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Singhal M, Pilania RK, Gupta P, Johnson N, Singh S. Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease. World J Clin Pediatr 2023; 12:97-106. [PMID: 37342454 PMCID: PMC10278081 DOI: 10.5409/wjcp.v12.i3.97] [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] [Received: 03/12/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
Coronary artery abnormalities are the most important complications in children with Kawasaki disease (KD). Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD. However, it has inherent limitations with regard to evaluation of mid and distal coronary arteries and, left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group. Catheter angiography (CA) is invasive, has high radiation exposure and fails to demonstrate abnormalities beyond lumen. The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems. In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children. Computed tomography coronary angiography (CTCA) can be performed during acute as well as convalescent phases of KD. It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Nameirakpam Johnson
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
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Lebedev S, Fournié E, Maier J, Stierstorfer K, Kachelrieß M. Motion compensation for aortic valves using partial angle CT reconstructions motion compensation of cardiac valve CT. Med Phys 2021; 49:1495-1506. [PMID: 34822186 DOI: 10.1002/mp.15379] [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: 03/03/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A motion compensation method that is aimed at correcting motion artifacts of cardiac valves is proposed. The primary focus is the aortic valve. METHODS The method is based around partial angle reconstructions and a cost function including the image entropy. A motion model is applied to approximate the cardiac motion in the temporal and spatial domain. Based on characteristic values for velocities and strain during cardiac motion, penalties for the velocity and spatial derivatives are introduced to maintain anatomically realistic motion vector fields and avoid distortions. The model addresses global elastic deformation, but not the finer and more complicated motion of the valve leaflets. RESULTS The method is verified based on clinical data. Image quality was improved for most artifact impaired reconstructions. An image quality study with Likert scoring of the motion artifact severity on a scale from 1 (highest image quality) to 5 (lowest image quality/extreme artifact presence) was performed. The biggest improvements after applying motion compensation were achieved for strongly artifact impaired initial images scoring 4 and 5, resulting in an average change of the scores by -0.59 ± 0.06 and -1.33 ± 0.03, respectively. In case of artifact free images, a chance to introduce blurring was observed and their average score was raised by 0.42 ± 0.03. CONCLUSION Motion artifacts were consistently removed and image quality improved.
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Affiliation(s)
- Sergej Lebedev
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Siemens Healthineers, Forchheim, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | | | - Joscha Maier
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Marc Kachelrieß
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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Finck T, Klambauer K, Hendrich E, Will A, Martinoff S, Hadamitzky M. Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA). J Cardiovasc Dev Dis 2021; 8:jcdd8100119. [PMID: 34677188 PMCID: PMC8539421 DOI: 10.3390/jcdd8100119] [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: 08/24/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate a high-pitch spiral first (HPSF) approach for coronary computed tomography angiography (CCTA) in an unselected patient cohort and compare diagnostic yield and radiation exposure to CCTAs acquired via conventional, non-high-pitch spiral first (NHPSF) scan regimes. Materials and Methods: All consecutive patients from 1 January 2015 to 31 December 2017 were included. Two investigation protocols (HPSF/NHPSF) were used with the aim to achieve diagnostic image quality of all coronary segments. Low-pitch secondary scans followed the initial examination if image quality was unsatisfactory. Dosage and image quality were compared between both regimes. Results: 1410 patients were subject to a HPSF and 236 patients to a NHPSF approach. While the HPSF approach led to a higher fraction of re-scans (35% vs. 11%, p < 0.001), the fraction of aggregate scans that remained non-diagnostic after considering the initial and secondary scan was comparably low for the HPSF and NHPSF approach (0.78 vs. 0%, p = 0.18). Aggregate radiation exposure in the HPSF protocol was significantly lower (1.12 mSv (IQR: 0.73, 2.10) vs. 3.96 mSv (IQR: 2.23, 8.33) p < 0.001). Conclusions: In spite of a higher number of re-scans, a HPSF approach leads to a reduction in overall radiation exposure with diagnostic yields similar to a NHPSF approach.
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Cardiac-CT with the newest CT scanners: An incoming screening tool for competitive athletes? Clin Imaging 2021; 78:74-92. [PMID: 33773447 DOI: 10.1016/j.clinimag.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 11/20/2022]
Abstract
Competitive athletes of all skill levels are at risk of sudden cardiac death (SCD) due to certain heart conditions. Prior to engagement in high-intensity athletics, it is necessary to screen for these conditions in order to prevent sudden cardiac death. Cardiac-CT angiography (CCTA) is a reliable tool to rule out the leading causes of SCD by providing an exceptional overview of vascular and cardiac morphology. This allows CCTA to be a powerful resource in identifying cardiac anomalies in selected patients (i.e. unclear symptoms or findings at ECG or echocardiography) as well as to exclude significant coronary artery disease (CAD). With the advancement of technology over the last few years, the latest generations of computed tomography (CT) scanners provide better image quality at lower radiation exposures. With the amount of radiation exposure per scan now reaching the sub-millisievert range, the number of CT examinations it is supposed to increase greatly, also in the athlete's population. It is thus necessary for radiologists to have a clear understanding of how to make and interpret a CCTA examination so that these studies may be performed in a responsible and radiation conscious manner especially when used in the younger populations. Our work aims to illustrate the main radiological findings of CCTAs and highlight their clinical impact with some case studies. We also briefly describe critical features of state-of-the-art CT scanners that optimize different acquisitions to obtain the best quality at the lowest possible dose.
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Lebedev S, Fournie E, Stierstorfer K, Kachelrieß M. Stack transition artifact removal (STAR) for cardiac CT. Med Phys 2019; 46:4777-4791. [PMID: 31444974 DOI: 10.1002/mp.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In cardiac computed tomography (CT), irregular motion may lead to unique artifacts for scanners with a longitudinal collimation that does not cover the entire heart. Given partial coverage, subvolumes, or stacks, may be reconstructed and used to assemble a final CT volume. Irregular motion, for example, due to cardiac arrhythmia or breathing, may cause mismatch between neighboring stacks and therefore discontinuities within the final CT volume. The aim of this work is the removal of the discontinuities that are hereafter referred to as stack transition artifacts. METHOD AND MATERIALS A stack transition artifact removal (STAR) is achieved using a symmetric deformable image registration. A symmetric Demons algorithm was implemented and applied to stacks to remove mismatch and therefore the stack transition artifacts. The registration can be controlled with one parameter that affects the smoothness of the deformation vector field (DVF). The latter is crucial for realistically transforming the stacks. Different smoothness settings as well as an entirely automatic parameter selection that considers the required deformation magnitude for each registration were tested with patient data. Thirteen datasets were evaluated. Simulations were performed on two additional datasets. RESULTS AND CONCLUSION STAR considerably improved image quality while computing realistic DVFs. Discontinuities, for example, appearing as breaks or cuts in coronary arteries or cardiac valves, were removed or considerably reduced. A constant smoothing parameter that ensured satisfactory results for all datasets was found. The automatic parameter selection was able to find a proper setting for each individual dataset. Consequently, no over regularization of the DVF occurred that would unnecessarily limit the registration accuracy for cases with small deformations. The automatic parameter selection yielded the best overall results and provided a registration method for cardiac data that does not require user input.
