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Preuß D, Garcia G, Laule M, Dewey M, Rief M. Myocardial CT perfusion imaging for the detection of obstructive coronary artery disease: multisegment reconstruction does not improve diagnostic performance. Eur Radiol Exp 2022; 6:5. [PMID: 35099638 PMCID: PMC8804122 DOI: 10.1186/s41747-021-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/02/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Multisegment reconstruction (MSR) was introduced to shorten the temporal reconstruction window of computed tomography (CT) and thereby reduce motion artefacts. We investigated whether MSR of myocardial CT perfusion (CTP) can improve diagnostic performance in detecting obstructive coronary artery disease (CAD) compared with halfscan reconstruction (HSR). METHODS A total of 134 patients (median age 65.7 years) with clinical indication for invasive coronary angiography and without cardiac surgery prospectively underwent static CTP. In 93 patients with multisegment acquisition, we retrospectively performed both MSR and HSR and searched both reconstructions for perfusion defects. Subgroups with known (n = 68) or suspected CAD (n = 25) and high heart rate (n = 30) were analysed. The area under the curve (AUC) was compared applying DeLong approach using ≥ 50% stenosis on invasive coronary angiography as reference standard. RESULTS Per-patient analysis revealed the overall AUC of MSR (0.65 [95% confidence interval 0.53, 0.78]) to be inferior to that of HSR (0.79 [0.69, 0.88]; p = 0.011). AUCs of MSR and HSR were similar in all subgroups analysed (known CAD 0.62 [0.45, 0.79] versus 0.72 [0.57, 0.86]; p = 0.157; suspected CAD 0.80 [0.63, 0.97] versus 0.89 [0.77, 1.00]; p = 0.243; high heart rate 0.46 [0.19, 0.73] versus 0.55 [0.33, 0.77]; p = 0.389). Median stress radiation dose was higher for MSR than for HSR (6.67 mSv versus 3.64 mSv, p < 0.001). CONCLUSIONS MSR did not improve diagnostic performance of myocardial CTP imaging while increasing radiation dose compared with HSR. TRIAL REGISTRATION CORE320: clinicaltrials.gov NCT00934037, CARS-320: NCT00967876.
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Affiliation(s)
- Daniel Preuß
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Gonzalo Garcia
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Kaniewska M, Schuetz GM, Willun S, Schlattmann P, Dewey M. Noninvasive evaluation of global and regional left ventricular function using computed tomography and magnetic resonance imaging: a meta-analysis. Eur Radiol 2016; 27:1640-1659. [DOI: 10.1007/s00330-016-4513-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/02/2016] [Accepted: 07/18/2016] [Indexed: 01/06/2023]
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Rizvi A, Deaño RC, Bachman DP, Xiong G, Min JK, Truong QA. Analysis of ventricular function by CT. J Cardiovasc Comput Tomogr 2015; 9:1-12. [PMID: 25576407 PMCID: PMC4329068 DOI: 10.1016/j.jcct.2014.11.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 11/22/2022]
Abstract
The assessment of ventricular function, cardiac chamber dimensions, and ventricular mass is fundamental for clinical diagnosis, risk assessment, therapeutic decisions, and prognosis in patients with cardiac disease. Although cardiac CT is a noninvasive imaging technique often used for the assessment of coronary artery disease, it can also be used to obtain important data about left and right ventricular function and morphology. In this review, we will discuss the clinical indications for the use of cardiac CT for ventricular analysis, review the evidence on the assessment of ventricular function compared with existing imaging modalities such cardiac magnetic resonance imaging and echocardiography, provide a typical cardiac CT protocol for image acquisition and postprocessing for ventricular analysis, and provide step-by-step instructions to acquire multiplanar cardiac views for ventricular assessment from the standard axial, coronal, and sagittal planes. Furthermore, both qualitative and quantitative assessments of ventricular function as well as sample reporting are detailed.
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Affiliation(s)
- Asim Rizvi
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA
| | - Roderick C Deaño
- Division of Cardiovascular Disease, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Daniel P Bachman
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA
| | - Guanglei Xiong
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA
| | - James K Min
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA; Division of Cardiovascular Disease, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Quynh A Truong
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA; Division of Cardiovascular Disease, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
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Enhanced temporal resolution at cardiac CT with a novel CT image reconstruction algorithm: Initial patient experience. Eur J Radiol 2013; 82:270-4. [DOI: 10.1016/j.ejrad.2012.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 10/01/2012] [Accepted: 10/03/2012] [Indexed: 11/19/2022]
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Greupner J, Zimmermann E, Grohmann A, Dübel HP, Althoff TF, Althoff T, Borges AC, Rutsch W, Schlattmann P, Hamm B, Dewey M. Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol 2012; 59:1897-907. [PMID: 22595410 DOI: 10.1016/j.jacc.2012.01.046] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 12/27/2011] [Accepted: 01/17/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI). BACKGROUND Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients. METHODS A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed. RESULTS For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58). CONCLUSIONS 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.
