, Berlin, Germany.
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Abstract
Recent advances in computed tomography have the potential to change the way imaging is performed in the detection of coronary artery disease. The current generation of scanners offers the ability to rapidly acquire thin sections in conjunction with the electrocardiogram, allowing for both anatomic and physiologic data to be obtained. These advancements hold the promise for a noninvasive means of directly evaluating the coronary arteries that can be applied in every day practice. This article reviews the advances in technology and their implications for imaging the heart.
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Affiliation(s)
- James G Ravenel
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA.
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Mahnken AH, Wildberger JE, Koos R, Günther RW. Multislice Spiral Computed Tomography of the Heart: Technique, Current Applications, and Perspective. Cardiovasc Intervent Radiol 2005; 28:388-99. [PMID: 15959701 DOI: 10.1007/s00270-003-9218-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Multislice spiral computed tomography (MSCT) is a rapidly evolving, noninvasive technique for cardiac imaging. Knowledge of the principle of electrocardiogram-gated MSCT and its limitations in clinical routine are needed to optimize image quality. Therefore, the basic technical principle including essentials of image postprocessing is described. Cardiac MSCT imaging was initially focused on coronary calcium scoring, MSCT coronary angiography, and analysis of left ventricular function. Recent studies also evaluated the ability of cardiac MSCT to visualize myocardial infarction and assess valvular morphology. In combination with experimental approaches toward the assessment of aortic valve function and myocardial viability, cardiac MSCT holds the potential for a comprehensive examination of the heart using one single examination technique.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, Aachen University of Technology, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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22
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Mahnken AH, Koos R, Katoh M, Spuentrup E, Busch P, Wildberger JE, Kühl HP, Günther RW. Sixteen-slice spiral CT versus MR imaging for the assessment of left ventricular function in acute myocardial infarction. Eur Radiol 2005; 15:714-20. [PMID: 15682266 DOI: 10.1007/s00330-004-2592-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Revised: 11/09/2004] [Accepted: 11/16/2004] [Indexed: 01/10/2023]
Abstract
The aim of this study was to assess global left ventricular (LV) function and regional wall motion using retrospectively ECG-gated 16-slice computed tomography (CT) in comparison with magnetic resonance imaging (MRI). Twenty-one patients (18 male, 65.5+/-8.6 years) with acute myocardial infarction underwent multislice spiral CT (MSCT) and MRI. From manually drawn endo- and epicardial contours, LV volumes including myocardial mass, peak filling rate (PFR), peak ejection rate (PER), time to PER (TPER) and time from end-systole to PFR (TPFR) were calculated. Regional wall motion was assessed from cine loops using a 16-segment model of the left ventricle. LV function was analyzed using the Bland-Altman method, Pearson's correlation coefficient, multivariate analysis and post hoc t tests. Regional wall motion was evaluated with weighted kappa-statistics. Multivariate analysis revealed significant differences for global LV function as determined by MSCT and MRI. Post hoc t-tests showed significant differences for end-diastolic volume (EDV), PFR and TPER (P<0.05), while there was a good agreement for the LV volumes with an ejection fraction of 46.9+/-8.4% for MSCT and 46.9+/-8.9% for MRI. PER, PFR, TPER and TPFR presented a poor correlation and a wide range of scattering between MSCT and MRI. Regional wall motion scores showed a good agreement with kappa=0.791. Sixteen-slice spiral CT allows for reliable assessment of LV volumes, but is not yet suited for the evaluation of all functional parameters. Assessment of regional wall motion at rest is feasible.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, Aachen University of Technology, Pauwelsstrasse 30, 52074 Aachen, Germany.
