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Nishihara T, Miyoshi T, Nakashima M, Akagi N, Morimitsu Y, Inoue T, Miki T, Yoshida M, Toda H, Nakamura K, Yuasa S. Diagnostic improvements of calcium-removal image reconstruction algorithm using photon-counting detector CT for calcified coronary lesions. Eur J Radiol 2024; 172:111354. [PMID: 38309215 DOI: 10.1016/j.ejrad.2024.111354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To investigate the diagnostic performance of a calcium-removal image reconstruction algorithm with photon-counting detector-computed tomography (PCD-CT), a technology that hides only the calcified plaque from the spectral data in coronary calcified lesions. METHODS This retrospective study included 17 patients who underwent PCD-coronary CT angiography (CCTA) with at least one significant coronary stenosis (≥50 %) with calcified plaque by CCTA and invasive coronary angiography (ICA) performed within 60 days of CCTA. A total of 162 segments with calcified plaque were evaluated for subjective image quality using a 4-point scale. Their calcium-removal images were reconstructed from conventional images, and both images were compared with ICA images as the reference standard. The contrast-to noise ratios for both images were calculated. RESULTS Conventional and calcium-removal images had a subjective image quality of 2.7 ± 0.5 and 3.2 ± 0.9, respectively (p < 0.001). The percentage of segments with a non-diagnostic image quality was 32.7 % for conventional images and 28.3 % for calcium-removal images (p < 0.001). The segment-based diagnostic accuracy revealed an area under the receiver operating characteristic curve of 0.87 for calcium-removal images and 0.79 for conventional images (p = 0.006). Regarding accuracy, the specificity and positive predictive value of calcium-removal images were significantly improved compared with those of conventional images (80.5 % vs. 69.5 %, p = 0.002 and 64.1 % vs. 52.0 %, p < 0.001, respectively). The objective image quality of the mean contrast-to-noise ratio did not differ between the images (13.9 ± 3.6 vs 13.3 ± 3.4, p = 0.356) CONCLUSIONS: Calcium-removal images with PCD-CT can potentially be used to evaluate diagnostic performance for calcified coronary artery lesions.
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Affiliation(s)
- Takahiro Nishihara
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Mitsutaka Nakashima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriaki Akagi
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Morimitsu
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Inoue
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoki Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Xiong QF, Fu XR, Ku LZ, Zhou D, Guo SP, Zhang WS. Diagnostic performance of coronary computed tomography angiography stenosis score for coronary stenosis. BMC Med Imaging 2024; 24:39. [PMID: 38336622 PMCID: PMC10854174 DOI: 10.1186/s12880-024-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Coronary computed tomography angiography stenosis score (CCTA-SS) is a proposed diagnosis score that considers the plaque characteristics, myocardial function, and the diameter reduction rate of the lesions. This study aimed to evaluate the diagnostic performance of the CCTA-SS in seeking coronary artery disease (CAD). METHODS The 228 patients with suspected CAD who underwent CCTA and invasive coronary angiography (ICA) procedures were under examination. The diagnostic performance was evaluated with the receiver operating curve (ROC) for CCTA-SS in detecting CAD (defined as a diameter reduction of ≥ 50%) and severe CAD (defined as a diameter reduction of ≥ 70%). RESULTS The area under ROC (AUC) of CCTA-SS was 0.909 (95% CI: 0.864-0.943), which was significantly higher than that of CCTA (AUC: 0.826; 95% CI: 0.771-0.873; P = 0.0352) in diagnosing of CAD with a threshold of 50%. The optimal cutoff point of CCTA-SS was 51% with a sensitivity of 90.66%, specificity of 95.65%, positive predictive value of 98.80%, negative predictive value of 72.13%, and accuracy of 91.67%, whereas the optimal cutoff point of CCTA was 55%, and the corresponding values were 87.36%, 93.48%, 98.15%, 65.15%, and 88.60%, respectively. With a threshold of 70%, the performance of CCTA-SS with an AUC of 0.927 (95% CI: 0.885-0.957) was significantly higher than that of CCTA with an AUC of 0.521 (95% CI: 0.454-0.587) (P < 0.0001). CONCLUSIONS CCTA-SS significantly improved the diagnostic accuracy of coronary stenosis, including CAD and severe CAD, compared with CCTA.
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Affiliation(s)
- Qing-Feng Xiong
- Hainan Enhance International Medical Center, Boao, China.
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China.
| | - Xiao-Rong Fu
- Wuchang Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Lei-Zhi Ku
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Di Zhou
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Sheng-Peng Guo
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
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Lee DY, Chang CC, Ko CF, Lee YH, Tsai YL, Chou RH, Chang TY, Guo SM, Huang PH. Artificial intelligence evaluation of coronary computed tomography angiography for coronary stenosis classification and diagnosis. Eur J Clin Invest 2024; 54:e14089. [PMID: 37668089 DOI: 10.1111/eci.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Ruling out obstructive coronary artery disease (CAD) using coronary computed tomography angiography (CCTA) is time-consuming and challenging. This study developed a deep learning (DL) model to assist in detecting obstructive CAD on CCTA to streamline workflows. METHODS In total, 2929 DICOM files and 7945 labels were extracted from curved planar reformatted CCTA images. A modified Inception V3 model was adopted. To validate the artificial intelligence (AI) model, two cardiologists labelled and adjudicated the classification of coronary stenosis on CCTA. The model was trained to differentiate the coronary artery into binary stenosis classifications <50% and ≥50% stenosis. Using the quantitative coronary angiography (QCA) consensus results as a reference standard, the performance of the AI model and CCTA radiology readers was compared by calculating Cohen's kappa coefficients at patient and vessel levels. The net reclassification index was used to evaluate the net benefit of the DL model. RESULTS The diagnostic accuracy of the AI model was 92.3% and 88.4% at the patient and vessel levels, respectively. Compared with CCTA radiology readers, the AI model had a better agreement for binary stenosis classification at both patient and vessel levels (Cohen kappa coefficient: .79 vs. .39 and .77 vs. .40, p < .0001). The AI model also exhibited significantly improved model discrimination and reclassification (Net reclassification index = .350; Z = 4.194; p < .001). CONCLUSIONS The developed AI model identified obstructive CAD, and the model results correlated well with QCA results. Incorporating the model into the reporting system of CCTA may improve workflows.
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Affiliation(s)
- Dan-Ying Lee
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chun-Chin Chang
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chieh-Fu Ko
- Institute of Medical Informatics, National Cheng Kung University, Tainan City, Taiwan
| | - Yin-Hao Lee
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Medicine, Division of Cardiology, Taipei City Hospital, Taipei City, Taiwan
| | - Yi-Lin Tsai
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ruey-Hsing Chou
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Ting-Yung Chang
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shu-Mei Guo
- Institute of Medical Informatics, National Cheng Kung University, Tainan City, Taiwan
| | - Po-Hsun Huang
- Department of Internal Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
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Antonopoulos AS, Simantiris S. Preventative Imaging with Coronary Computed Tomography Angiography. Curr Cardiol Rep 2023; 25:1623-1632. [PMID: 37897677 DOI: 10.1007/s11886-023-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE OF REVIEW Coronary computed tomography angiography (CCTA) is the diagnostic modality of choice for patients with stable chest pain. In this review, we scrutinize the evidence on the use of CCTA for the screening of asymptomatic patients. RECENT FINDINGS Clinical evidence suggests that CCTA imaging enhances cardiovascular risk stratification and prompts the timely initiation of preventive treatment leading to reduced risk of major adverse coronary events. Visualization of coronary plaques by CCTA also helps patients to comply with preventive medications. The presence of non-obstructive plaques and total plaque burden are prognostic for cardiovascular events. High-risk plaque features and pericoronary fat attenuation index, enrich the prognostic output of CCTA on top of anatomical information by capturing information on plaque vulnerability and coronary inflammatory burden. Timely detection of atherosclerotic disease or coronary inflammation by CCTA can assist in the deployment of targeted preventive strategies and novel therapeutics to prevent cardiovascular disease.
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Affiliation(s)
- Alexios S Antonopoulos
- Biomedical Research Foundation of the Academy of Athens (BRFAA), 4 Soranou Efesiou Street, Athens, Greece.