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Affiliation(s)
- Sergej Lebedev
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Siemens Healthineers, 91301, Forchheim, Germany.,Department of Physics and Astronomy, University of Heidelberg, 69120, Heidelberg, Germany
| | | | | | - Marc Kachelrieß
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Medical Faculty, University of Heidelberg, 69120, Heidelberg, Germany
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Low-Dose Computed Tomography Reduces Radiation Exposure by 90% Compared With Traditional Computed Tomography Among Patients Undergoing Hip-Preservation Surgery. Arthroscopy 2019; 35:1385-1392. [PMID: 30987906 PMCID: PMC6500754 DOI: 10.1016/j.arthro.2018.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/03/2018] [Accepted: 11/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the delivered radiation dose between a low-dose hip computed tomography (CT) scan protocol and traditional hip CT scan protocols (i.e., "traditional CT"). METHODS This was a retrospective comparative cohort study. Patients who underwent hip-preservation surgery (including arthroscopy, surgical hip dislocation, or periacetabular osteotomy procedures) at our institution between 2016 and 2017 were identified. Patients were excluded if they had a body mass index (BMI) greater than 35, they underwent previous surgery, or a radiation dose report was absent. The low-dose group included patients who underwent hip CT at our institution using a standardized protocol of 100 kV (peak), 100 milliampere-seconds (mAs), and a limited scanning field. The traditional CT group included patients who had hip CT scans performed at outside institutions. The total effective dose (Ehip), effective dose per millimeter of body length scanned, patients' age, and patients' BMI were compared by univariate analysis. The correlation of Ehip to BMI was assessed. RESULTS The study included 41 consecutive patients in the low-dose group and 18 consecutive patients in the traditional CT group. Low-dose CT resulted in a 90% reduction in radiation exposure compared with traditional CT (Ehip, 0.97 ± 0.28 mSv vs 9.68 ± 6.67 mSv; P < .0001). Age (28 ± 11 years vs 26 ± 10 years, P = .42), sex (83% female patients vs 76% female patients, P = .74), and BMI (24 ± 3 vs 24 ± 3, P = .75) were not different between the 2 groups. Ehip had a poor but significant correlation to BMI in the low-dose CT group (R2 = 0.14, slope = 0.03, P = .02) and did not correlate to BMI in the traditional CT group (R2 = 0.13, P = .14). CONCLUSIONS A low-dose hip CT protocol for the purpose of hip-preservation surgical planning resulted in a 90% reduction in radiation exposure compared with traditional CT. LEVEL OF EVIDENCE Level II, diagnostic study.
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Reduction of radiation dose for coronary computed tomography angiography using prospective electrocardiography-triggered high-pitch acquisition in clinical routine. Pol J Radiol 2019; 83:e260-e267. [PMID: 30627245 PMCID: PMC6323584 DOI: 10.5114/pjr.2018.76791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/23/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the image quality, radiation exposure, and means of application in a group of patients who underwent coronary computed tomography angiography (CCTA) performed with low-dose prospective electrocardiography (ECG)-triggered acquisition in which a standard sequence was added if the low-dose sequence did not allow reliable exclusion of coronary stenosis with respect to image quality. Material and methods The present study was approved by the Ethics Committee of the Faculty of Medicine, and informed consent was obtained from all patients. The authors performed a retrospective review of 256 consecutive patients referred for CCTA using dual-source CT scanner (Definition FLASH, Siemens, Germany). CCTA was performed using prospective ECG-triggered high-pitch acquisition. In patients with higher heart rates (> 65 bpm) or in whom irregular heart rates were noted prior to the scan, a subsequent CCTA was performed immediately (double flash protocol). The effective radiation dose was calculated for each patient. All images were evaluated by two independent observers for quality on a four-point scale with 1 being non-diagnostic image quality and 4 being excellent. Results Mean effective whole-body dose of CCTA was 1.6 ± 0.4 mSv (range, 0.4-5.4) for the entire cardiac examination and 0.9 ± 0.3 mSv (range, 0.4-2.8) for individual prospective ECG-triggered high-pitch CCTAs. In 27 of these patients with higher heart rates or occasional premature ventricular contractions or atrial fibrillation, subsequent CCTAs were performed immediately. The average image quality score was good to excellent with less than 1% unevaluable coronary segments. The double flash protocol resulted in a fully diagnostic CCTA in all cases. Conclusions The prospective ECG-triggered high-pitch CCTA technique is feasible and promising in clinical routine with good to excellent image quality and minimal radiation dose. The double flash protocol might become a more robust tool in patients with higher heart rates or arrhythmia.
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Forte E, Monti S, Parente CA, Beyer L, De Rosa R, Infante T, Cavaliere C, Cademartiri F, Salvatore M, Stroszczynski C, Tedeschi C. Image Quality and Dose Reduction by Dual Source Computed Tomography Coronary Angiography: Protocol Comparison. Dose Response 2018; 16:1559325818805838. [PMID: 30349426 PMCID: PMC6194939 DOI: 10.1177/1559325818805838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023] Open
Abstract
Purpose: To compare image quality and radiation dose among different protocols in patients who underwent a 128-slice dual source computed tomography coronary angiography (DSCT-CTCA). Methods: Ninety patients were retrospectively grouped according to heart rate (HR): 26 patients (group A) with stable HR ≤60 bpm were acquired using high pitch spiral mode (FLASH); 48 patients (group B) with irregular HR ≤60 bpm or stable HR between 60 and 70 bpm using step and shoot mode; and 16 patients (group C) with irregular HR >60 bpm or stable HR ≥70 bpm by retrospective electrocardiogram pulsing acquisition. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured for the main vascular structures. Moreover, the dose-length product and the effective dose were assessed. Results: Both SNR and CNR were higher in group A compared to group C (18.27 ± 0.32 vs 11.22 ± 0.50 and 16.75 ± 0.32 vs 10.17 ± 0.50; P = .001). The effective dose was lower in groups A and B (2.09 ± 1.27 mSv and 4.60 ± 2.78 mSv, respectively) compared to group C (9.61 ± 5.95 mSv) P < .0001. Conclusion: The correct selection of a low-dose, HR-matched CTCA scan protocol with a DSCT scanner provides substantial reduction of radiation exposure and better SNR and CNR.