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23
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Koch K, Oellig F, Oberholzer K, Bender P, Kunz P, Mildenberger P, Hake U, Kreitner KF, Thelen M. Assessment of right ventricular function by 16-detector-row CT: comparison with magnetic resonance imaging. Eur Radiol 2004; 15:312-8. [PMID: 15565315 DOI: 10.1007/s00330-004-2543-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 10/04/2004] [Accepted: 10/07/2004] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to determine right ventricular (RV) function from 16-detector-row CT by using two different software tools in comparison with MRI. Nineteen patients underwent cardiac CT. (1) With semiautomated contour detection software end-diastolic and end-systolic RV volumes were determined from short-axis CT reformations (MPR) created at every 10% of the RR-interval. (2) End-systolic and end-diastolic axial images were transformed to 3D to determine the volumes by using a threshold-supported reconstruction algorithm. Steady-state free-precession cine-MRI of the heart was done in short-axis orientation. RV function could not be analyzed in one patient because of sternal wire artifacts in MRI. Mean end-diastolic (155.4+/-54.6 ml) and end-systolic (79.1+/-37.0 ml) RV volumes determined with MPR correlated well with MRI [151.9+/-53.7 ml (r=0.98) and 75.0+/-36.0 ml (r=0.96), respectively (P<0.001)]. RV stroke volume (76.2+/-20.2 ml for MPR-CT, 76.9+/-20.7 ml for MRI, r=0.93) showed a good correlation and RV ejection fraction (50.8+/-8.4% for MPR-CT, 51.9+/-7.4% for MRI, r=0.74) only a moderate one. Threshold supported 3D reconstructions revealed insufficient correlations with MRI (r=0.31-0.59). MPR-based semiautomated analysis of cardiac 16 detector-row CT allows for RV functional analysis. The results correlate well with MRI findings. Threshold value-supported 3D reconstructions did not show satisfying results because of inhomogeneities of RV contrast enhancement.
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Affiliation(s)
- K Koch
- Department of Radiology, Johannes Gutenberg-University Mainz, 55131, Mainz, Germany.
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24
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Juergens KU, Maintz D, Grude M, Boese JM, Heimes B, Fallenberg EM, Heindel W, Fischbach R. Multi-detector row computed tomography of the heart: does a multi-segment reconstruction algorithm improve left ventricular volume measurements? Eur Radiol 2004; 15:111-7. [PMID: 15565319 DOI: 10.1007/s00330-004-2530-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 09/17/2004] [Accepted: 09/28/2004] [Indexed: 11/30/2022]
Abstract
A multi-segment cardiac image reconstruction algorithm in multi-detector row computed tomography (MDCT) was evaluated regarding temporal resolution and determination of left ventricular (LV) volumes and global LV function. MDCT and cine magnetic resonance (CMR) imaging were performed in 12 patients with known or suspected coronary artery disease. Patients gave informed written consent for the MDCT and the CMR exam. MDCT data were reconstructed using the standard adaptive cardiac volume (ACV) algorithm as well as a multi-segment algorithm utilizing data from three, five and seven rotations. LV end-diastolic (LV-EDV) and end-systolic volumes and ejection fraction (LV-EF) were determined from short-axis image reformations and compared to CMR data. Mean temporal resolution achieved was 192+/-24 ms using the ACV algorithm and improved significantly utilizing the three, five and seven data segments to 139+/-12, 113+/-13 and 96+/-11 ms (P<0.001 for each). Mean LV-EDV was without significant differences using the ACV algorithm, the multi-segment approach and CMR imaging. Despite improved temporal resolution with multi-segment image reconstruction, end-systolic volumes were less accurately measured (mean differences 3.9+/-11.8 ml to 8.1+/-13.9 ml), resulting in a consistent underestimation of LV-EF by 2.3-5.4% in comparison to CMR imaging (Bland-Altman analysis). Multi-segment image reconstruction improves temporal resolution compared to the standard ACV algorithm, but this does not result in a benefit for determination of LV volume and function.