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Spyridon Simantiris
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Pugliese L, Ricci F, Sica G, Scaglione M, Masala S. Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2074. [PMID: 37370969 DOI: 10.3390/diagnostics13122074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
In recent decades, cardiac computed tomography (CT) has emerged as a powerful non-invasive tool for risk stratification, as well as the detection and characterization of coronary artery disease (CAD), which remains the main cause of morbidity and mortality in the world. Advances in technology have favored the increasing use of cardiac CT by allowing better performance with lower radiation doses. Coronary artery calcium, as assessed by non-contrast CT, is considered to be the best marker of subclinical atherosclerosis, and its use is recommended for the refinement of risk assessment in low-to-intermediate risk individuals. In addition, coronary CT angiography (CCTA) has become a gate-keeper to invasive coronary angiography (ICA) and revascularization in patients with acute chest pain by allowing the assessment not only of the extent of lumen stenosis, but also of its hemodynamic significance if combined with the measurement of fractional flow reserve or perfusion imaging. Moreover, CCTA provides a unique incremental value over functional testing and ICA by imaging the vessel wall, thus allowing the assessment of plaque burden, composition, and instability features, in addition to perivascular adipose tissue attenuation, which is a marker of vascular inflammation. There exists the potential to identify the non-obstructive lesions at high risk of progression to plaque rupture by combining all of these measures.
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Affiliation(s)
- Luca Pugliese
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Francesca Ricci
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, 80131 Napoli, Italy
| | - Mariano Scaglione
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Masala
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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Liu Z, Yang J, Chen Y. The Chinese Experience of Imaging in Cardiac Intervention: A Bird's Eye Review. J Thorac Imaging 2022; 37:374-384. [PMID: 36162061 DOI: 10.1097/rti.0000000000000680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.
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Affiliation(s)
- Zinuan Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, P.R. China
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
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Yi Y, Xu C, Guo N, Sun J, Lu X, Yu S, Wang Y, Vembar M, Jin Z, Wang Y. Performance of an Artificial Intelligence-based Application for the Detection of Plaque-based Stenosis on Monoenergetic Coronary CT Angiography: Validation by Invasive Coronary Angiography. Acad Radiol 2022; 29 Suppl 4:S49-S58. [PMID: 34895831 DOI: 10.1016/j.acra.2021.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES To explore the value of an artificial intelligence (AI)-based application for identifying plaque-specific stenosis and obstructive coronary artery disease from monoenergetic spectral reconstructions on coronary computed tomography angiography (CTA). MATERIALS AND METHODS This retrospective study enrolled 71 consecutive patients (52 men, 19 women; 63.3 ± 10.7 years) who underwent coronary CTA and invasive coronary angiography for diagnosing coronary artery disease. The conventional 120 kVp images and eight different virtual monoenergetic images (VMIs) (from 40 keV to 140 keV at increment of 10 keV) were reconstructed. An AI system automatically detected plaques from the conventional 120 kVp images and VMIs and calculated the degree of stenosis, which was further compared to invasive coronary angiography. The assessment was performed at a segment, vessel, and patient level. RESULTS Vessel and segment-based analyses showed comparable diagnostic performance between conventional CTA images and VMIs from 50 keV to 90 keV. For vessel-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of conventional CTA were 74.3% (95% CI: 64.9%-82.0%), 85.6% (95% CI: 77.0%-91.4%), 84.3% (95% CI: 75.2%-90.7%), 76.1% (95% CI: 67.1%-83.3%) and 79.8% (95% CI: 73.7%-84.9%), respectively; the average sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy values of the VMIs ranging from 50 keV to 90 keV were 71.6%, 90.7%, 87.5%, 64.1% and 81.6%, respectively. For plaque-based assessment, diagnostic performance of the average VMIs ranging from 50 keV to 100 keV showed no significant statistical difference in diagnostic accuracy compared to those of conventional CTA images in detecting calcified (91.4% vs. 93.8%, p > 0.05), noncalcified (92.6% vs. 85.2%, p > 0.05) or mixed (80.2% vs. 81.2%, p > 0.05) stenosis, although the specificity was slightly higher (53.4% vs. 40.0%, p > 0.05) in detecting stenosis caused by mixed plaques. For VMIs above 100 keV, the diagnostic accuracy dropped significantly. CONCLUSION Our study showed that the performance of an AI-based application employed to detect significant coronary stenosis in virtual monoenergetic reconstructions ranging from 50 keV to 90 keV was comparable to conventional 120 kVp reconstructions.
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Antonopoulos AS, Angelopoulos A, Tsioufis K, Antoniades C, Tousoulis D. Cardiovascular risk stratification by coronary computed tomography angiography imaging: current state-of-the-art. Eur J Prev Cardiol 2022; 29:608-624. [PMID: 33930129 DOI: 10.1093/eurjpc/zwab067] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022]
Abstract
Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. The current CT armamentum is also further enhanced by perivascular Fat Attenuation Index (FAI), a non-invasive metric of coronary inflammation, which allows for the first time the direct quantification of the residual vascular inflammatory burden. Machine learning and radiomic features' extraction and spectral CT for tissue characterization are also expected to maximize the diagnostic and prognostic yield of CCTA. The combination of anatomical, functional, and biological information on coronary circulation by CCTA offers a unique toolkit for the risk stratification of patients, and patient selection for targeted aggressive prevention strategies. We hereby provide a review of the current state-of-the art in the field and discuss how integrating the full capacities of CCTA into clinical care pathways opens new opportunities for the tailored management of coronary artery disease.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Andreas Angelopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Charalambos Antoniades
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
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Koons E, VanMeter P, Rajendran K, Yu L, McCollough C, Leng S. Improved quantification of coronary artery luminal stenosis in the presence of heavy calcifications using photon-counting detector CT. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12031. [PMID: 35677467 DOI: 10.1117/12.2613019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Coronary CT Angiography (cCTA) is commonly used to detect and quantify luminal stenoses in patients with coronary artery disease (CAD). However, its use is limited in patients with heavy coronary calcifications due to calcium blooming, which is caused by insufficient spatial resolution. This study evaluated the ability of a photon-counting-detector (PCD) CT in quantifying luminal stenosis in the presence of heavy calcifications relative to an energy-integrating-detector (EID) CT. Cylindrical rods of 4.5 mm diameter (with 3 mm lumen), which contained calcium hydroxyapatite (CaHA) to emulate calcifications of varying shapes and sizes and an iodine or blood analog to emulate the coronary lumen, were placed within an anthropomorphic thorax phantom and scanned at matched dose on an EID-CT and a PCD-CT scanner. Stenoses were qualitatively evaluated and quantified using commercial software. Measured percent area stenosis was compared to reference values. PCD-CT provided better visualization of calcium plaques and the patent lumen, and more accurate stenosis quantification for all plaques. In one rod (75% occlusion with ring-shaped plaque), only PCD-CT was able to determine that the vessel was not fully obstructed. The phantom results indicate luminal stenoses that were previously considered non-assessable due to the presence of heavily-calcified plaques can be assessed using PCD-CT. Clinical studies to support these conclusions are underway.