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Affiliation(s)
| | | | | | - Lukas Beyer
- Department of Radiology, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Carlo Tedeschi
- Department of Radiology, Universitätsklinikum Regensburg, Regensburg, Germany.,P.S.I. Napoli Est, ASL Napoli 1 Centro, Naples, Italy
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High-Pitch Coronary Computed Tomographic Angiography Using the Third-Generation Dual-Source Computed Tomography. J Comput Assist Tomogr 2018; 42:248-255. [DOI: 10.1097/rct.0000000000000678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT. Clin Res Cardiol 2017; 106:485-492. [PMID: 28168514 DOI: 10.1007/s00392-017-1077-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting. METHODS Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA. RESULTS SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts. CONCLUSION SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.
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Hou QR, Gao W, Sun AM, Wang Q, Qiu HS, Wang F, Hu LW, Li JY, Zhong YM. A prospective evaluation of contrast and radiation dose and image quality in cardiac CT in children with complex congenital heart disease using low-concentration iodinated contrast agent and low tube voltage and current. Br J Radiol 2016; 90:20160669. [PMID: 27925466 DOI: 10.1259/bjr.20160669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To the assess image quality, contrast dose and radiation dose in cardiac CT in children with congenital heart disease (CHD) using low-concentration iodinated contrast agent and low tube voltage and current in comparison with standard dose protocol. METHODS 110 patients with CHD were randomized to 1 of the 2 scan protocols: Group A (n = 45) with 120 mA tube current and contrast agent of 270 mgI/ml in concentration (Visipaque™; GE Healthcare Ireland, Co., Cork, UK); and Group B (n = 65) with the conventional 160 mA and 370 mgI/ml concentration contrast (Iopamiro®; Shanghai Bracco Sine Pharmaceutical Corp Ltd, Shanghai, China). Both groups used 80 kVp tube voltage and were reconstructed with 70% adaptive statistical iterative reconstruction algorithm. The CT value and noise in aortic arch were measured and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A five-point scale was used to subjectively evaluate image quality. Contrast and radiation dose were recorded. RESULTS There was no difference in age and weight between the two groups (all p > 0.05). The iodine load and radiation dose in Group A were statistically lower (3976 ± 747 mgI vs 5763 ± 1018 mgI in iodine load and 0.60 ± 0.08 mSv vs 0.77 ± 0.10 mSv in effective dose; p < 0.001). However, image noise, CT value, CNR, SNR and subjective image quality for the two groups were similar (all p > 0.05), and with good agreement between the two observers. Comparing the surgery results, the diagnostic accuracy for extracardiac and intracardiac defects for Group A was 96% and 92%, respectively, while the corresponding numbers for Group B were 95% and 93%. CONCLUSION Compared with the standard dose protocol, the use of low tube voltage (80 kVp), low tube current (120 mA) and low-concentration iodinated contrast agent (270 mgI/ml) enables a reduction of 30% in iodine load and 22% in radiation dose while maintaining compatible image quality and diagnostic accuracy. Advances in knowledge: The new cardiac CT scanning protocol can largely reduce the adverse effects of radiation and contrast media to children. Meanwhile, it also can be used effectively to examine complex CHD.
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Affiliation(s)
- Qiao-Ru Hou
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Gao
- 2 Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ai-Min Sun
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Sheng Qiu
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Wang
- 3 Department of Radiology, Wuhan Medical and Healthcare Center for Woman and Children, Hubei, China
| | - Li-Wei Hu
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Ying Li
- 4 CT Research Center, GE Healthcare, Shanghai, China
| | - Yu-Min Zhong
- 1 Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tang PH, Du BJ, Fang XM, Hu XY, Qian PY, Gao QS. Submillisievert coronary CT angiography with adaptive prospective ECG-triggered sequence acquisition and iterative reconstruction in patients with high heart rate on the dual-source CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:807-820. [PMID: 27612046 DOI: 10.3233/xst-160589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To assess the application value of submillisievert coronary CT angiography (CCTA) in patients with a high heart rate (HR) acquired with adaptive prospective ECG-triggered sequence acquisition and iterative reconstruction on the secondary generation dual-source CT. MATERIALS AND METHODS A total of 120 consecutive high-HR patients suspected with coronary artery disease underwent CCTA and invasive coronary angiography (ICA) within two weeks. Patients were randomly assigned into three groups: group A (n = 40), where the patients underwent retrospectively ECG-triggered acquisition CCTA at 100 kVp; group B (n = 40), where the patients received adaptive prospective ECG-triggered sequence acquisition at 100 kVp; and group C (n = 40), where the patients performed adaptive prospective ECG-triggered sequence acquisition at 80 kVp with iterative reconstruction. The mean CT values, signal noise ratios (SNR) and contrast noise ratios (CNR) in the ascending aorta and coronary arteries of the three groups were measured and compared. The image quality and radiation dose among the three groups were compared. The consistency of displaying the coronary stenosis of each group was assessed compared with the results of ICA as the gold standard. RESULTS There was no significant difference in gender, age and body mass index (BMI) (all P > 0.05). The mean attenuations, SNRs and CNRs in the ascending aorta and coronary artery were not significantly different between group A and group B (P > 0.05). The mean attenuations of group C were significantly higher than group A and group B (P < 0.01), but the image noise and CNR were significantly lower in group C (P < 0.01). The number of appreciable segments among the three groups was not significantly different on a per-segment and per-vessel basis (P > 0.05). The subjective image quality among the three groups was not significantly different (P > 0.05). With the ICA result as a reference standard, there was good consistency in the evaluation of the coronary stenosis degree between CCTA and ICA (r > 0.75), as well as in the assessment of the coronary stenosis rate using the Bland- Altman analysis. The mean radiation dose in group B was half of that in group A. Moreover, the mean radiation dose in group C was less than one sixth of that in group A and less than 1 mSv (0.7±0.2 mSv). CONCLUSIONS For patients with high HR, adaptive prospective ECG-triggered sequence acquisition on the FLASH dual-source CT results in equal image quality and half of the radiation dose reduction compared with retrospectively ECG-triggered spiral acquisition at the same tube voltage (100 kVp) and same R-R interval of exposure. In addition, adaptive prospective ECG-triggered sequence acquisition combined with low tube voltage and iterative reconstruction can further reduce the radiation dose to the submillisievert level without compromising image quality and the accuracy of assessing the coronary stenosis degree, and can be popularized as a routine technique.