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Affiliation(s)
- Kai Uwe Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
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25
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Herzog C, Wimmer-Greinecker G, Schwarz W, Dogan S, Moritz A, Fichtlscherer S, Vogl TJ. Progress in CT imaging for the cardiac surgeon. Semin Thorac Cardiovasc Surg 2004; 16:242-8. [DOI: 10.1053/j.semtcvs.2004.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Abstract
The socioeconomic importance of heart disease provides considerable motivation for development of radiologic tools for noninvasive imaging of the coronary arteries. Current computed tomographic (CT) techniques combine high speed and spatial resolution with sophisticated electrocardiographic synchronization and robustness of use. Application of these modalities for evaluation of coronary artery disease is a topic of active current research. Coronary artery calcium measurements with different CT techniques have been used for determining the risk of coronary events, but the exact role of this marker for cardiac risk stratification remains unclear pending results of population-based studies. Contrast material-enhanced CT coronary angiography has become an established clinical indication for some scenarios (eg, coronary artery anomalies, bypass patency, surgical planning). With current technology, the accuracy of CT coronary angiography for detection of coronary artery stenoses appears promising enough to warrant pursuit of this application, but sensitivity is still not high enough for routine diagnostic needs. The high negative predictive value of a normal CT coronary angiogram, however, may be useful for reliable exclusion of coronary artery stenosis. The cross-sectional nature of CT may allow noninvasive assessment of the coronary artery wall. Use of contrast-enhanced CT coronary angiography for detection, characterization, and quantification of atherosclerotic changes and total disease burden in coronary arteries as a potential tool for cardiac risk stratification is currently being investigated.
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Affiliation(s)
- U Joseph Schoepf
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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27
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Abstract
Magnetic resonance imaging and/or contrast-enhanced multidetector computed tomography may be used separately or, often more effectively, in an integrated fashion, to address important issues in patients with coronary artery disease causing ischemic cardiac disease (ICD). These issues include complications of myocardial infarction, such as ventricular dysfunction, myocardial wall rupture, aneurysm formation, intracavitary thrombus, mitral insufficiency, and pericarditis, as well as aspects of planning and monitoring therapy for ICD, such as revascularization and ventricular aneurysm repair.
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Affiliation(s)
- Richard D White
- Center for Integrated Non-Invasive Cardiovascular Imaging, Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Mahnken AH, Klotz E, Hennemuth A, Jung B, Koos R, Wildberger JE, Günther RW. Measurement of cardiac output from a test-bolus injection in multislice computed tomography. Eur Radiol 2003; 13:2498-504. [PMID: 12904885 DOI: 10.1007/s00330-003-2054-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2003] [Revised: 07/07/2003] [Accepted: 07/14/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to assess the feasibility of non-invasive determination of cardiac function from test-bolus data in multislice spiral computed tomography (MSCT). In 25 patients enhancement data gathered from a standardized test-bolus injection were analyzed. The test-bolus examination was performed prior to a retrospectively ECG-gated MSCT of the heart. A time-attenuation curve was obtained in the ascending aorta at the level of the pulmonary arteries. A gamma variate fit was applied to the curve in order to exclude recirculation and get pure first-pass data. Using the known amount of iodine injected, cardiac output (CO), and stroke volume (SV) were determined from integration of the fitted contrast enhancement curve using a reformation of the Stewart-Hamilton equation. Results were compared with CO and SV calculated from the geometric analysis of the retrospectively gated MSCT data using the ARGUS Software (Siemens, Forchheim, Germany). The CO and SV determined from test-bolus analysis and from geometric analysis correlated well with Pearson's correlation coefficients of 0.87 and 0.88, respectively. The standard deviation of the difference between both methods was 0.51 l/min for CO (8.6%) and 11.0 ml for SV (12.3%). Non-invasive quantification of CO seems to be feasible from a standard test-bolus injection. It provides valuable information on cardiac function without additional radiation or application of contrast material.
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Affiliation(s)
- Andreas H Mahnken
- Department of Radiology, University Hospital, Aachen University of Technology, Pauwelsstrasse 52, 52074, Aachen, Germany.
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