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Greupner J, Zimmermann E, Hamm B, Dewey M. Automatic vs semi-automatic global cardiac function assessment using 64-row CT. Br J Radiol 2011; 85:e243-53. [PMID: 22045953 DOI: 10.1259/bjr/65747000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Global cardiac function assessment using multidetector CT (MDCT) is time-consuming. Therefore we sought to compare an automatic software tool with an established semi-automatic method. METHODS A total of 36 patients underwent CT with 64 × 0.5 mm detector collimation, and global left ventricular function was subsequently assessed by two independent blinded readers using both an automatic region-growing-based software tool (with and without manual adjustment) and an established semi-automatic software tool. We also analysed automatic motion mapping to identify end-systole. RESULTS The time needed for assessment using the semi-automatic approach (12:12 ± 6:19 min) was reduced by 75-85% with the automatic software tool (unadjusted, 01:34 ± 0:29 min, adjusted, 02:53 ± 1:19 min; both p<0.001). There was good correlation (r=0.89; p<0.001) for the ejection fraction (EF) between the adjusted automatic (58.6 ± 14.9%) and the semi-automatic (58.0 ± 15.3%) approaches. Also the manually adjusted automatic approach led to significantly smaller limits of agreement than the unadjusted automatic approach for end-diastolic volume (±36.4 ml vs ±58.5 ml, p>0.05). Using motion mapping to automatically identify end-systole reduced analysis time by 95% compared with the semi-automatic approach, but showed inferior precision for EF and end-systolic volume. CONCLUSION Automatic function assessment using MDCT with manual adjustment shows good agreement with an established semi-automatic approach, while reducing the analysis by 75% to less than 3 min. This suggests that automatic CT function assessment with manual correction may be used for fast, comfortable and reliable evaluation of global left ventricular function.
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Affiliation(s)
- J Greupner
- Department of Radiology, Charité - Medical School Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Assessment of Mitral Valve Stenosis by Helical MDCT: Comparison With Transthoracic Doppler Echocardiography and Cardiac Catheterization. AJR Am J Roentgenol 2011; 197:614-22. [PMID: 21862803 DOI: 10.2214/ajr.10.5132] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Quantitative assessment of left ventricular systolic wall thickening using multidetector computed tomography. Eur J Radiol 2009; 72:92-7. [DOI: 10.1016/j.ejrad.2008.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 06/06/2008] [Accepted: 06/30/2008] [Indexed: 11/17/2022]
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Planimetry of the aortic valve orifice area: comparison of multislice spiral computed tomography and magnetic resonance imaging. Eur J Radiol 2009; 77:426-35. [PMID: 19783394 DOI: 10.1016/j.ejrad.2009.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 08/17/2009] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine the comparability of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) for measuring the aortic valve orifice area (AVA) and grading aortic valve stenosis. MATERIALS AND METHODS Twenty-seven individuals, among them 18 patients with valvular stenosis, underwent AVA planimetry by both MSCT and MRI. In the subset of patients with valvular stenosis, AVA was also calculated from transthoracic Doppler echocardiography (TTE) using the continuity equation. RESULTS There was excellent correlation between MSCT and MRI (r = 0.99) and limits of agreement were in an acceptable range (± 0.42 cm(2)) although MSCT yielded a slightly smaller mean AVA than MRI (1.57 ± 0.83 cm(2) vs. 1.67 ± 0.98 cm(2), p < 0.05). However, in the subset of patients with valvular stenosis, the mean AVA was not different between MSCT and MRI (1.05 ± 0.30 cm(2) vs. 1.04 ± 0.39 cm(2); p > 0.05). The mean AVAs on both MSCT and MRI were systematically larger than on TTE (0.88 ± 0.28 cm(2), p < 0.001 each). Using an AVA of 1.0 cm(2) on TTE as reference, the best threshold for detecting severe-to-critical stenosis on MSCT and MRI was an AVA of 1.25 cm(2) and 1.30 cm(2), respectively, resulting in an accuracy of 96% each. CONCLUSION Our study specifies recent reports on the suitability of MSCT for quantifying AVA. The data presented here suggest that certain methodical discrepancies of AVA measurements exist between MSCT, MRI and TTE. However, MSCT and MRI have shown excellent correlation in AVA planimetry and similar accuracy in grading aortic valve stenosis.
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Ghersin E, Abadi S, Yalonetsky S, Engel A, Lessick J. Clinical evaluation of a fully automated model-based algorithm to calculate left ventricular volumes and ejection fraction using multidetector computed tomography. ACTA ACUST UNITED AC 2009; 11:43-51. [DOI: 10.1080/17482940802588317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schnapauff D, Teige F, Hamm B, Dewey M. Comparison between the image quality of multisegment and halfscan reconstructions of non-invasive CT coronary angiography. Br J Radiol 2009; 82:969-75. [PMID: 19505967 DOI: 10.1259/bjr/27290085] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to compare the image quality of multisegment and halfscan reconstructions of multislice computed tomography (MSCT) coronary angiography. 126 patients with suspected coronary artery disease and uninfluenced heart rates were examined by 16-slice CT before they underwent invasive coronary angiography. Multisegment and halfscan reconstructions were performed in all patients, and subjective image quality, overall vessel length, vessel length free of motion artefacts and contrast-to-noise ratios (CNRs) were compared for both techniques. The diagnostic accuracy of both approaches was compared with the results of invasive coronary angiography. Overall image quality scores of multisegment reconstruction were superior to those of halfscan reconstruction (13.3+/-2.1 vs 11.9+/-2.9; p<0.001). Multisegment reconstruction depicted significantly longer overall coronary vessel lengths (p<0.001) and larger vessel proportions free of motion artefacts in three of the four main coronary arteries. CNRs in the left main, left anterior descending and left circumflex coronary arteries were significantly higher when multisegment reconstruction was used (p<0.001). Overall accuracy was higher for multisegment reconstruction compared with halfscan reconstruction (87% vs 62%). In conclusion, multisegment reconstruction significantly improves image quality and diagnostic accuracy of MSCT coronary angiography compared with standard halfscan reconstruction, resulting in vessel lengths depicted free of motion comparable to those of CT performed in patients given beta-blockers to lower heart rates.