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Affiliation(s)
- Pei-Hua Tang
- Department of Radiology, Department of Electrocardiogram, Wuxi No.4 People's Hospital, Binghu District, Wuxi, China
| | - Ben-Jun Du
- Department of Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiang-Ming Fang
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Nanchang District, Wuxi, China
| | - Xiao-Yun Hu
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Nanchang District, Wuxi, China
| | - Ping-Yan Qian
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Nanchang District, Wuxi, China
| | - Quan-Sheng Gao
- Laboratory of the Animal Center, Academy of Military Medical Sciences, Haidian District, Beijing, China
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Long B, Koyfman A. Best Clinical Practice: Current Controversies in Evaluation of Low-Risk Chest Pain-Part 1. J Emerg Med 2016; 51:668-676. [PMID: 27693075 DOI: 10.1016/j.jemermed.2016.07.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chest pain is a common presentation to the emergency department (ED), though the majority of patients are not diagnosed with acute coronary syndrome (ACS). Many patients are admitted to the hospital due to fear of ACS. OBJECTIVE Our aim was to investigate controversies in low-risk chest pain evaluation, including risk of missed ACS, stress test, and coronary computed tomography angiography (CCTA). DISCUSSION Chest pain accounts for 10 million ED visits in the United States annually. Many patients are at low risk for a major cardiac adverse event (MACE). With negative troponin and nonischemic electrocardiogram (ECG), the risk of MACE and myocardial infarction (MI) is < 1%. The American Heart Association recommends further evaluation in low- to intermediate-risk patients within 72 h. These modalities add little to further risk stratification. These evaluations do not appropriately risk stratify patients who are already at low risk, nor do they diagnose acute MI. CCTA is an anatomic evaluation of the coronary vasculature with literature support to decrease ED length of stay, though it is associated with downstream testing. Literature is controversial concerning further risk stratification in already low-risk patients. CONCLUSIONS With nonischemic ECG and negative cardiac biomarker, the risk of ACS approaches < 1%. Use of stress test and CCTA for risk stratification of low-risk chest pain patients is controversial. These tests may allow prognostication but do not predict ACS risk beyond ECG and troponin. CCTA may be useful for intermediate-risk patients, though further studies are required.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
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Selçuk T, Otçu H, Yüceler Z, Bilgili Ç, Bulakçı M, Savaş Y, Çelik Ö. Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality. Balkan Med J 2016; 33:283-93. [PMID: 27308072 DOI: 10.5152/balkanmedj.2016.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/01/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. AIMS In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. STUDY DESIGN Retrospective cross-sectional study. METHODS Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts- 4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. RESULTS Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. CONCLUSION CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates.
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Affiliation(s)
- Tuba Selçuk
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey; Department of Medical Imaging Techniques, İstanbul Gelişim University Vocational School of Health Services
| | - Hafize Otçu
- Department of Radiology, Halkalı Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zeyneb Yüceler
- Department of Radiology, Şereflikoçhisar Government Hospital, Ankara, Turkey
| | - Çiğdem Bilgili
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Mesut Bulakçı
- Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Yıldıray Savaş
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Halkalı Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Alshamari M, Geijer M, Norrman E, Lidén M, Krauss W, Wilamowski F, Geijer H. Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice. Acta Radiol 2016. [PMID: 26221055 DOI: 10.1177/0284185115595667] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lumbar spine radiography is often performed instead of CT for radiation dose concerns. PURPOSE To compare image quality and diagnostic information from low dose lumbar spine CT at an effective dose of about 1 mSv with lumbar spine radiography. MATERIAL AND METHODS Fifty-one patients were examined by both methods. Five reviewers scored all examinations on eight image quality criteria using a five-graded scale and also assessed three common pathologic changes. RESULTS Low dose CT scored better than radiography on the following: sharp reproduction of disc profile and vertebral end-plates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5), intervertebral foramina and pedicles (OR, 4.3; 95% CI, 3.1-5.9), intervertebral joints (OR, 139; 95% CI, 59-326), spinous and transverse processes (OR, 7.0; 95% CI, 4.3-11.2), sacro-iliac joints (OR, 4.2; 95% CI, 3.2-5.7), reproduction of the adjacent soft tissues (OR, 2.9; 95% CI, 2.1-4.0), and absence of any obscuring superimposed gastrointestinal gas and contents (OR, 188; 95% CI, 66-539). Radiography scored better on sharp reproduction of cortical and trabecular bone (OR, 0.3; 95% CI, 0.2-0.4). The reviewers visualized disk degeneration, spondylosis/diffuse idiopathic skeletal hyperostosis (DISH) and intervertebral joint osteoarthritis more clearly and were more certain with low dose CT. Mean time to review low dose CT was 204 s (95% CI, 194-214 s.), radiography 152 s (95% CI, 146-158 s.). The effective dose for low dose CT was 1.0-1.1 mSv, for radiography 0.7 mSv. CONCLUSION Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.
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Affiliation(s)
- Muhammed Alshamari
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Geijer
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, Sweden
| | - Eva Norrman
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Lidén
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Wolfgang Krauss
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Franciszek Wilamowski
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Håkan Geijer
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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16
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Liu Y, Li J, Zhao H, Jia Y, Ren J, Xu J, Hao Y, Zheng M. Image quality and radiation dose of dual-source CT cardiac angiography using prospective ECG-triggering technique in pediatric patients with congenital heart disease. J Cardiothorac Surg 2016; 11:47. [PMID: 27059600 PMCID: PMC4826524 DOI: 10.1186/s13019-016-0460-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/05/2016] [Indexed: 11/30/2022] Open
Abstract
Background All studies involving use of ionizing radiation should be performed in accordance with the ALARA (As Low As Reasonably Achievable) principle, especially in children. In this study, the prospective ECG triggering technique with low voltage was used in dual-source computed tomography (DSCT) angiography to investigate if image quality with low radiation dose could be satisfactory in pediatric patients with congenital heart disease. Methods Sixty pediatric patients with suspected congenital cardiovascular anomalies were enrolled prospectively in the study. They were randomly assigned to two groups for DSCT angiography. Group A were scanned by prospective ECG-triggering computed tomography angiography (CTA) with 80 kV tube voltage, while group B by used non-ECG-gated CTA with the same tube voltage. The anomaly accuracy was evaluated based on the surgical and/or conventional cardiac angiography findings. The overall image quality was assessed on a five-point scale. And the diagnostic accuracy and radiation dose was evaluated in both groups. Results There were 127 cardiovascular anomalies in Group A and 108 in Group B. The mean subjective image quality and diagnostic accuracy between these two groups were significantly different (P = 0.007 and 0.011, respectively). The mean effective dose in Group A and Group B was 0.38 ± 0.13 mSv and 0.35 ± 0.17 mSv, respectively. But there was no significant difference between two groups (P = 0.197). Conclusions The prospective ECG triggering technique in DSCT scan can offer better image quality and diagnostic accuracy with low radiation exposure in pediatric patients with congenital heart diseases. This technique has potential to become a new clinical routine in pediatric cardiac computed tomography (CT) imaging.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Jian Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Yan Jia
- Siemens China Ltd., Shang Hai, China
| | - Jing Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Jian Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Yuewen Hao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, China.