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Affiliation(s)
- Emily Koons
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Di Jiang M, Zhang XL, Liu H, Tang CX, Li JH, Wang YN, Xu PP, Zhou CS, Zhou F, Lu MJ, Zhang JY, Yu MM, Hou Y, Zheng MW, Zhang B, Zhang DM, Yi Y, Xu L, Hu XH, Yang J, Lu GM, Ni QQ, Zhang LJ. The effect of coronary calcification on diagnostic performance of machine learning-based CT-FFR: a Chinese multicenter study. Eur Radiol 2020; 31:1482-1493. [PMID: 32929641 DOI: 10.1007/s00330-020-07261-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the effect of coronary calcification morphology and severity on the diagnostic performance of machine learning (ML)-based coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) with FFR as a reference standard. METHODS A total of 442 patients (61.2 ± 9.1 years, 70% men) with 544 vessels who underwent CCTA, ML-based CT-FFR, and invasive FFR from China multicenter CT-FFR study were enrolled. The effect of calcification arc, calcification remodeling index (CRI), and Agatston score (AS) on the diagnostic performance of CT-FFR was investigated. CT-FFR ≤ 0.80 and lumen reduction ≥ 50% determined by CCTA were identified as vessel-specific ischemia with invasive FFR as a reference standard. RESULTS Compared with invasive FFR, ML-based CT-FFR yielded an overall sensitivity of 0.84, specificity of 0.94, and accuracy of 0.90 in a total of 344 calcification lesions. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of CT-FFR across different calcification arc, CRI, or AS levels. CT-FFR exhibited improved discrimination of ischemia compared with CCTA alone in lesions with mild-to-moderate calcification (AUC, 0.89 vs. 0.69, p < 0.001) and lesions with CRI ≥ 1 (AUC, 0.89 vs. 0.71, p < 0.001). The diagnostic accuracy and specificity of CT-FFR were higher than CCTA alone in patients and vessels with mid (100 to 299) or high (≥ 300) AS. CONCLUSION Coronary calcification morphology and severity did not influence diagnostic performance of CT-FFR in ischemia detection, and CT-FFR showed marked improved discrimination of ischemia compared with CCTA alone in the setting of calcification. KEY POINTS • CT-FFR provides superior diagnostic performance than CCTA alone regardless of coronary calcification. • No significant differences in the diagnostic performance of CT-FFR were observed in coronary arteries with different coronary calcification arcs and calcified remodeling indexes. • No significant differences in the diagnostic accuracy of CT-FFR were observed in coronary arteries with different coronary calcification score levels.
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Affiliation(s)
- Meng Di Jiang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiao Lei Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, 510080, China
| | - Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jian Hua Li
- Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Peng Peng Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Fan Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Meng Jie Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jia Yin Zhang
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Meng Meng Yu
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110001, China
| | - Min Wen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Bo Zhang
- Department of Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Dai Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Yan Yi
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 10029, China
| | - Xiu Hua Hu
- Department of Radiology, Shaoyifu Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, 310016, China
| | - Jian Yang
- Department of Radiology, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Qian Qian Ni
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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11
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Sun B, Chen Z, Duan Q, Xue Y, Chen L, Zhang Z, An J. A direct comparison of 3 T contrast-enhanced whole-heart coronary cardiovascular magnetic resonance angiography to dual-source computed tomography angiography for detection of coronary artery stenosis: a single-center experience. J Cardiovasc Magn Reson 2020; 22:40. [PMID: 32475355 PMCID: PMC7262765 DOI: 10.1186/s12968-020-00630-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In recent years, substantial advances have been made in noninvasive cardiac imaging, including cardiac computed tomography (CT) and cardiovascular magnetic resonance (CMR). The purpose of this study was to prospectively compare the diagnostic performance of contrast-enhanced whole heart coronary CMR angiography (CCMRA) to dual-source coronary CT angiography (CCTA) for the diagnosis of significant coronary stenoses (≥50%) in patients with known or suspected coronary artery disease (CAD) referred for conventional x-ray coronary angiography. METHODS Our objective was to directly compare the diagnostic accuracy of contrast-enhanced whole-heart CCMRA (CE-CCMRA) to dual-source CCTA (DS-CCTA) for the detection of CAD. We prospectively studied 57 symptomatic patients with suspected or known CAD who were scheduled for conventional x-ray coronary angiography. Significant CAD was defined as an x-ray defined diameter reduction of ≥50% in a coronary artery with a reference diameter of ≥1.5 mm. RESULTS CE-CCMRA and DS-CCTA were completed in 51 (89%) of 57 patients without complications. The acquisition times of CE-CCMRA and DS-CCTA, respectively, were 9.5 ± 3.1 min and 8.3 ± 1.4 s. On patient-based analysis, the sensitivity, specificity, positive and negative predictive value of CE-CCMRA and DS-CCTA were 93.5% versus 93.5%(P > 0.05), 85% versus 90%(P > 0.05), 90.6% versus 93.5%(P > 0.05), and 89.4% versus 90%(P > 0.05), respectively. The area under the curve (AUC) was 0.89 (95% CI: 0.79 to 0.99) for CE-CCMRA and 0.92 (95% CI: 0.83 to 1.00) for DS-CCTA. CONCLUSIONS DS-CCTA was found to be superior to CE-CCMRA in the diagnosis of significant coronary stenoses (≥50%) in patients with suspected or known CAD scheduled for conventional x-ray coronary angiography, owing to shorter scanning times and higher spatial resolution. However, CE-CCMRA and DS-CCTA have similar diagnostic accuracies.
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Affiliation(s)
- Bin Sun
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China
| | - Zhiyong Chen
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China.
| | - Qing Duan
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China
| | - Yunjing Xue
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China
| | - Lianglong Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China
| | | | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
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12
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Fei M, Xiang L, Chai X, Jin J, You T, Zhao Y, Ruan C, Hao Y, Zhu L. Plasma soluble C-type lectin-like receptor-2 is associated with the risk of coronary artery disease. Front Med 2019; 14:81-90. [PMID: 31280468 DOI: 10.1007/s11684-019-0692-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/03/2019] [Indexed: 01/10/2023]
Abstract
Accumulating evidence suggests that C-type lectin-like receptor-2 (CLEC-2) plays an important role in atherothrombosis. In this case-control study, we investigated the association between CLEC-2 and incidence of coronary artery disease (CAD). A total of 216 patients, including 14 cases of stable angina pectoris (SAP, non-ACS) and 202 cases of acute coronary syndrome (ACS), and 89 non-CAD control subjects were enrolled. Plasma levels of soluble CLEC-2 (sCLEC-2) were measured using the enzyme-linked immunosorbent assay (ELISA). Compared with the control group (65.69 (55.36-143.22) pg/mL), the plasma levels of sCLEC-2 were significantly increased in patients with CAD (133.67 (88.76-220.09) pg/mL) and ACS (134.16 (88.88-225.81) pg/mL). The multivariate adjusted odds ratios (95% confidence interval) of CAD reached 2.01 (1.52-2.66) (Ptrend < 0.001) for each 1-quartile increase in sCLEC-2. Restricted cubic splines showed a positive dose-response association between sCLEC2 and CAD incidence (Plinearity < 0.001). The addition of sCLEC-2 to conventional risk factors improved the C statistic (0.821 vs. 0.761, P = 0.004) and reclassification ability (net reclassification improvement: 57.45%, P < 0.001; integrated discrimination improvement: 8.27%, P < 0.001) for CAD. In conclusion, high plasma sCLEC-2 is independently associated with CAD risk, and the prognostic value of sCLEC-2 may be evaluated in future prospective studies.
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Affiliation(s)
- Min Fei
- Cyrus Tang Medical Institute, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, 215123, China.,Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, 215006, China
| | - Li Xiang
- Department of Cardiology, The Second Affiliated Hospital, Soochow University, Suzhou, 215004, China
| | - Xichen Chai
- Department of Cardiology, The First Affiliated Hospital, Soochow University, Suzhou, 215006, China
| | - Jingchun Jin
- Department of Blood Transfusion, The First Affiliated Hospital, China Medical University, Shenyang, 110001, China
| | - Tao You
- Cyrus Tang Medical Institute, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, 215123, China.,Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, 215006, China
| | - Yiming Zhao
- Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, 215006, China
| | - Changgeng Ruan
- Cyrus Tang Medical Institute, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, 215123, China.,Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, 215006, China
| | - Yiwen Hao
- Department of Blood Transfusion, The First Affiliated Hospital, China Medical University, Shenyang, 110001, China.
| | - Li Zhu
- Cyrus Tang Medical Institute, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, 215123, China. .,Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, 215006, China.