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Affiliation(s)
- D Schnapauff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Germany.
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12
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Achenbach S, Ropers U, Kuettner A, Anders K, Pflederer T, Komatsu S, Bautz W, Daniel WG, Ropers D. Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection of coronary artery disease. JACC Cardiovasc Imaging 2009; 1:177-86. [PMID: 19356426 DOI: 10.1016/j.jcmg.2007.11.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 11/15/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the influence of a systematic approach to lower heart rate for coronary computed tomography (CT) angiography on diagnostic accuracy of 64-slice single- and dual-source CT. BACKGROUND Coronary CT angiography is often impaired by motion artifacts, so that routine lowering of heart rate is usually recommended. This is often conceived as a major limitation of the technique. It is expected that higher temporal resolution, such as with dual-source 64-slice CT, would allow diagnostic imaging even without systematic pre-treatment for lowering the heart rate. METHODS Two hundred patients with suspected coronary artery disease were first randomized to either 64-slice single-source CT (n = 100) or dual-source CT (n = 100) for contrast-enhanced coronary artery evaluation. In each group, patients were further randomized to either receive systematic heart rate control (oral and intravenous beta-blockade for a target heart rate < or =60 beats/min) or receive no premedication. Evaluability of datasets and diagnostic accuracy were compared between groups against the results obtained from invasive angiography. RESULTS Systematic pre-treatment lowered heart rate during CT coronary angiography by 10 beats/min. Heart rate control significantly improved evaluability in single-source CT (93% vs. 69% on a per-patient basis, p = 0.005), whereas it did not in dual-source CT (96% vs. 98%). In evaluable patients, sensitivity to detect the presence of at least 1 coronary stenosis by single-source CT was 86% and 79%, respectively, with and without heart rate control (p = NS). For dual-source CT, it was 100% and 95%, respectively (p = NS). The rate of correctly classified patients, defined as evaluable and correct classification as to the presence or absence of at least 1 coronary artery stenosis, was significantly improved by heart rate control in single-source CT (78% vs. 57%, p = 0.04), whereas there was no such influence in dual-source CT (87% vs. 93%). CONCLUSIONS Systematic heart rate control significantly improves image quality for coronary visualization by 64-slice single-source CT, whereas image quality and diagnostic accuracy remain unaffected in dual-source CT angiography. Improved temporal resolution obviates the need for heart rate control.
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Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64. Eur Radiol 2008; 19:816-28. [PMID: 18998142 DOI: 10.1007/s00330-008-1203-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 07/25/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective "CORE-64" trial ("Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors"). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows.
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Lessick J, Ghersin E, Abadi S, Yalonetsky S. Accuracy of the long-axis area-length method for the measurement of left ventricular volumes and ejection fraction using multidetector computed tomography. Can J Cardiol 2008; 24:685-9. [PMID: 18787718 DOI: 10.1016/s0828-282x(08)70666-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multidetector computed tomography (MDCT) is useful for assessing left ventricular (LV) volumes and function. Validation has mainly been carried out using Simpson's method of summing up consecutive short-axis areas. Because the latter method is time-consuming, many users prefer using a quicker method, based on a single view or a pair of views. OBJECTIVES To evaluate the accuracy of the long-axis area-length method (AL), which has not been validated for MDCT, using Simpson's method as the gold standard, as well as right anterior oblique LV angiography as a clinical standard. METHODS Twenty-three patients admitted with acute chest pain were clinically evaluated with electrocardiogram-gated MDCT and invasive LV angiography. MDCT-based end-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were calculated using Simpson's method, biplane AL and single-plane AL. For LV angiography, EF was calculated using single-plane AL. RESULTS A Bland-Altman analysis showed a close agreement between biplane AL and Simpson's method for EF, with 1% underestimation, 95% CI of +/-11% and a correlation of 0.89. For end-diastolic, end-systolic and stroke volumes, overestimations of 7 mL, 4 mL and 2 mL, and 95% CI of +/-27 mL, +/-15 mL and +/-26 mL, respectively were found. Correlation coefficients were 0.95, 0.97 and 0.82, respectively. Comparisons with LV angiography were considerably weaker. The vertical long-axis AL method by MDCT correlated better with both LV angiography and Simpson's method than the horizontal long-axis AL method. CONCLUSIONS The biplane AL method gives results for EF, which correspond closely with the more cumbersome Simpson's method, although volumes are slightly overestimated.