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Litmanovich DE, Tack DM, Shahrzad M, Bankier AA. Dose reduction in cardiothoracic CT: review of currently available methods. Radiographics 2015; 34:1469-89. [PMID: 25310412 DOI: 10.1148/rg.346140084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiation exposure from computed tomography (CT) has received much attention lately in the medical literature and the media, given the relatively high radiation dose that characterizes a CT examination. Although there are a variety of possible strategies for reducing radiation exposure from CT in an individual patient, optimal CT image acquisition requires that the radiologist understand new scanner technology and how to implement the most effective means of dose reduction while maintaining image quality. The authors describe a practical approach to dose reduction in cardiothoracic radiology, discussing CT radiation dose metrics (eg, CT dose index, dose-length product, effective diameter, and size-specific dose estimate) as well as CT scanner parameters that directly or indirectly influence radiation dose (eg, scan length, x-ray tube output, tube current modulation, pitch, image reconstruction techniques [including iterative reconstruction], and noise reduction). These variables are discussed in terms of their relative importance to image quality and the implications of parametric changes for image quality and diagnostic content, and practical recommendations are made for their immediate implementation in the clinical setting. Taken together, the principles of physics and key parameters involved in reducing radiation dose while maintaining image quality can serve as a "survival guide" for a diagnostic radiology practice.
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Affiliation(s)
- Diana E Litmanovich
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Shapiro 4, Boston, MA 02215 (D.E.L., M.S., A.A.B.); and Department of Radiology, Epicura Hospital, Baudour, Belgium (D.M.T.)
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Zhu X, Shi Z, Zhu Y, Liu W, Yang G, Yu T, Tang L, Xu Y. Individually adapted tube current selection and contrast medium injection protocol of coronary CT angiography based on test bolus parameters: a feasibility study. Acta Radiol 2015; 56:666-72. [PMID: 24938658 DOI: 10.1177/0284185114536156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/28/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Test bolus is mostly used to determine the starting point of a full cardiac scanning with respect to injection of a larger bolus of contrast material. So far there are limited data demonstrating the feasibility of using information obtained from a test bolus to adjust contrast delivery protocols and tube current individually during coronary computed tomography angiography (CCTA). PURPOSE To evaluate the feasibility of individually adapted tube current selection and contrast injection protocols of CCTA based on test bolus parameters. MATERIAL AND METHODS Test bolus followed by CCTA was performed in 93 patients at 100 kV and in 81 patients at 120 kV, respectively. Simulated attenuation of the descending aorta (SimDA) of CCTA was calculated at a fixed contrast injection rate of 4 mL/s. Univariate and multivariate comparisons were performed to identify associations of SimDA and image noise of CCTA (NoiseCCTA) with test bolus information and patient-related factors including body weight (BW), body mass index (BMI), and body surface area (BSA). RESULTS Compared with BW, BMI, and BSA, SimDA was more closely related to the peak time of left ventricle and peak enhancement of right ventricle obtained from test bolus (r = 0.495 and r = 0.642 for 100 and 120 kV protocol, respectively). Similarly, NoiseTB was much more closely related to NoiseCCTA (r = 0.740 and r = 0.630 for 100 and 120 kV protocol, respectively) when compared with BW, BMI, and BSA. CONCLUSION It is feasible to individually adapt tube current and contrast injection protocol of CCTA based on the information of test bolus.
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Affiliation(s)
- Xiaomei Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Zhaofei Shi
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Yinsu Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Wangyan Liu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Guanyu Yang
- Laboratory of Image Science & Technology, School of Computer Science and Engineering, Southeast University, Nanjing, Jiangsu, PR China
| | - Tongfu Yu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Lijun Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Yi Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
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Stefanini GG, Windecker S. Can coronary computed tomography angiography replace invasive angiography? Coronary computed tomography angiography cannot replace invasive angiography. Circulation 2015; 131:418-25; discussion 426. [PMID: 25623124 DOI: 10.1161/circulationaha.114.008148] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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Do S, Karl WC, Singh S, Kalra M, Brady T, Shin E, Pien H. High fidelity system modeling for high quality image reconstruction in clinical CT. PLoS One 2014; 9:e111625. [PMID: 25390888 PMCID: PMC4229099 DOI: 10.1371/journal.pone.0111625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022] Open
Abstract
Today, while many researchers focus on the improvement of the regularization term in IR algorithms, they pay less concern to the improvement of the fidelity term. In this paper, we hypothesize that improving the fidelity term will further improve IR image quality in low-dose scanning, which typically causes more noise. The purpose of this paper is to systematically test and examine the role of high-fidelity system models using raw data in the performance of iterative image reconstruction approach minimizing energy functional. We first isolated the fidelity term and analyzed the importance of using focal spot area modeling, flying focal spot location modeling, and active detector area modeling as opposed to just flying focal spot motion. We then compared images using different permutations of all three factors. Next, we tested the ability of the fidelity terms to retain signals upon application of the regularization term with all three factors. We then compared the differences between images generated by the proposed method and Filtered-Back-Projection. Lastly, we compared images of low-dose in vivo data using Filtered-Back-Projection, Iterative Reconstruction in Image Space, and the proposed method using raw data. The initial comparison of difference maps of images constructed showed that the focal spot area model and the active detector area model also have significant impacts on the quality of images produced. Upon application of the regularization term, images generated using all three factors were able to substantially decrease model mismatch error, artifacts, and noise. When the images generated by the proposed method were tested, conspicuity greatly increased, noise standard deviation decreased by 90% in homogeneous regions, and resolution also greatly improved. In conclusion, the improvement of the fidelity term to model clinical scanners is essential to generating higher quality images in low-dose imaging.
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Affiliation(s)
- Synho Do
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - William Clem Karl
- Department of Electrical and Computer Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Sarabjeet Singh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mannudeep Kalra
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tom Brady
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ellie Shin
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Homer Pien
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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Noël PB, Köhler T, Fingerle AA, Brown KM, Zabic S, Münzel D, Haller B, Baum T, Henninger M, Meier R, Rummeny EJ, Dobritz M. Evaluation of an iterative model-based reconstruction algorithm for low-tube-voltage (80 kVp) computed tomography angiography. J Med Imaging (Bellingham) 2014; 1:033501. [PMID: 26158054 DOI: 10.1117/1.jmi.1.3.033501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/03/2014] [Accepted: 09/11/2014] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to investigate the improvement in diagnostic quality of an iterative model-based reconstruction (IMBR) algorithm for low-tube-voltage (80-kVp) and low-tube-current in abdominal computed tomography angiography (CTA). A total of 11 patients were imaged on a 256-slice multidetector computed tomography for visualization of the aorta. For all patients, three different reconstructions from the low-tube-voltage data are generated: filtered backprojection (FBP), IMBR, and a mixture of both [Formula: see text]. To determine the diagnostic value of IMBR-based reconstructions, the image quality was assessed. With IMBR-based reconstructions, image noise could be significantly reduced, which was confirmed by a highly improved contrast-to-noise ratio. In the image quality assessment, radiologists were able to reliably detect more third-order and higher aortic branches in the IMBR reconstructions compared to FBP reconstructions. The effective dose level was, on average, 3.0 mSv for 80-kVp acquisitions. Low-tube-voltage CTAs significantly improve vascular contrast as presented by others; however, this effect in combination with IMBR enabled yet another substantial improvement of diagnostic quality. For IMBR, a significant improvement of image quality and a decreased radiation dose at low-tube-voltage can be reported.