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13
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Ntsinjana HN, Tann O, Hughes M, Derrick G, Secinaro A, Schievano S, Muthurangu V, Taylor AM. Utility of adenosine stress perfusion CMR to assess paediatric coronary artery disease. Eur Heart J Cardiovasc Imaging 2018; 18:898-905. [PMID: 27461210 DOI: 10.1093/ehjci/jew151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/28/2016] [Indexed: 12/30/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR), using adenosine stress perfusion and late-gadolinium enhancement (LGE), is becoming the 'gold standard' non-invasive imaging modality in the assessment of adults with coronary artery disease (CAD). However, despite its proved feasibility in paediatric patients, clinical utility has not been demonstrated. Therefore, this study aims to establish the role of adenosine stress perfusion CMR as a screening test in paediatric patients with acquired or congenital CAD. Methods and results A total of 58 paediatric patients underwent 61 consecutive clinically indicated coronary artery assessments for diagnostic and clinical decision-making purposes. The diagnosis was based on X-ray or computed tomography coronary angiography for anatomy, adenosine stress CMR imaging for myocardial perfusion and LGE for tissue characterization. Two studies were aborted because of unwanted side effects of adenosine stress, thus 59 studies were completed in 56 patients [median age 14.1 years (interquartile range 10.9-16.2)]. When compared with coronary anatomical imaging, adenosine stress perfusion CMR performed as follows: sensitivity 100% (95% confidence interval, CI: 71.6-100%), specificity 98% (95% CI: 86.7-99.9%), positive predictive value (PPV) 92.9% (95% CI: 64.2-99.6%), and negative predictive value 100% (95% CI: 89.9-100%). Conclusion In paediatric CAD, adenosine stress perfusion CMR imaging is adequate as an initial, non-invasive screening test for the identification of significant coronary artery lesions, with anatomical imaging used to confirm the extent of the culprit lesion.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK.,Deparetment of Paediatrics, Paediatric Cardiology Division, CH Baragwanath Academic Hospital and University of the Wiwatersrand, Johannesburg, South Africa
| | - Oliver Tann
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Marina Hughes
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Graham Derrick
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
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Liew G, Chow C, van Pelt N, Younger J, Jelinek M, Chan J, Hamilton-Craig C. Cardiac Society of Australia and New Zealand Position Statement: Coronary Artery Calcium Scoring. Heart Lung Circ 2017; 26:1239-1251. [DOI: 10.1016/j.hlc.2017.05.130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/06/2017] [Indexed: 01/07/2023]
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15
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Ippolito D, Fior D, Franzesi CT, Riva L, Casiraghi A, Sironi S. Diagnostic accuracy of 256-row multidetector CT coronary angiography with prospective ECG-gating combined with fourth-generation iterative reconstruction algorithm in the assessment of coronary artery bypass: evaluation of dose reduction and image quality. LA RADIOLOGIA MEDICA 2017; 122:893-901. [PMID: 28849537 DOI: 10.1007/s11547-017-0800-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/10/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Effective radiation dose in coronary CT angiography (CTCA) for coronary artery bypass graft (CABG) evaluation is remarkably high because of long scan lengths. Prospective electrocardiographic gating with iterative reconstruction can reduce effective radiation dose. OBJECTIVES To evaluate the diagnostic performance of low-kV CT angiography protocol with prospective ecg-gating technique and iterative reconstruction (IR) algorithm in follow-up of CABG patients compared with standard retrospective protocol. METHODS Seventy-four non-obese patients with known coronary disease treated with artery bypass grafting were prospectively enrolled. All the patients underwent 256 MDCT (Brilliance iCT, Philips) CTCA using low-dose protocol (100 kV; 800 mAs; rotation time: 0.275 s) combined with prospective ECG-triggering acquisition and fourth-generation IR technique (iDose4; Philips); all the lengths of the bypass graft were included in the evaluation. A control group of 42 similar patients was evaluated with a standard retrospective ECG-gated CTCA (100 kV; 800 mAs).On both CT examinations, ROIs were placed to calculate standard deviation of pixel values and intra-vessel density. Diagnostic quality was also evaluated using a 4-point quality scale. RESULTS Despite the statistically significant reduction of radiation dose evaluated with DLP (study group mean DLP: 274 mGy cm; control group mean DLP: 1224 mGy cm; P value < 0.001). No statistical differences were found between PGA group and RGH group regarding intra-vessel density absolute values and SNR. Qualitative analysis, evaluated by two radiologists in "double blind", did not reveal any significant difference in diagnostic quality of the two groups. CONCLUSIONS The development of high-speed MDCT scans combined with modern IR allows an accurate evaluation of CABG with prospective ECG-gating protocols in a single breath hold, obtaining a significant reduction in radiation dose.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
| | - Davide Fior
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Luca Riva
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Alessandra Casiraghi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
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16
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Kim J, Kwag HJ, Yoo SM, Yoo JY, Chae IH, Choi DJ, Park MJ, Vembar M, Chun EJ. Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events. Eur Radiol 2017; 28:1356-1364. [DOI: 10.1007/s00330-017-5095-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 09/06/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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17
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He Y, Pang J, Dai Q, Fan Z, An J, Li D. Diagnostic Performance of Self-navigated Whole-Heart Contrast-enhanced Coronary 3-T MR Angiography. Radiology 2016; 281:401-408. [PMID: 27192461 DOI: 10.1148/radiol.2016152514] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the diagnostic performance of self-navigated whole-heart coronary 3-T magnetic resonance (MR) angiography by using conventional invasive coronary angiography (ICA) as the reference gold standard. Materials and Methods This study was approved by the local ethics committee. Written informed consent was obtained from each patient before the study. Thirty-nine consecutive patients underwent coronary MR angiography and later underwent ICA. Coronary MR angiography was performed with a 3-T imager with contrast agent enhancement during free breathing with self-navigated affine motion correction reconstruction. Coronary segments with reference diameters larger than 1.5 mm were included in the comparison between coronary MR angiography and ICA. The coronary MR angiography images were evaluated by two experienced readers blinded to the ICA results to identify significant luminal narrowing (>50% diameter reduction in reference ICA). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were performed to detect significant coronary artery stenosis. Results Coronary MR angiography examinations were successfully performed in all 39 patients. A total of 327 coronary segments had reference luminal diameter larger than 1.5 mm. Of these 327 coronary segments, 303 (92.7%) segments had a quality score greater than 1 at coronary MR angiography and were included in the analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.2%, 75.0%, 81.8%, 70.6%, and 76.9%, respectively, on a per-patient basis. Conclusion Contrast-enhanced self-navigated coronary 3-T MR angiography is a promising technique for the noninvasive detection of clinically significant coronary stenosis. © RSNA, 2016.
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Affiliation(s)
- Yi He
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Jianing Pang
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Qinyi Dai
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Zhanming Fan
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Jing An
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Debiao Li
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
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18
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Individualized reduction of radiation dose with a chest circumference-adapted technique and iterative reconstructions in 256-slice retrospective and prospective ECG-triggered computed tomography coronary angiography. Coron Artery Dis 2016; 26:308-16. [PMID: 25714067 DOI: 10.1097/mca.0000000000000232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the impact of chest circumference (CC)-adjusted tube current and iterative reconstructions (iDose) on individualized radiation dose reduction and image quality (IQ) in ECG-triggered computed tomography coronary angiography (CTCA). MATERIALS AND METHODS A total of 102 patients underwent retrospectively ECG-triggered CTCA utilizing CC-adapted tube current [mAs=1000×(0.051×CC-23.765)/900] and filtered back projection (FBP) reconstruction (group A). On the basis of the CC-adjusted tube current technique, 54 patients (group B) underwent retrospective ECG-triggered CTCA with a 20% mAs reduction compared with group A and 90 patients (group C) underwent prospective ECG-triggered CTCA with an 80% mAs reduction compared with group A; both groups B and C were reconstructed with FBP and iDose. Subjective IQ was assessed, and image noise, signal-to-noise, and contrast-to-noise ratios (SNR and CNR) were quantified. RESULTS Patients in group A had the highest radiation dose, followed by group B and group C. iDose provided decreased image noise and increased SNR and CNR, as did subjective IQ. The image noise was higher and SNR and CNR in group B were obviously lower than those in group A with FBP, but in group B, iDose4 increased the mean objective IQ. There was no difference between group B with iDose and group A with FBP, as was the case with subjective IQ. CONCLUSION The combination of a CC-adapted technique, prospective triggering, and partial iterative reconstruction techniques reduces the radiation dose significantly, without significant degradation of IQ.
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Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain. Am J Cardiol 2015; 116:1017-21. [PMID: 26251004 DOI: 10.1016/j.amjcard.2015.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting.