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Affiliation(s)
- Jonathan Lessick
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
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Precision of Forty Slice Spiral Computed Tomography for Quantifying Aortic Valve Stenosis. Invest Radiol 2008; 43:719-28. [DOI: 10.1097/rli.0b013e318184d7c5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Evaluation of right ventricular function with multidetector computed tomography: comparison with magnetic resonance imaging and analysis of inter- and intraobserver variability. Eur Radiol 2008; 19:278-89. [PMID: 18704431 DOI: 10.1007/s00330-008-1146-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 07/11/2008] [Accepted: 07/20/2008] [Indexed: 10/21/2022]
Abstract
This study was performed to prospectively compare multidetector computed tomography (MDCT) with 16 simultaneous sections and magnetic resonance imaging (MRI) for the assessment of global right ventricular function in 50 patients. MDCT using a semiautomatic analysis tool showed good correlation with MRI for end-diastolic volume (EDV, r=0.83, p<0.001), end-systolic volume (ESV, r=0.86, p<0.001) and stroke volume (SV, r=0.74, p<0.001), but only a moderate correlation for the ejection fraction (EF, r=0.67, p<0.001). Bland Altman analysis revealed a slight, but insignificant overestimation of EDV (4.0 ml, p=0.08) and ESV (2.4 ml, p=0.07), and underestimation of EF (0.1%, p=0.92) with MDCT compared with MRI. All limits of agreement between both modalities (EF: +/-15.7%, EDV: +/-31.0 ml, ESV: +/-18.0 ml) were in a moderate but acceptable range. Interobserver variability of MDCT was not significantly different from that of MRI. For MDCT software, the post-processing time was significantly longer (19.6+/-5.8 min) than for MRI (11.8+/-2.6 min, p<0.001). Accurate assessment of right ventricular volumes by 16-detector CT is feasible but still rather time-consuming.
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Schnapauff D, Zimmermann E, Dewey M. Technical and Clinical Aspects of Coronary Computed Tomography Angiography. Semin Ultrasound CT MR 2008; 29:167-75. [DOI: 10.1053/j.sult.2008.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Stolzmann P, Scheffel H, Leschka S, Schertler T, Frauenfelder T, Kaufmann PA, Marincek B, Alkadhi H. Reference values for quantitative left ventricular and left atrial measurements in cardiac computed tomography. Eur Radiol 2008; 18:1625-34. [PMID: 18446346 DOI: 10.1007/s00330-008-0939-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/25/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022]
Abstract
To assess reference values for left ventricular (LV) and left atrial (LA) dimensions, global LV function, and LV-myocardial mass for cardiac CT. We examined 120 subjects undergoing a coronary angiography using 64-slice and dual-source CT. All individuals had a low cardiovascular risk, normal ECG, negative biomarkers, and a normal cardiac CT examination. All subjects had a negative medical history of cardiovascular disease both on admission and at clinical 6-month follow-up. The following measurements were obtained: septal wall thickness (SWT), posterior wall thickness (PWT), LV inner diameter (LVID), LA anterior posterior diameter (LAD(sys)), end-systolic volume (ESV), and end-diastolic volume (EDV), LV-myocardial mass (LVMM). We found significant gender-related differences for all LV dimensions (SWT(sys), SWT(dia),PWT(sys),PWT(dia),LVID(sys),LVID(dia)). LAD(sys) showed no significant difference between males and females. Significant differences were found for global LV functional parameters including ESV, EDV, and SV, whereas no significant differences were found for the EF. LV-myocardial mass parameters showed significant gender-related differences. No significant correlation was found between any of these parameters and age. All data were transferred to percentile ranks. This study provides gender-related reference values and percentiles for LV and LA quantitative measurements for cardiac CT and should assist in interpreting results.
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Affiliation(s)
- Paul Stolzmann
- Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Juergens KU, Seifarth H, Range F, Wienbeck S, Wenker M, Heindel W, Fischbach R. Automated Threshold-Based 3D Segmentation Versus Short-Axis Planimetry for Assessment of Global Left Ventricular Function with Dual-Source MDCT. AJR Am J Roentgenol 2008; 190:308-314. [DOI: 10.2214/ajr.07.2283] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Kai Uwe Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany
| | - Harald Seifarth
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany
| | - Felix Range
- Department of Cardiology and Angiology, University of Muenster, Muenster, Germany
| | - Susanne Wienbeck
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany
| | - Mirja Wenker
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany
| | - Roman Fischbach
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, D-48149 Muenster, Germany
- Department of Radiology, Asklepios Clinic Altona, Hamburg, Germany
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20
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Dewey M, Rutsch W, Hamm B. Is there a gender difference in noninvasive coronary imaging? Multislice computed tomography for noninvasive detection of coronary stenoses. BMC Cardiovasc Disord 2008; 8:2. [PMID: 18230167 PMCID: PMC2268658 DOI: 10.1186/1471-2261-8-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 01/29/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Multislice computed tomography (MSCT) coronary angiography is the foremost alternative to invasive coronary angiography. METHODS We sought to compare the diagnostic accuracy of MSCT in female and male patients with suspected coronary disease. Altogether 50 women and 95 men underwent MSCT with 0.5 mm detector collimation. Coronary artery stenoses of at least 50% on conventional coronary angiography were considered significant. RESULTS The coronary vessel diameters of all four main coronary artery branches were significantly larger in men than in women. The diagnostic accuracy of MSCT in identifying patients with coronary artery disease was significantly lower for women (72%) compared with men (89%, p < 0.05). Also sensitivity (70% vs. 95%), positive predictive value (64% vs. 93%), and the rate of nondiagnostic examinations (14% vs. 4%, all: p < 0.05) were significantly worse for women. The effective radiation dose of MSCT coronary angiography was significantly higher in the examination of women (13.7 +/- 1.2 mSv) than of men (11.7 +/- 0.9 mSv, p < 0.001), mainly as a result of the fact that the radiosensitive female breast (contributing 24.5% of the dose in women) is in the x-ray path. CONCLUSION Noninvasive coronary angiography with MSCT might be less accurate and sensitive for women than men. Also, women are exposed to a significantly higher effective radiation dose than men.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité, Medical School, Humboldt-Universität zu Berlin, Germany