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Affiliation(s)
- Peter B Noël
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Thomas Köhler
- Philips Research Laboratories , Hamburg 22335, Germany
| | | | - Kevin M Brown
- Philips Healthcare , Cleveland, Ohio 44143, United States
| | | | - Daniela Münzel
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Bernhard Haller
- Technische Universität München , Institute of Medical Statistics and Epidemiology, Munich 81675, Germany
| | - Thomas Baum
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Martin Henninger
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Reinhard Meier
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Ernst J Rummeny
- Technische Universität München , Department of Radiology, Munich 81675, Germany
| | - Martin Dobritz
- Technische Universität München , Department of Radiology, Munich 81675, Germany
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Muenzel D, Noël PB, Gramer BM, Leber V, Schneider A, Leber A, Vembar M, Fingerle AA, Rummeny EJ, Huber A. Dynamic CT perfusion imaging of the myocardium using a wide-detector scanner: a semiquantitative analysis in an animal model. Clin Imaging 2014; 38:675-80. [DOI: 10.1016/j.clinimag.2014.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/16/2014] [Accepted: 05/20/2014] [Indexed: 12/25/2022]
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High-pitch prospective ECG-triggered helical coronary computed tomography angiography in clinical practice: image quality and radiation dose. Int J Cardiovasc Imaging 2014; 31:125-33. [DOI: 10.1007/s10554-014-0515-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
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Lee AM, Engel LC, Hui GC, Liew G, Ferencik M, Sidhu MS, Hoffmann U, Ghoshhajra BB. Coronary computed tomography angiography at 140 kV versus 120 kV: assessment of image quality and radiation exposure in overweight and moderately obese patients. Acta Radiol 2014; 55:554-62. [PMID: 24031049 DOI: 10.1177/0284185113502745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although a tube potential of 140 kV is available on most computed tomography (CT) scanners, its incremental diagnostic value versus 120 kV has been controversial. PURPOSE To retrospectively evaluate the image quality and radiation exposure of cardiac computed tomography angiography (CCTA) performed at 140 kV in comparison to CCTA at 120 kV in overweight and moderately obese patients. MATERIAL AND METHODS Eighty-eight patients who were referred for CCTA between January 2010 and May 2012 were included. Forty-four patients who were overweight or moderately obese (body mass index [BMI], 25-35 kg/m(2)) underwent CCTA with dual-source CT (DSCT) scanner at 140 kV. Forty-four match controls who underwent CCTA with DSCT at 120 kV were identified per BMI, average heart rate, scan indication, and scan acquisition mode. All scans were performed per routine protocols with direct physician supervision. Quantitative image metrics (CT attenuation, image noise, contrast-to-noise ratio [CNR], and signal-to-noise ratio [SNR] of left main [LM] and proximal right coronary artery [RCA]) were assessed. Effective radiation dose was compared between the two groups. RESULTS Overall, all scans were diagnostic without any non-evaluable coronary segment per clinical report. 140 kV had a lower attenuation and image noise versus 120 kV (P<0.01). Both SNR and CNR of proximal coronary arteries were similar between 140 kV and 120 kV (SNR, LM P=0.93, RCA P=0.62; CNR, LM P=0.57, RCA P=0.77). 140 kV was associated with a 35.3% increase in effective radiation dose as compared with 120 kV (5.1 [3.6-8.2] vs. 3.3 [2.0-5.1] mSv, respectively; P<0.01). CONCLUSION 140 kV CCTA resulted in similar image quality but a higher effective radiation dose in comparison to 120 kV CCTA. Therefore, in overweight and moderately obese patients, a tube potential of 120 kV may be sufficient for CCTA with diagnostic image quality.
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Affiliation(s)
- Ashley M Lee
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Leif-Christopher Engel
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Gladwin C Hui
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Gary Liew
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Maros Ferencik
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Manavjot S Sidhu
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
| | - Brian B Ghoshhajra
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Department of Radiology and Division of Cardiology, Boston, MA, USA
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Meta-analysis: diagnostic accuracy of coronary CT angiography with prospective ECG gating based on step-and-shoot, Flash and volume modes for detection of coronary artery disease. Eur Radiol 2014; 24:2345-52. [PMID: 24865695 DOI: 10.1007/s00330-014-3221-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/28/2014] [Accepted: 05/06/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the diagnostic performance of coronary computed tomographic angiography (CCTA) with prospective electrocardiograph (ECG) gating based on step-and-shoot (SAS), Flash and volume imaging modes. METHODS We searched the electronic databases PubMed for all published studies regarding CCTA. We used an exact binomial rendition of the bivariate mixed-effects regression model developed for synthesis of diagnostic data. RESULTS A total of 21,852 segments, 4,851 vessels and 1,375 patients were identified using database searches. Patient-level pooled sensitivity was 0.99 (95 % confidence interval [CI], 0.98-1.00); specificity was 0.88 (CI, 0.85-0.91). The results showed that the sensitivity and specificity for detection of significant stenosis did not differ in the three protocols (P = 0.24). No heterogeneity was found at the patient level for sensitivity (Q = 26.23; P = 0.12; I (2) = 27.56 % [CI, 0.00-67.02 %]) and specificity (Q = 19.54; P = 0.42; I (2) = 2.78 % [CI, 0.00-66.26 %]). CONCLUSIONS CCTA with prospective ECG gating has similar high diagnostic value to rule out CAD in all three presented modes. KEY POINTS • The accuracy of CCTA with different prospective ECG gating is similar • CCTA with prospective ECG gating is effective to exclude coronary artery disease • The radiation dose of volume mode increases with higher heart rate.