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Xie D, Na J, Zhang M, Dong S, Xiao X. CT angiography of the lower extremity and coronary arteries using 256-section CT: a preliminary study. Clin Radiol 2015; 70:1281-8. [PMID: 26275584 DOI: 10.1016/j.crad.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/18/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
AIM To investigate the possible use of a 256-section computed tomography (CT) prospective electrocardiography (ECG)-gated wide volume scanning protocol for combined angiography of the lower extremity and coronary arteries, after a single injection of contrast medium, in patients with lower extremity peripheral arterial disease (PAD). MATERIALS AND METHODS Thirty-four patients with suspected PAD underwent CT angiography (CTA) with a prospective ECG-gated protocol that covered the level of the tracheal bifurcation to the foot sole. Digital subtraction angiography (DSA) of the lower extremity arteries was performed on patients requiring therapeutic intervention. Image quality and stenosis of the coronary and lower extremity arteries were assessed. RESULTS A total of 93.1% of the coronary segments were adequate for diagnosis. 17 (50%) patients showed coronary artery stenosis ≥50%. A total of 95.8% of the lower extremity arterial segments were adequate for diagnosis. Twenty-eight patients with severe lower extremity arterial stenosis or occlusion underwent DSA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTA for the detection of significant lower arterial stenosis (≥50%) was 94.8%, 97.2%, 95.3%, 96.9%, and 96.3%, respectively. CONCLUSION Using the prospective ECG-gated wide volume CTA protocol, images of the coronary and lower extremity arteries suitable for diagnosis can be acquired simultaneously after a single injection of contrast agent. In addition to accurately diagnosing PAD, combined angiography may be used to screen for coronary heart disease in patients with PAD.
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Affiliation(s)
- D Xie
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - J Na
- Department of MRI, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - M Zhang
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - S Dong
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - X Xiao
- Department of Computer Tomography, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
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Abstract
Cardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion, and patient outcomes. The presence of positive vessel remodeling, low-attenuation plaques, napkin-ring sign, or spotty calcification on CCTA could be useful information on high-risk vulnerable plaques. The napkin-ring sign, especially, showed higher accuracy for the detection of thin-cap fibroatheroma. Recently, it was reported that cardiac 3D single-photon emission tomography/CT fusion imaging, noninvasive fractional flow reserve computed from CT, and integrated CCTA and CT myocardial perfusion were associated with improved diagnostic accuracy for the detection of hemodynamically significant CAD. Furthermore, several randomized, large clinical trials have evaluated the clinical value of CCTA for chest pain triage in the emergency department or long-term reduction in death, myocardial infarction, or hospitalization for unstable angina. In this review we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion.
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Affiliation(s)
- Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Allajbeu I, Hajro E, Temali I, Cekrezi B, Preza K. The Role of CT Angiography of Coronaries in Early Diagnosis of Coronary Artery Plaques in Albanian People with No History of Cardiovascular Disease in Correlation with Traditional Risk Factors. Mater Sociomed 2014; 26:163-7. [PMID: 25126008 PMCID: PMC4130675 DOI: 10.5455/msm.2014.26.163-167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022] Open
Abstract
Objective: To evaluate the role of CT angiography of coronaries (CTAC) in the diagnosis of subclinical atherosclerosis by detection of coronary artery plaques (CAP) in a group of consecutive albanian individuals with no history of coronary artery disease (CAD) or acute coronary syndrome and to investigate the relation between the prevalence of CAP, traditional risk factors and the expected 10-year risk of fatal cardiovascular event (CVE) based on our own experience. Method and Technique: This is a prospective study including 456 patients with no history of CAD who underwent CTAC in our hospital from September 2009 to March 2013. Risk estimation of fatal CVE was assessed using Systematic Coronary Risk Evaluation (SCORE) and then CT scan was performed with a 64 detector CT, including Ca Score and angiography of coronaries with iv contrast. Results: From 456 patients 61.4% were low risk and 32.9% were at intermediate risk according to SCORE. The prevalence of CAP diagnosed by CTAC was calculated as 55.7 % overall. Though the presence and severity of CAP increased significantly with the increase of SCORE, it was found to be 44.1% in the low risk patients and 80% in the intermediate risk group, with a presence of 17% and 25% of stenotic plaques (>50%) respectively. Significant correlation was found between all traditional risk factors and CAP. Conclusion: Although a direct relation between the prevalence of CAP, risk factors and the related 10-year risk of fatal CVE was found, there was a significant prevalence of CAP in low –intermediate risk group with a considerable presence of stenotic lesions. Also 8.3% of patients with no risk factors and 18% of the patients with Ca score 0 had CAP in CT angiography, one resulting with severe stenosis. Our results suggest once more that CT angiography is a reliable, very accurate noninvasive technique for the diagnosis of early CAD, especially in the low-intermediate risk patients compared to the traditional evaluation schemes and Ca score, thus should be considered in this group as a diagnostic guide for optimal therapy planning.
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Affiliation(s)
- Iris Allajbeu
- Division of Radiology, American Hospital of Tirana, Albania
| | - Edjon Hajro
- Division of Radiology, American Hospital of Tirana, Albania
| | - Indrit Temali
- Division of Radiology, American Hospital of Tirana, Albania
| | - Bledi Cekrezi
- Division of Radiology, American Hospital of Tirana, Albania
| | - Krenar Preza
- Division of Radiology, Mother Tereza University Hospital of Tirana, Albania
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Korosoglou G, Giusca S, Gitsioudis G, Erbel C, Katus HA. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification. Front Physiol 2014; 5:291. [PMID: 25147526 PMCID: PMC4123729 DOI: 10.3389/fphys.2014.00291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/18/2014] [Indexed: 12/18/2022] Open
Abstract
Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.
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Alani A, Nakanishi R, Budoff MJ. Recent improvement in coronary computed tomography angiography diagnostic accuracy. Clin Cardiol 2014; 37:428-33. [PMID: 24756932 DOI: 10.1002/clc.22286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/13/2014] [Indexed: 01/07/2023] Open
Abstract
Although invasive coronary angiography has been the gold standard for evaluating coronary artery disease (CAD), it should not be routinely performed as an initial test to assess CAD in subjects with suspected CAD by the recent guidelines, due to cost, invasiveness, and measurable risk. Coronary computed tomography angiography (CCTA) is a rapidly growing, noninvasive imaging modality that developed quickly over the last decade, and its role for evaluation of CAD becomes of great promise with high diagnostic accuracy. Although artifact issues have created some challenges for CCTA, recent advances-including the introduction of more detectors, leading to broader coverage, and faster and higher-definition scanners-allow improved precision and fewer uninterpretable studies. This review article summarizes the current key literature regarding the diagnostic accuracy of CCTA in native coronary arteries, stents, coronary artery bypass grafts, lesions with high calcification, and the functional assessment of CAD.
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Affiliation(s)
- Anas Alani
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, California
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25
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Gitsioudis G, Hosch W, Iwan J, Voss A, Atsiatorme E, Hofmann NP, Buss SJ, Siebert S, Kauczor HU, Giannitsis E, Katus HA, Korosoglou G. When do we really need coronary calcium scoring prior to contrast-enhanced coronary computed tomography angiography? Analysis by age, gender and coronary risk factors. PLoS One 2014; 9:e92396. [PMID: 24714677 PMCID: PMC3979653 DOI: 10.1371/journal.pone.0092396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 02/21/2014] [Indexed: 12/17/2022] Open
Abstract
Aims To investigate the value of coronary calcium scoring (CCS) as a filter scan prior to coronary computed tomography angiography (CCTA). Methods and Results Between February 2008 and April 2011, 732 consecutive patients underwent clinically indicated CCTA. During this ‘control phase’, CCS was performed in all patients. In patients with CCS≥800, CCTA was not performed. During a subsequent ‘CCTA phase’ (May 2011–May 2012) another 200 consecutive patients underwent CCTA, and CCS was performed only in patients with increased probability for severe calcification according to age, gender and atherogenic risk factors. In patients where CCS was not performed, calcium scoring was performed in contrast-enhanced CCTA images. Significant associations were noted between CCS and age (r = 0.30, p<0.001) and coronary risk factors (χ2 = 37.9; HR = 2.2; 95%CI = 1.7–2.9, p<0.001). Based on these associations, a ≤3% pre-test probability for CCS≥800 was observed for males <61 yrs. and females <79 yrs. According to these criteria, CCS was not performed in 106 of 200 (53%) patients during the ‘CCTA phase’, including 47 (42%) males and 59 (67%) females. This resulted in absolute radiation saving of ∼1 mSv in 75% of patients younger than 60 yrs. Of 106 patients where CCS was not performed, estimated calcium scoring was indeed <800 in 101 (95%) cases. Non-diagnostic image quality due to calcification was similar between the ‘control phase’ and the ‘CCTA’ group (0.25% versus 0.40%, p = NS). Conclusion The value of CCS as a filter for identification of a high calcium score is limited in younger patients with intermediate risk profile. Omitting CCS in such patients can contribute to further dose reduction with cardiac CT studies.