| | - Wolfgang Rutsch
- Department of Cardiology, Charité, Medical School, Humboldt-Universität zu Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Medical School, Humboldt-Universität zu Berlin, Germany
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21
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Tay SC, Primak AN, Fletcher JG, Schmidt B, Amrami KK, Berger RA, McCollough CH. Four-dimensional computed tomographic imaging in the wrist: proof of feasibility in a cadaveric model. Skeletal Radiol 2007; 36:1163-9. [PMID: 17805530 DOI: 10.1007/s00256-007-0374-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 08/08/2007] [Accepted: 08/12/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High-resolution real-time three-dimensional (3D) imaging of the moving wrist may provide novel insights into the pathophysiology of joint instability. The purpose of this work was to assess the feasibility of using retrospectively gated spiral computed tomography (CT) to perform four-dimensional (4D) imaging of the moving wrist joint. MATERIALS AND METHODS A cadaver forearm from below the elbow was mounted on a motion simulator which performed radioulnar deviation of the wrist at 30 cycles per minute. An electronic trigger from the simulator provided the "electrocardiogram" (ECG) signal required for gated reconstructions. Four-dimensional and 3D images were compared by a blinded observer for image quality and presence of artifacts. RESULTS Image quality of 4D images was found to be excellent at the extremes of radial and ulnar deviation (end-motion phases). Some artifacts were seen in mid-motion phases. CONCLUSION 4D CT musculoskeletal imaging is feasible. Four-dimensional CT may allow clinicians to assess functional (dynamic) instabilities of the wrist joint.
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Affiliation(s)
- Shian-Chao Tay
- Orthopedics Biomechanics Laboratory, Mayo Clinic College of Medicine, Rochester, MN, USA
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22
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Assessment of Global Left and Right Ventricular Function Using Dual-Source Computed Tomography (DSCT) in Comparison to MRI. Invest Radiol 2007; 42:756-64. [DOI: 10.1097/rli.0b013e3180cc206f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Dewey M, Teige F, Rutsch W, Schink T, Hamm B. CT coronary angiography: influence of different cardiac reconstruction intervals on image quality and diagnostic accuracy. Eur J Radiol 2007; 67:92-9. [PMID: 17766074 DOI: 10.1016/j.ejrad.2007.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 07/25/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE To prospectively analyze image quality and diagnostic accuracy of different reconstruction intervals of coronary angiography using multislice computed tomography (MSCT). MATERIALS AND METHODS For each of 47 patients, 10 ECG-gated MSCT reconstructions were generated throughout the RR interval from 0 to 90%, resulting in altogether 470 datasets. These datasets were randomly analyzed for image quality and accuracy and compared with conventional angiography. Statistical comparison of intervals was performed using nonparametric analysis for repeated measurements to account for clustering of arteries within patients. RESULTS Image reconstruction intervals centered at 80, 70, and 40% of the RR interval resulted (in that order) in the best overall image quality for all four main coronary vessels. Eighty percent reconstructions also yielded the highest diagnostic accuracy of all intervals. The combination of the three best intervals (80, 70, and 40%) significantly reduced the nondiagnostic rate as compared with 80% alone (p=0.005). However, the optimal reconstruction interval combination achieved significantly improved specificities and nondiagnostic rates (p<0.05). The optimal combination consisted of 1.7+/-0.9 reconstruction intervals on average. In approximately half of the patients (49%, 23/47) a single reconstruction was optimal. In 18 (38%), 3 (6%), and 3 (6%) patients one, two, and three additional reconstruction intervals were required, respectively, to achieve optimal quality. In 28% of the patients the optimal combination consisted of reconstructions other than the three best intervals (80, 70, and 40%). CONCLUSION Multiple image reconstruction intervals are essential to ensure high image quality and accuracy of CT coronary angiography.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité Medical School, Humboldt-Universität zu Berlin, Germany.
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24
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Wu YW, Tadamura E, Kanao S, Yamamuro M, Okayama S, Ozasa N, Toma M, Kimura T, Kita T, Marui A, Komeda M, Togashi K. Left Ventricular Functional Analysis Using 64-Slice Multidetector Row Computed Tomography: Comparison with Left Ventriculography and Cardiovascular Magnetic Resonance. Cardiology 2007; 109:135-42. [PMID: 17713329 DOI: 10.1159/000105555] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 12/22/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The progress in computed tomography (CT) has improved temporal resolution and shortened the acquisition time. We compared cardiac function using 64-slice CT with left ventriculography (LVG) and cardiovascular magnetic resonance (CMR). METHODS A head-to-head comparison between CT, LVG and CMR was performed in 41 patients. In global LV function, CMR served as the reference. Regional wall motion was compared in a 5-point scoring system. RESULTS CT had excellent intra- and interobserver reproducibility. Ejection fraction, end-diastolic and end-systolic volumes by CT were closely correlated with CMR (r = 0.95, 0.96 and 0.98, respectively), while LVG underestimated LV volumes (p < 0.01). The standard deviation of ejection fraction difference between CT and CMR was significantly lower than that between LVG and CMR (p = 0.0015). In regional function, there were good agreements of 94.8% (kappa = 0.82) between CT and LVG and 94.5% (kappa = 0.84) between CT and CMR. The intermethod agreements in mild hypokinesis using CT tended to be lower. CONCLUSION An excellent correlation was observed between CT and CMR in the LV function over a wide range of heart rates. However, even though 64-slice CT tended to be less sensitive in detecting mild hypokinesis, it still showed excellent concordance in advanced regional abnormalities.