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Jiang B, Wang J, Lv X, Cai W. Dual-source CT versus single-source 64-section CT angiography for coronary artery disease: A meta-analysis. Clin Radiol 2014; 69:861-9. [PMID: 24854029 DOI: 10.1016/j.crad.2014.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 01/14/2023]
Abstract
AIM To perform a meta-analysis to compare the diagnostic performance of single-source 64-section computed tomography (CT) versus dual-source CT angiography for diagnosis of coronary artery disease (CAD). MATERIALS AND METHODS The Cochrane Library, MEDLINE, and EMBASE were searched for relevant original papers. Inclusion criteria were (1) significant CAD defined as ≥50% reduction in luminal diameter by invasive coronary angiography as reference standard; (2) single-source 64-section CT or dual-source CT was used; (3) results were reported in absolute numbers of true-positive, false-positive, true-negative, and false-negative results or sufficiently detailed data for deriving these numbers were presented. A random-effects model was used for the meta-analysis. RESULTS Fifty-one papers including 3966 patients who underwent single-source 64-section CT and 2047 patients who underwent dual-source CT at a per-patient level were pooled. The diagnostic values of single-source 64-section CT versus dual-source CT were 97% versus 97% for sensitivity (p = 0.386), 78% versus 86% for specificity (p < 0.001), 90% versus 85% for positive predictive value (PPV; p < 0.001), 93% versus 97% for negative predictive value (NPV; p = 0.001), 6.8 versus 6.5 for positive likelihood ratio (p = 0.018), 0.04 versus 0.04 for negative likelihood ratio (p = 0.625), and 191.59 versus 207.37 for diagnostic odds ratio (p = 0.043), respectively. CONCLUSION Dual-source CT and single-source 64-section CT have similar negative likelihood ratios and, therefore, there was no significant difference in their utility to rule out CAD in intermediate-risk patients. However, compared to single-source 64-section CT, dual-source CT has significantly higher specificity, so that CT-based decisions for subsequent coronary catheter angiography are more accurate.
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Affiliation(s)
- B Jiang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - J Wang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China.
| | - X Lv
- Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
| | - W Cai
- Department of Cardiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China
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Walther S, Schueler S, Tackmann R, Schuetz GM, Schlattmann P, Dewey M. Compliance with STARD Checklist among Studies of Coronary CT Angiography: Systematic Review. Radiology 2014; 271:74-86. [DOI: 10.1148/radiol.13121720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liu D, Jia H, Fu Y, He W, Ma D. Prognostic utility of coronary computed tomographic angiography: a 5-year follow-up in type 2 diabetes patients with suspected coronary artery disease. J Diabetes Res 2014; 2014:103459. [PMID: 24772442 PMCID: PMC3964760 DOI: 10.1155/2014/103459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/27/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To analyze the predictive value of coronary computed tomography angiography on acute coronary artery events in patients with type 2 diabetes. METHODS Coronary computed tomography angiography was performed in 250 type 2 diabetic patients. After a follow-up for 5 years, 145 patients were excluded as they did not have any coronary events. The remaining 95 patients were divided into study group and control group. According to their density and shape, the coronary artery plaques were classified into 3 types and 4 types, respectively. RESULTS There is no statistically significant difference in the degree of stenosis between two groups. The proportion of calcified plaques in the study group was lower than in the control group. The proportion of mixed-calcified plaques in the study group was higher than in the other. Type III plaques have a 76.2% sensitivity and negative predictive value was 64.5% for acute coronary events; type IV plaques have a sensitivity of 52.6% and positive predictive value of 63% for chronic coronary events. CONCLUSIONS CCTA may be used as a non-invasive modality for evaluating and predicting vulnerable coronary atherosclerosis plaques in patients with type 2 diabetes.
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Affiliation(s)
- Daliang Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng District, Beijing 100050, China
| | - Huijuan Jia
- Department of Radiology, Liaocheng People's Hospital, 67 West-Dongchang Road, Liaocheng, Shandong 252000, China
| | - Yucun Fu
- Department of Radiology, Liaocheng People's Hospital, 67 West-Dongchang Road, Liaocheng, Shandong 252000, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng District, Beijing 100050, China
| | - Daqing Ma
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Xicheng District, Beijing 100050, China
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Tognolini A, Arellano C, Marfori W, Heidari G, Sayre J, Krishnam M, Ruehm S. Comprehensive low-dose imaging of carotid and coronary arteries with a single-injection dual-source CT angiography protocol. Clin Radiol 2014; 69:246-53. [DOI: 10.1016/j.crad.2013.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/27/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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Li M, Du XM, Jin ZT, Peng ZH, Ding J, Li L. The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis. PLoS One 2014; 9:e84937. [PMID: 24465453 PMCID: PMC3897406 DOI: 10.1371/journal.pone.0084937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/20/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT. MATERIALS AND METHODS PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem. RESULTS 91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%. CONCLUSION The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
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Affiliation(s)
- Min Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Xiang-min Du
- Department of Medical Engineering, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Zhi-tao Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - Zhao-hui Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Juan Ding
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Li Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
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Radiation dose reduction in pediatric cardiac computed tomography: experience from a tertiary medical center. Pediatr Cardiol 2014; 35:171-9. [PMID: 23872908 DOI: 10.1007/s00246-013-0758-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
Cardiac CT angiography (cCTA) has become an established method for the assessment of congenital heart disease. However, the potential harmful effects of ionizing radiation must be considered, particularly in younger, more radiosensitive patients. In this study, we sought to assess the temporal change in radiation doses from pediatric cCTA during an 8-year period at a tertiary medical center. This retrospective study included all patients ≤18 years old who were referred to electrocardiography (ECG)-gated cCTA for the assessment of congenital heart disease or inflammatory disease (Kawasaki disease) from November 2004 to September 2012. During the study period, 95 patients were scanned using 3 different scanner models-64-slice multidetector CT (64-MDCT) and first- (64-DSCT) and second-generation (128-DSCT) dual-source CT-and 3 scan protocols-retrospective ECG-gated helical scanning (RG), prospective ECG-triggered axial scanning (PT), or prospective ECG-triggered high-pitch helical scanning (HPH). Effective dose (ED) was calculated with the dose length product method with a conversion factor (k) adjusted for age. ED was then compared among scan protocols. Image quality was extracted from clinical cCTA reports when available. Overall, 94 % of scans were diagnostic (80 % for 64-slice MDCT, 93 % for 64-slice DSCT, and 97 % for 128-slice DSCT).With 128-DSCT, median ED (1.0 [range 0.6-2.0] mSv) decreased by 85.8 % and 66.8 % compared with 64-MDCT (6.8 [range 2.9-13.6] mSv) and 64-DSCT (2.9 [range 0.9-4.1] mSv), respectively. With HPH, median ED (0.9 [range 0.6-1.8] mSv) decreased by 59.4 % and 85.4 % compared with PT (2.2 [range 0.9-3.4] mSv) and RG (6.1 [range 2.5-10.6] mSv). cCTA can now be obtained at very low radiation doses in pediatric patients using the latest dual-source CT technology in combination with prospective ECG-triggered HPH acquisition.
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Sabarudin A, Sun Z. Coronary CT angiography: Dose reduction strategies. World J Cardiol 2013; 5:465-472. [PMID: 24392191 PMCID: PMC3879694 DOI: 10.4330/wjc.v5.i12.465] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
With the introduction of 64- and post-64 slice computed tomography (CT) technology, coronary CT angiography has been increasingly used as a less invasive modality for the diagnosis of coronary artery disease. Despite its high diagnostic value and promising results compared to invasive coronary angiography, coronary CT angiography is associated with high radiation dose, leading to potential risk of radiation-induced cancer. A variety of dose-reduction strategies have been reported recently to reduce radiation dose with effective outcomes having been achieved. This article presents an overview of the various methods currently used for radiation dose reduction.