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Affiliation(s)
- Gitsios Gitsioudis
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
- * E-mail:
| | - Waldemar Hosch
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Johannes Iwan
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - Andreas Voss
- University of Heidelberg, Institute of Psychology, Heidelberg, Germany
| | - Edem Atsiatorme
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - Nina P. Hofmann
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - Sebastian J. Buss
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - Stefan Siebert
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | | | - Hugo A. Katus
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
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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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Keenan NG, Pugliese F, Davies LC. The role of computed tomography in cardiovascular imaging: from X-ray department to emergency room. Expert Rev Cardiovasc Ther 2014; 12:57-69. [DOI: 10.1586/14779072.2014.870034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Muenzel D, Kabus S, Gramer B, Leber V, Vembar M, Schmitt H, Wildgruber M, Fingerle AA, Rummeny EJ, Huber A, Noël PB. Dynamic CT perfusion imaging of the myocardium: a technical note on improvement of image quality. PLoS One 2013; 8:e75263. [PMID: 24130697 PMCID: PMC3793993 DOI: 10.1371/journal.pone.0075263] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/13/2013] [Indexed: 11/28/2022] Open
Abstract
Objective To improve image and diagnostic quality in dynamic CT myocardial perfusion imaging (MPI) by using motion compensation and a spatio-temporal filter. Methods Dynamic CT MPI was performed using a 256-slice multidetector computed tomography scanner (MDCT). Data from two different patients–with and without myocardial perfusion defects–were evaluated to illustrate potential improvements for MPI (institutional review board approved). Three datasets for each patient were generated: (i) original data (ii) motion compensated data and (iii) motion compensated data with spatio-temporal filtering performed. In addition to the visual assessment of the tomographic slices, noise and contrast-to-noise-ratio (CNR) were measured for all data. Perfusion analysis was performed using time-density curves with regions-of-interest (ROI) placed in normal and hypoperfused myocardium. Precision in definition of normal and hypoperfused areas was determined in corresponding coloured perfusion maps. Results The use of motion compensation followed by spatio-temporal filtering resulted in better alignment of the cardiac volumes over time leading to a more consistent perfusion quantification and improved detection of the extend of perfusion defects. Additionally image noise was reduced by 78.5%, with CNR improvements by a factor of 4.7. The average effective radiation dose estimate was 7.1±1.1 mSv. Conclusion The use of motion compensation and spatio-temporal smoothing will result in improved quantification of dynamic CT MPI using a latest generation CT scanner.
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Affiliation(s)
- Daniela Muenzel
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
- * E-mail:
| | - Sven Kabus
- Philips Research Laboratories, Digital Imaging Department, Hamburg, Germany
| | - Bettina Gramer
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Vivian Leber
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Mani Vembar
- Philips Healthcare, CT Clinical Science, Cleveland, Ohio, United States of America
| | - Holger Schmitt
- Philips Research Laboratories, Digital Imaging Department, Hamburg, Germany
| | - Moritz Wildgruber
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Alexander A. Fingerle
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Ernst J. Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Armin Huber
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Peter B. Noël
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Gharib AM, Zahiri H, Matta J, Pettigrew RI, Abd-Elmoniem KZ. Feasibility of coronary artery wall thickening assessment in asymptomatic coronary artery disease using phase-sensitive dual-inversion recovery MRI at 3T. Magn Reson Imaging 2013; 31:1051-8. [PMID: 23642801 PMCID: PMC3729736 DOI: 10.1016/j.mri.2013.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/26/2013] [Accepted: 03/09/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of this study was to (a) investigate the image quality of phase-sensitive dual-inversion recovery (PS-DIR) coronary wall imaging in healthy subjects and in subjects with known coronary artery disease (CAD) and to (b) investigate the utilization of PS-DIR at 3T in the assessment of coronary artery thickening in subjects with asymptomatic but variable degrees of CAD. MATERIALS AND METHODS A total of 37 subjects participated in this institutional review board-approved and HIPAA-compliant study. These included 21 subjects with known CAD as identified on multidetector computed tomography angiography (MDCT). Sixteen healthy subjects without known history of CAD were included. All subjects were scanned using free-breathing PS-DIR magnetic resonance imaging (MRI) for the assessment of coronary wall thickness at 3T. Lumen-tissue contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and quantitative vessel parameters including lumen area and wall thickness were measured. Statistical analyses were performed. RESULTS PS-DIR was successfully completed in 76% of patients and in 88% of the healthy subjects. Phase-sensitive signed-magnitude reconstruction, compared to modulus-magnitude images, significantly improved lumen-tissue CNR in healthy subjects (26.73±11.95 vs. 14.65±9.57, P<.001) and in patients (21.45±7.61 vs. 16.65±5.85, P<.001). There was no difference in image CNR and SNR between groups. In arterial segments free of plaques, coronary wall was thicker in patients in comparison to healthy subjects (1.74±0.27 mm vs. 1.17±0.14 mm, P<.001), without a change in lumen area (4.51±2.42 mm2 vs. 5.71±3.11mm2, P=.25). CONCLUSIONS This is the first study to demonstrate the feasibility of successfully obtaining vessel wall images at 3T using PS-DIR in asymptomatic patients with known variable degrees of CAD as detected by MDCT. This was achieved with a fixed subject-invariant planning of blood signal nulling. With that limitation alleviated, PS-DIR coronary wall MRI is capable of detecting arterial thickening and positive arterial remodeling at 3T in asymptomatic CAD.
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Affiliation(s)
- Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch, The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
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Petcherski O, Gaspar T, Halon DA, Peled N, Jaffe R, Molnar R, Lewis BS, Rubinshtein R. Diagnostic accuracy of 256-row computed tomographic angiography for detection of obstructive coronary artery disease using invasive quantitative coronary angiography as reference standard. Am J Cardiol 2013. [PMID: 23206926 DOI: 10.1016/j.amjcard.2012.10.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We assessed the performance of a new-generation, 256-row computed tomography (CT) scanner for detection of obstructive coronary artery disease (CAD) compared to invasive quantitative coronary angiography. A total 121 consecutive symptomatic patients without known CAD referred for invasive coronary angiography (age 59 ± 12 years, 37% women) underwent clinically driven 256-row coronary computed tomographic angiography (CCTA) before the invasive procedure. Obstructive CAD (>50% diameter stenosis) was assessed visually on CCTA by 2 independent observers using the 18-segment society of cardiovascular CT model and on invasive angiograms using quantitative coronary angiography (the reference standard). Observers were unaware of the findings from the alternate modality. Nonassessable coronary computed tomographic angiographic segments were considered obstructive for the purpose of analysis. Quantitative coronary angiography demonstrated obstructive CAD in 145 segments in 82 of 121 patients (68%). Overall, 1,677 coronary segments were available for comparative analysis, of which 39 (2.3%) were nonassessable by CCTA, mostly because of heavy calcification. Patient-based and segment-based analysis showed a sensitivity of 100% and 97% (95% confidence interval 95% to 100%) and specificity of 69% (95% confidence interval 55% to 84%) and 97% (confidence interval 96% to 98%), respectively. Four segments with obstructive CAD in 4 patients were not detected by CCTA. All 4 patients had additional coronary obstructions identified by CCTA. The predictive accuracy was 90% (range 85% to 95%) for patient based and 97% (96% to 98%) for segment based analysis. In conclusion, 256-row CCTA showed high sensitivity and high predictive accuracy for detection of obstructive CAD in patients without previously known disease. Although coronary calcification might still interfere with analysis, the rate of nonassessable segments was low.