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Affiliation(s)
- Yen-Wen Wu
- Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
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25
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Leschka S, Scheffel H, Desbiolles L, Plass A, Gaemperli O, Valenta I, Husmann L, Flohr TG, Genoni M, Marincek B, Kaufmann PA, Alkadhi H. Image Quality and Reconstruction Intervals of Dual-Source CT Coronary Angiography. Invest Radiol 2007; 42:543-9. [PMID: 17620936 DOI: 10.1097/rli.0b013e31803b93cf] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate reconstruction intervals and image quality in dual-source computed tomography (DSCT) coronary angiography for optimal placement of the ECG-pulsing window. MATERIALS AND METHODS DSCT coronary angiography was performed in 60 patients. Thirteen datasets were reconstructed in 5% increments from 20-80%. Two readers independently assessed image quality of each segment in each percentage-interval, using scores ranging from 1 (no motion artifacts) to 4 (nonevaluable). RESULTS Mean heart rate (HR) was 69.0 +/- 18.9 beats per minute (bpm) (range, 35-117 bpm). Diagnostic image quality (scores 1-3) was found in 97.8% of all segments (763 of 780). The 70% RR-interval provided best image quality in all patients and all HRs. The narrowest reconstruction window providing diagnostic image quality was 60-70% for HR <60 bpm, 60-80% for 60-70 bpm, 55-80% for 70-80 bpm, and 30-80% for HR >80 bpm. CONCLUSIONS DSCT coronary angiography provides best image quality for various HRs at 70%. The ECG-pulsing window can be adapted according to the HR while maintaining diagnostic image quality.
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Affiliation(s)
- Sebastian Leschka
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
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26
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Dewey M, Teige F, Laule M, Hamm B. Influence of heart rate on diagnostic accuracy and image quality of 16-slice CT coronary angiography: comparison of multisegment and halfscan reconstruction approaches. Eur Radiol 2007; 17:2829-37. [PMID: 17639410 DOI: 10.1007/s00330-007-0685-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Revised: 04/06/2007] [Accepted: 05/08/2007] [Indexed: 10/23/2022]
Abstract
The lower the heart rate the better image quality in multislice computed tomography (MSCT) coronary angiography. We prospectively assessed the influence of heart rate on per-patient diagnostic accuracy and image quality of MSCT coronary angiography and compared adaptive multisegment and standard halfscan reconstruction. A consecutive cohort of 126 patients scheduled to undergo conventional coronary angiography was examined with 16-slice CT. For all heart rate groups, per-patient diagnostic accuracy was significantly higher for multisegment than halfscan reconstruction with values of 95 vs. 79% (p < 0.05, <65 bpm, 38 patients), 85 vs. 66% (p < 0.05, 65-74 bpm, 47 patients), and 78% vs. 41% (p < 0.001, >74 bpm, 41 patients). Differences in diagnostic accuracy between adjacent heart rate groups were only significant for halfscan reconstruction for the comparison between the 65-74 and >74 bpm group (p < 0.05). The vessel lengths free of motion artifacts were significantly longer with multisegment reconstruction in all heart rate groups and for all coronary arteries (p < 0.005). For noninvasive MSCT coronary angiography, both per-patient diagnostic accuracy and image quality decline with increasing heart rate, and multisegment reconstruction at high heart rates yields similar results as standard halfscan reconstruction at low heart rates.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, P.O. Box 10098, 10117, Berlin, Germany.
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27
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Mahnken AH, Bruder H, Suess C, Mühlenbruch G, Bruners P, Hohl C, Guenther RW, Wildberger JE. Dual-Source Computed Tomography for Assessing Cardiac Function. Invest Radiol 2007; 42:491-8. [PMID: 17568271 DOI: 10.1097/rli.0b013e3180336ca1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the influence of heart rate and temporal resolution on the assessment of global ventricular function with dual-source computed tomography (DSCT). MATERIALS AND METHODS A dynamic cardiac phantom was repeatedly scanned with a DSCT scanner applying a standardized scan protocol at different heart rates, ranging from 40 to 140 bpm. Images were reconstructed with monosegmental and bisegmental algorithms using data from a single source and from both sources. Ventricular volumes and ejection fraction (EF) were computed by semiautomated analysis. Results were compared with the phantom's real volumes. Interscan, intraobserver, and interobserver variability were calculated. RESULTS For single-source data reconstruction temporal resolution was fixed to 165 milliseconds, whereas dual-source image reconstructions resulted in a temporal resolution of 83 milliseconds (monosegmental) and 67.7+/-14.2 milliseconds (bisegmental), respectively. In general, deviation from the phantom's real volumes was less with dual-source data reconstruction when compared with single-source data reconstruction. Comparing dual-source data reconstruction with single-source data reconstruction, the percent deviation from the phantom's real volumes for EF was 0.7% (monosegmental), 0.7% (bisegmental), and 4.3% (single source), respectively. There was no correlation between heart rate and EF for dual-source data reconstruction (r=-0.168; r=-0.157), whereas a relevant correlation was observed for single-source data reconstruction (r=-0.844). Interscan, intraobserver, and interobserver variability for EF were 1.4%, 0.9%, and 0.3%, respectively. CONCLUSIONS DSCT allows reliable quantification of global ventricular function independent of the heart rate. Multisegmental image reconstruction is not needed for DSCT assessment of global ventricular function.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Aachen, Germany.