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Sun Z, Almoudi M. Coronary computed tomography angiography: an overview of clinical applications. Interv Cardiol 2013. [DOI: 10.2217/ica.12.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hosch W, Hofmann NP, Mueller D, Iwan J, Gitsioudis G, Siebert S, Giannitsis E, Kauczor HU, Katus HA, Korosoglou G. Body mass index-adapted prospective coronary computed tomography angiography. Determining the lowest limit for diagnostic purposes. Eur J Radiol 2013; 82:e232-9. [PMID: 23332891 DOI: 10.1016/j.ejrad.2012.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/17/2012] [Accepted: 12/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the value of 4 different protocols for prospectively triggered 256-slice coronary computed tomography angiography (coronary CTA). METHODS Two hundred and ten patients underwent prospectively triggered coronary CTA for suspected or known coronary artery disease (CAD). Patients with heart rate >75 bps before the scan despite ß-blocker administration and with arrhythmia were excluded. From January to September 2010, 60 patients underwent coronary CTA using a non-tailored protocol (120 kV; 200 mAs) and served as our 'control' group. From September 2010 to April 2012, based on the body mass index (BMI) of the examined patients (BMI subgroups of <25; 25-28; 28-30, and ≥ 30 kg/m(2)) current tube voltage and tube current were: (1) slightly, (2) moderately or (3) strongly reduced, resulting into the 3 following BMI-adapted acquisition groups: (1) a 'standard' (100/120 kV; 100-200 mAs; n=50), 2) a 'low dose' (100/120 kV; 75-150 mAs; n=50), and 3) an 'ultra-low dose' (100/120 kV; 50-100 mAs; n=50) protocol. RESULTS Patients examined using the non-tailored protocol exhibited the highest radiation exposure (3.2 ± 0.4 mSv), followed by the standard (1.6 ± 0.7 mSv), low-dose (1.2 ± 0.6 mSv) and ultra-low dose protocol (0.7 ± 0.3 mSv) (radiation savings of 50%, 63% and 78% respectively). Overall image quality was similar with standard dose (1.9 ± 0.6) and low-dose (2.0 ± 0.5) compared to the non-tailored group (1.9 ± 0.5) (p=NS for all). In the ultra-low dose group however, image quality was significant reduced (2.7 ± 0.6), p<0.05 versus all other groups). CONCLUSION Using BMI-adapted low dose acquisitions image quality can be maintained with simultaneous radiation savings of ∼65% (dose of ∼1 mSv). This appears to be the lower limit for diagnostic coronary CTA, whereas ultra-low dose acquisitions result in significant image degradation.
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Affiliation(s)
- Waldemar Hosch
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany.
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Sun Z. Cardiac CT imaging in coronary artery disease: Current status and future directions. Quant Imaging Med Surg 2012; 2:98-105. [PMID: 23256066 DOI: 10.3978/j.issn.2223-4292.2012.05.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 05/14/2012] [Indexed: 12/12/2022]
Abstract
Computed tomography has undergone rapid developments over the last decades, in particular, the emergence and technological improvements of multislice CT scanners enable satisfactory performance of cardiac CT imaging. Cardiac CT has been widely used in the diagnosis of coronary artery disease, which is the leading cause of death in industrialized countries. Cardiac CT also provides valuable information to predict the extent and prognosis of coronary artery disease. The main disadvantage of cardiac CT imaging is radiation dose, which raises concern in recent years, as there is potential risk of radiation-induced malignancy. This article will provide an overview of the current research status of cardiac CT imaging in the diagnosis of coronary artery disease, highlight the key applications of cardiac CT imaging and briefly discuss future directions of this fast advancing technique.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, GPO Box U 1987 Perth, Western Australia 6845, Australia
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Evaluation of chronic ischemic heart disease with myocardial perfusion and regional contraction analysis by contrast-enhanced 256-MSCT. Jpn J Radiol 2012. [DOI: 10.1007/s11604-012-0159-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Hosch W, Stiller W, Mueller D, Gitsioudis G, Welzel J, Dadrich M, Buss SJ, Giannitsis E, Kauczor HU, Katus HA, Korosoglou G. Reduction of radiation exposure and improvement of image quality with BMI-adapted prospective cardiac computed tomography and iterative reconstruction. Eur J Radiol 2012; 81:3568-76. [DOI: 10.1016/j.ejrad.2011.06.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 06/25/2011] [Accepted: 06/29/2011] [Indexed: 02/08/2023]
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Li JL, Huang MP, Liang CH, Zhao ZJ, Liu H, Cui YH, Liu QS, Zhang JE, Yang L, Ivanc TB, Yanof JH. Individualized radiation dose control in 256-slice CT coronary angiography (CTCA) in retrospective ECG-triggered helical scans: Using a measure of body size to adjust tube current selection. Eur J Radiol 2012; 81:3146-53. [DOI: 10.1016/j.ejrad.2012.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 04/20/2012] [Accepted: 04/21/2012] [Indexed: 12/01/2022]
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Multislice computed tomography angiography in the diagnosis of coronary artery disease. J Geriatr Cardiol 2012; 8:104-13. [PMID: 22783294 PMCID: PMC3390077 DOI: 10.3724/sp.j.1263.2011.00104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 12/20/2022] Open
Abstract
Multislice CT angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease. High diagnostic value has been achieved with multislice CT angiography with use of 64- and more slice CT scanners. In addition, multislice CT angiography shows accurate detection and analysis of coronary calcium, characterization of coronary plaques, as well as prediction of the disease progression and major cardiac events. Thus, patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures. The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease; prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques. Limitations of multislice CT angiography in coronary artery disease are also briefly discussed, and future directions are highlighted.
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Sabarudin A, Sun Z, Ng KH. A systematic review of radiation dose associated with different generations of multidetector CT coronary angiography. J Med Imaging Radiat Oncol 2012; 56:5-17. [PMID: 22339741 DOI: 10.1111/j.1754-9485.2011.02335.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The purpose of this paper is to perform a systematic review on radiation dose reduction in coronary computed tomography (CT) angiography that is done using different generations of multidetector CT (MDCT) scanners ranging from four-slice to 320-slice CTs, and have different dose-saving techniques. The method followed was to search for references on coronary CT angiography (CTA) that had been published in English between 1998 and February 2011. The effective radiation dose reported in each study based on different generations of MDCT scanners was analysed and compared between the types of scanners, gender, exposure factors and scanning protocols. Sixty-six studies were eligible for inclusion in this analysis. The mean effective dose (ED) for MDCT angiography with retrospective electrocardiogram (ECG) gating without use of any dose-saving protocol was 6.0 ± 2.8, 10.4 ± 4.90 and 11.8 ± 5.9 mSv for four-slice, 16-slice and 64-slice CTs, respectively. More dose-saving strategies were applied in recent CT generations including prospective ECG-gating protocols, application of lower tube voltage and tube current modulation to achieve a noteworthy dose reduction. Prospective ECG-gating protocol was increasingly used in 64, 125, 256 and 320 slices with corresponding ED of 4.1 ± 1.7, 3.6 ± 0.4, 3.0 ± 1.9 and 7.6 ± 1.6 mSv, respectively. Lower tube voltage and tube current modulation were widely applied in 64-slice CT and resulted in significant dose reduction (P < 0.05). This analysis has shown that dose-saving strategies can substantially reduce the radiation dose in CT coronary angiography. The fact that more and more clinicians are opting for dose-saving strategies in CT coronary angiography indicates an increased awareness of risks associated with high radiation doses among them.