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Schönenberger E, Schnapauff D, Teige F, Laule M, Hamm B, Dewey M. Patient acceptance of noninvasive and invasive coronary angiography. PLoS One 2007; 2:e246. [PMID: 17327910 PMCID: PMC1796945 DOI: 10.1371/journal.pone.0000246] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 01/27/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Noninvasive angiography using multislice computed tomography (MSCT) is superior to magnetic resonance imaging (MRI) for detection of coronary stenoses. We compared patient acceptance of these two noninvasive diagnostic tests and invasive conventional coronary angiography (Angio). METHODS AND FINDINGS A total of 111 consecutive patients with suspected coronary artery disease underwent MSCT, MRI, and Angio. Subsequently, patient acceptance of the three tests was evaluated with questionnaires in all patients. The main acceptance variables were preparation and information prior to the test, degree of concern, comfort, degree of helplessness, pain (on visual analog scales), willingness to undergo the test again, and overall satisfaction. Preparation for each test was not rated significantly differently, whereas patients were significantly more concerned about Angio than the two noninvasive tests (p<0.001). No pain during MSCT, MRI, and Angio as assessed on visual analog scales (0 to 100) was reported by 99, 93, and 31 patients, respectively. Among the 82 patients who felt pain during at least one procedure, both CT (0.9+/-4.5) and MRI (5.2+/-16.6) were significantly less painful than Angio (24.6+/-23.4, both p<0.001). MSCT was considered significantly more comfortable (1.49+/-0.64) than MRI (1.75+/-0.81, p<0.001). In both the no-revascularization (55 patients) and the revascularization group (56 patients), the majority of the patients (73 and 71%) would prefer MSCT to MRI and Angio for future imaging of the coronary arteries. None of the patients indicated to be unwilling to undergo MSCT again. The major advantages patients attributed to MSCT were its fast, uncomplicated, noninvasive, and painless nature. CONCLUSIONS Noninvasive coronary angiography with MSCT is considered more comfortable than MRI and both MSCT and MRI are less painful than Angio. Patient preference for MSCT might tip the scales in favor of this test provided that the diagnostic accuracy of MSCT can be shown to be high enough for clinical application.
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Affiliation(s)
- Eva Schönenberger
- Department of Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Florian Teige
- Department of Radiology, Charité, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité, Humboldt-Universität zu Berlin, Berlin, Germany
- * To whom correspondence should be addressed. E-mail:
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Dewey M, Schnapauff D, Teige F, Hamm B. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging. Eur Radiol 2007; 17:2038-43. [PMID: 17268800 DOI: 10.1007/s00330-006-0570-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 11/18/2006] [Accepted: 12/21/2006] [Indexed: 01/17/2023]
Abstract
Both multislice computed tomography (CT) and magnetic resonance imaging (MRI) are emerging as methods to detect coronary artery stenoses and assess cardiac function and morphology. Non-cardiac structures are also amenable to assessment by these non-invasive tests. We investigated the rate of significant and insignificant non-cardiac findings using CT and MRI. A total of 108 consecutive patients suspected of having coronary artery disease and without contraindications to CT and MRI were included in this study. Significant non-cardiac findings were defined as findings that required additional clinical or radiological follow-up. CT and MR images were read independently in a blinded fashion. CT yielded five significant non-cardiac findings in five patients (5%). These included a pulmonary embolism, large pleural effusions, sarcoid, a large hiatal hernia, and a pulmonary nodule (>1.0 cm). Two of these significant non-cardiac findings were also seen on MRI (pleural effusions and sarcoid, 2%). Insignificant non-cardiac findings were more frequent than significant findings on both CT (n = 11, 10%) and MRI (n = 7, 6%). Incidental non-cardiac findings on CT and MRI of the coronary arteries are common, which is why images should be analyzed by radiologists to ensure that important findings are not missed and unnecessary follow-up examinations are avoided.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, P.O. Box 10098, 10117 Berlin, Germany.
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30
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Dewey M, Rutsch W, Schnapauff D, Teige F, Hamm B. Coronary Artery Stenosis Quantification Using Multislice Computed Tomography. Invest Radiol 2007; 42:78-84. [PMID: 17220725 DOI: 10.1097/01.rli.0000251569.01317.60] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Reliable noninvasive detection of stenoses with multislice computed tomography (MSCT) is feasible. This study's aim was to analyze the agreement, correlation, and reliability of MSCT with conventional coronary angiography as the reference standard for quantification of coronary artery stenoses. MATERIALS AND METHODS A total of 118 significant (at least 50%) coronary artery stenoses with a reference vessel diameter of at least 1.5 mm in 62 patients were analyzed by MSCT using 16 detector rows (Aquilion, Toshiba, Otawara, Japan), multisegment reconstruction, and voxel sizes of 0.35x0.35x0.5 mm. The degree of stenosis on MSCT and quantitative coronary angiography (QCA) was measured by correlating the difference between the reference vessel diameter (average of 2 measurements directly proximal and distal to the stenosis) and the stenotic vessel diameter to the reference vessel diameter. RESULTS Correlation between the percent diameter stenosis determined by MSCT (78.2+/-13.6%) and QCA (76.0+/-14.8%) was significant (P<0.001) but only moderately so (R=0.51). Bland-Altman analysis revealed no systematic under- or overestimation with MSCT but large limits of agreements (+/-27.6%). Also the limits of agreement for interobserver agreement (reliability) of MSCT data were considerably large (+/-24.8%). Among the 27 coronary artery stenoses with a reference diameter of at least 3.5 mm, there was improved correlation (R=0.80) and the limits of agreement between MSCT and QCA were significantly smaller (+/-17.3%, P<0.008). The agreement between MSCT and QCA was not significantly different for stenoses with no calcification or only calcium spots (+/-28.2%) as compared with those with moderate-or-severe calcifications (+/-27.3%; P=0.8). MSCT allowed correct classification of coronary stenoses into low-grade (below 75%) and high-grade stenoses (at least 75%), in 62% (73 of 118). CONCLUSIONS The accuracy and reliability of coronary artery stenosis quantification with MSCT using isotropic voxel sizes and multisegment reconstruction is still too low to recommend routine clinical application because of rather low agreement, correlation, and reliability. Despite these limitations, the current results demonstrate the potential of MSCT for reliable and accurate quantification of coronary artery stenoses in the near future provided that further improvements in spatial and temporal resolution will be achieved.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Berlin, Germany.
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31
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Dewey M, Müller M, Eddicks S, Schnapauff D, Teige F, Rutsch W, Borges AC, Hamm B. Evaluation of Global and Regional Left Ventricular Function With 16-Slice Computed Tomography, Biplane Cineventriculography, and Two-Dimensional Transthoracic Echocardiography. J Am Coll Cardiol 2006; 48:2034-44. [PMID: 17112993 DOI: 10.1016/j.jacc.2006.04.104] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 03/17/2006] [Accepted: 04/17/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We sought to compare left ventricular (LV) function assessed with multislice computed tomography (MSCT), biplane cineventriculography (CVG), and transthoracic echocardiography (Echo), with magnetic resonance imaging (MRI) as the reference standard. BACKGROUND With the same data as acquired for noninvasive coronary angiography, MSCT enables registration of myocardial function. METHODS A total of 88 patients (64 men and 24 women) underwent MSCT with 16 x 0.5 mm detector collimation, CVG, and MRI, whereas Echo was retrospectively analyzed in a subset of 30 patients. RESULTS Regarding the ejection fraction, the agreement was significantly superior for MSCT than for CVG (+/- 10.2% vs. +/- 16.8%; p < 0.001) and Echo (+/- 11.0% vs. +/- 21.2%; p < 0.001). For the end-diastolic and end-systolic volumes, the limits of agreement with CVG (p < 0.001) and Echo (p < 0.001 and p < 0.02, respectively) were also significantly larger than with MSCT. In comparison with MSCT, CVG significantly overestimated the end-diastolic and end-systolic volumes (p < 0.001). Intraobserver analysis of MSCT yielded limits of agreement for ejection fraction (+/- 4.8%), end-diastolic volume (+/- 15.6 ml) and end-systolic volume (+/- 8.0 ml), and myocardial mass (+/- 18.2 g). The accuracy in identifying patients and myocardial segments with abnormal regional function was significantly higher with MSCT (84% and 95%) than with CVG (63% and 90%; p < 0.002 and p < 0.001), whereas MSCT and Echo were not significantly different in identifying patients with abnormal regional function. CONCLUSIONS Our results indicate that the assessment of global and regional LV function with MSCT is more accurate than with CVG, whereas MSCT is superior to Echo for global function. This suggests that MSCT allows reliable evaluation of global and regional LV function.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité, Medical School, Humboldt-University, Berlin, Germany.
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32
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Husmann L, Leschka S, Desbiolles L, Schepis T, Koepfli P, Gaemperli O, Seifert B, Flohr TG, Frauenfelder T, Marincek B, Kaufmann PA, Alkadhi H. Thick Maximum Intensity Projections for the Assessment of Left Ventricular Function With 64-Slice Computed Tomography. Invest Radiol 2006; 41:746-52. [PMID: 16971798 DOI: 10.1097/01.rli.0000236906.05265.4f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the accuracy of thick maximum intensity projections (MIP) from computed tomography (CT) data sets mimicking projection images from biplane ventriculography for evaluation of left ventricular (LV) parameters. MATERIALS AND METHODS Fifty-eight patients underwent 64-slice CT. Multiphase images were reconstructed in 10% steps of the RR interval. MIP images (70-mm thickness) of the contrast-enhanced LV in fixed 30 degrees right anterior oblique (RAO)/60 degrees left anterior oblique (LAO) and in adapted short-/long-axis planes were reconstructed. LV parameters were calculated using the area-length method formula. Three-dimensional assessment with semiautomated software served as reference standard. RESULTS Use of thick MIP reconstructions had a high intermethod reliability (86-94%) compared with the 3-dimensional approach. Smaller measurement errors were found for thick MIP reconstructions in adapted short-/long-axis planes. A significant projection error (3.0%, P < 0.001) of thick MIP reconstructions was found using fixed 30 degrees RAO/60 degrees LAO compared with adapted short-/long-axis reconstructions. CONCLUSION Thick MIP reconstructions with adapted short-/long-axis planes allow an accurate assessment of LV parameters compared with the established 3-dimensional method.
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Affiliation(s)
- Lars Husmann
- Institute of Diagnostic Radiology, University of Zurich, Zurich, Switzerland
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