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Affiliation(s)
- Akmal Sabarudin
- Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia, Australia
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The Year in Cardiac Imaging. J Am Coll Cardiol 2012; 59:1849-60. [DOI: 10.1016/j.jacc.2012.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/27/2012] [Accepted: 01/31/2012] [Indexed: 11/20/2022]
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Tomizawa N, Nojo T, Akahane M, Torigoe R, Kiryu S, Ohtomo K. Prediction of the attenuation of the ascending aorta using bolus-tracking parameters and heart rate in coronary computed tomography angiography. Eur J Radiol 2012; 81:3250-3. [PMID: 22370097 DOI: 10.1016/j.ejrad.2012.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 02/02/2012] [Accepted: 02/03/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the correlation between bolus-tracking parameters and heart rate (HR) with attenuation of the ascending aorta and create a linear regression model for predicting coronary attenuation in coronary computed tomography angiography (CCTA). METHODS A total of 50 patients (31 men, 19 women; mean age, 67.2±10.8 y) underwent CCTA using a 320-detector CT scanner. A bolus-tracking scan was performed to optimize the scan timing. The average HR under normal breathing for 10s was recorded just before the bolus-tracking scan started. Attenuation values of the pulmonary artery at 7s (PA7) and 10s (PA10) after the beginning of the injection were recorded during the bolus-tracking scan and the ascending aortic attenuation (CEAAo) was measured during the diagnostic scan. RESULTS A positive correlation was observed between PA7 and CEAAo (r=0.41, P=0.003) and PA10 and CEAAo (r=0.66, P<0.0001), and weak negative correlation was observed between HR and CEAAo (r=-0.46, P=0.15). A multivariable linear regression model for predicting CEAAo was evaluated, and the residual error between the predicted and the measured CEAAo was within approximately ±100 HU. CONCLUSIONS Coronary attenuation could be predicted using HR and pulmonary artery attenuation during the bolus-tracking method.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Chong FY, Soon K, Brown F, Bell K, Lim YL. Negative coronary CT angiography for chest pain assessment predicts low event rate in 5 years. J Med Imaging Radiat Oncol 2012; 56:55-7. [DOI: 10.1111/j.1754-9485.2011.02332.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sun Z, Ng KH. Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy. Eur J Radiol 2012; 81:e94-100. [DOI: 10.1016/j.ejrad.2011.01.070] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 12/28/2022]
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Sun Z, Ng KH. Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2012; 28:2109-19. [PMID: 22212661 DOI: 10.1007/s10554-011-0006-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 12/21/2011] [Indexed: 02/06/2023]
Abstract
To perform a systematic review and meta-analysis of the diagnostic value of prospective ECG-gating coronary CT angiography in the diagnosis of coronary artery disease. A search of biomedical databases for English literature was performed to identify studies investigating the diagnostic value of 64- or more slice CT angiography with use of prospective ECG-gating in the diagnosis of coronary artery disease. Sensitivity, specificity, positive and negative predictive value estimates pooled across studies were tested using a fixed effects model. Fourteen studies met selection criteria for inclusion in the analysis. Pooled estimates and 95% confidence interval (CI) of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography for diagnosis of significant coronary stenosis were 99% (95% CI: 98, 100%), 91% (95% CI: 88, 94%), 94% (95% CI: 91, 96%) and 99% (95% CI: 97, 100%), according to the patient-based assessment. The mean values of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography were 95% (95% CI: 93, 96%), 95% (95% CI: 93, 95%), 88% (95% CI: 86, 90%), and 98% (95% CI: 97, 98%), according to vessel-based assessment; 92% (95% CI: 90, 93%), 97% (95% CI: 97, 98%), 84% (95% CI: 82, 86%), 99% (95% CI: 99, 99%), according to segment-based assessment, respectively. The mean effective dose was 3.3 mSv (95% CI: 2.3, 4.1 mSv) for the prospective ECG-gating coronary CT angiography. This analysis shows that for a predominantly male population with a high disease prevalence the use of coronary CT angiography with prospective ECG gating allows for a reduced radiation exposure without a sacrifice in diagnostic efficacy.
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Sun Z, Ng KH. Coronary computed tomography angiography in coronary artery disease. World J Cardiol 2011; 3:303-10. [PMID: 21949572 PMCID: PMC3176898 DOI: 10.4330/wjc.v3.i9.303] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/06/2011] [Accepted: 07/13/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature. METHODS A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from five main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques. RESULTS One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source and dual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the five radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively. CONCLUSION This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction.
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Affiliation(s)
- Zhonghua Sun
- Zhonghua Sun, Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
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Muenzel D, Noel PB, Dorn F, Dobritz M, Rummeny EJ, Huber A. Step and shoot coronary CT angiography using 256-slice CT: effect of heart rate and heart rate variability on image quality. Eur Radiol 2011; 21:2277-84. [PMID: 21710267 DOI: 10.1007/s00330-011-2185-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/21/2011] [Accepted: 05/09/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of heart rate variability (HRV) and heart rate (HR) on intra-image "motion" and inter-image "stairstep" artefacts in step-and-shoot coronary CT angiography (CCTA) using a wide detector CT scanner. METHODS 66 patients underwent step-and-shoot CCTA using 256-slice CT. Patients were divided into two groups (Group 1: HR <65 bpm, Group 2 ≥65bpm). Motion artefacts were quantified using a 5-point-scale. Stairstep artefacts were defined by measurements of misalignment. Image noise, contrast-to-noise-ratio (CNR), signal-to-noise-ratio (SNR), and radiation dose were assessed. RESULTS Mean HR was 66 ± 16.7 bpm (range: 45-125 bpm) and mean HRV was 10.7 ± 17.5 bpm. A significant correlation between HR and stairstep artefacts (r = 0.46, p < 0.001) and motion artefacts (r = 0.63, p < 0.001) was found. Group 2 showed significantly increased step artefacts with a mean misalignment of 1.4 mm compared to 0.4 mm in Group 1 (p < 0.001). There was no significant effect of HRV on stairstep artefacts (r = 0.15, p = 0.416) and motion artefacts (r = 0.13, p = 0.311). No significant differences in image noise, CNR, SNR, and radiation dose were seen. CONCLUSIONS Unlike CCTA using narrow CT detectors, HRV has no significant effect on motion and stairstep artefacts using a wide CT detector with high z-coverage. However, a higher HR still increases stairstep and motion artefacts.
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Affiliation(s)
- D Muenzel
- Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.
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Using clinical cardiovascular risk scores to predict coronary artery plaque severity and stenosis detected by CT coronary angiography in asymptomatic Chinese subjects. Int J Cardiovasc Imaging 2011; 27:669-78. [DOI: 10.1007/s10554-011-9874-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
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Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2011; 28:943-53. [DOI: 10.1007/s10554-011-9902-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 05/25/2011] [Indexed: 11/25/2022]
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Image quality in obese patients undergoing 256-row computed tomography coronary angiography. Int J Cardiovasc Imaging 2011; 28:633-9. [DOI: 10.1007/s10554-011-9848-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
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Tang JH, Fu BM, Zhu H, Tang B, Sun Y, Zhang J, Yang DK, He XS. Three-dimensional CT angiography for preoperative evaluation of patients undergoing hepatic resection using the Glissonean pedicle transection method. Shijie Huaren Xiaohua Zazhi 2010; 18:3420-3424. [DOI: 10.11569/wcjd.v18.i32.3420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the use of three-dimensional CT angiography for preoperative evaluation of patients undergoing hepatic resection using the Glissonean pedicle transection method.
METHODS: The image data for 23 patients undergoing CT angiography with a Philips 256-slice Intelligent CT Scanner were analyzed with Philips brilliance software. Three-dimensional and maximum intensity projection (MIP) image reconstruction was performed. Based on the reconstructed data, liver segment resection models were developed to evaluate the possibility of preoperative virtual liver segment resection.
RESULTS: Based on three-dimensional reconstruction data, the average liver volume and weight, excluding the portal vein and hepatic vein, were 1 219 mL ± 191 mL and 1 451 g ± 227 g, respectively. The portal vein could be divided into four types: I, II, III and IV. Patients with types I and II portal vein were fit for hepatic resection using the Glissonean pedicle transection method. There is no significant difference in the weight of resected liver between virtual and actual hepatectomy (P > 0.05).
CONCLUSION: Three-dimensional CT angiography is a good strategy for preoperative evaluation of patients undergoing hepatic resection using the Glissonean pedicle transection method.
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