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Li M, Zhang GM, Zhao JS, Jiang ZW, Peng ZH, Jin ZT, Sun G. Diagnostic performance of dual-source CT coronary angiography with and without heart rate control: systematic review and meta-analysis. Clin Radiol 2013; 69:163-71. [PMID: 24268513 DOI: 10.1016/j.crad.2013.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography with and without the application of a β-blocker. MATERIALS AND METHODS An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize diagnostic test data. RESULTS The pooled sensitivity at the patient level was 0.98 [95% confidence intervals (CI): 0.97-0.99], and specificity 0.88 (95% CI: 0.84-0.91). The results showed that without heart rate control, the sensitivity and specificity at the patient level did not decrease (p = 0.27 and 0.56, respectively). At the artery level, no significant differences in sensitivity and specificity for studies with and without heart rate control were detected (p = 0.04 and 0.05, respectively). At the segment level, the specificity decreased without heart rate control (p = 0.03), whereas the sensitivity was not influenced (p = 0.63). The median radiation exposure was 2.6 mSv, with 1.6 mSv and 8 mSv for heart rate-controlled studies and uncontrolled studies, respectively. CONCLUSIONS DSCT coronary angiography without heart rate control has a similar excellent diagnostic performance at the patient level as that of heart rate control groups. However, controlling for heart rate to decrease radiation and to provide effective information for selecting the therapeutic strategy and risk stratification is recommended.
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Affiliation(s)
- M Li
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - G-M Zhang
- Department of Medical Cardiology, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - J-S Zhao
- Department of Radiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong Province, China
| | - Z-W Jiang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Z-H Peng
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Z-T Jin
- Department of Cardiology, General Hospital of the Second Artillery, Beijing, China
| | - G Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
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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: 32] [Impact Index Per Article: 2.9] [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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Romagnoli A, Schillaci O, Arganini C, Gaspari E, Ricci A, Morosetti D, Coco I, Crusco S, Calabria F, Sperandio M, Simonetti G. Hybrid SPECT/CT Imaging in the Evaluation of Coronary Stenosis: Role in Diabetic Patients. ISRN RADIOLOGY 2013; 2013:419737. [PMID: 24959556 PMCID: PMC4045525 DOI: 10.5402/2013/419737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/05/2012] [Indexed: 12/02/2022]
Abstract
Purpose. Our purpose was to combine the results of the MDCT (multidetector computed tomography) morphological data and the SPECT (single-photon emission computed tomography) data using hybrid imaging to overcome the limits of the MDCT in the evaluation of coronary stenosis in diabetic patients with large amount of calcium in the coronary arteries. Method and Materials. 120 diabetic patients underwent MDCT examination and SPECT examination. We evaluated 324 coronary arteries. After the examinations, we merged CT and SPECT images. Results. CT evaluation: 52 (32.8%) coronaries with stenosis ≥ 50%, 228 (70.4%) with stenosis < 50%, and 44 (13.6%) with a doubtful evaluation. SPECT evaluation: 80 (24.7%) areas with hypoperfusion, 232 (71.6%) with normal perfusion, and 12 (3.7%) with a doubtful evaluation. Of 324 coronary arteries and corresponding areas, the hybrid SPECT/CT evaluation showed 92 (28.4%) areas with hypoperfusion, and 232 (71.6%) with normal perfusion. Conclusion. Hybrid CT/SPECT imaging could be useful in the detection of significant coronary stenosis in patients with large amount of coronary calcifications.
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Affiliation(s)
- Andrea Romagnoli
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Orazio Schillaci
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Chiara Arganini
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Eleonora Gaspari
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Aurora Ricci
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Daniele Morosetti
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Irene Coco
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Sonia Crusco
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Ferdinando Calabria
- Dipartimento di Medicina Nucleare e Neuroradiologia, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, IS, Italy
| | - Massimiliano Sperandio
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
| | - Giovanni Simonetti
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Ospedaliera Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Roma, Italy
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Hetterich H, Nikolaou K, Reiser MF, Bamberg F. The Big Picture: Evidence Base and Current Trials in Cardiac CT. CURRENT RADIOLOGY REPORTS 2013; 1:246-254. [PMID: 24883235 PMCID: PMC4034169 DOI: 10.1007/s40134-013-0022-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Cardiac computed tomography angiography (CCTA) has technically matured into a robust imaging modality for various cardiac disorders. Whereas early trials focused on assessment of the efficacy of CCTA in comparison with established recommended methods, current research efforts focus on the effectiveness of the technique in specific clinical scenarios. In this article, we provide an overview of recent technology advances, describe major clinical scenarios in which CCTA has been evaluated, and detail pertinent evidence from completed or ongoing clinical trials, including its use to investigate acute chest pain, its use among patients with stable chest pain syndrome, and its prognostic value for the occurrence of cardiovascular events.
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Affiliation(s)
- Holger Hetterich
- Department of Clinical Radiology, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Konstantin Nikolaou
- Department of Clinical Radiology, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Maximilian F. Reiser
- Department of Clinical Radiology, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Fabian Bamberg
- Department of Clinical Radiology, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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Gimelli A, Coceani M. State of the Art Hybrid Technology: SPECT/CT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Engel LC, Lee AM, Seifarth H, Sidhu MS, Brady TJ, Hoffmann U, Ghoshhajra BB. Weekly dose reports: the effects of a continuous quality improvement initiative on coronary computed tomography angiography radiation doses at a tertiary medical center. Acad Radiol 2013; 20:1015-23. [PMID: 23830607 DOI: 10.1016/j.acra.2013.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/14/2013] [Accepted: 04/30/2013] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES Numerous protocols have been developed to reduce cardiac computed tomography angiography (cCTA) radiation dose while maintaining image quality. However, cCTA practice is highly dependent on physician and technologist experience and education. In this study, we sought to evaluate the incremental value of real-time feedback via weekly dose reports on a busy cCTA service. MATERIALS AND METHODS This time series analysis consisted of 450 consecutive patients whom underwent physician-supervised cCTA for clinically indicated native coronary evaluation between April 2011 and January 2013, with 150 patients before the initiation of weekly dose report (preintervention period: April-September 2011) and 150 patients after the initiation (postintervention period: September 2011-February 2012). To assess whether overall dose reductions were maintained over time, results were compared to a late control group consisting of 150 consecutive cCTA exams, which were performed after the study (September 2012-January 2013). Patient characteristics and effective radiation were recorded and compared. RESULTS Total radiation dose was significantly lower in the postintervention period (3.4 mSv [1.7-5.7] and in the late control group (3.3 mSv [2.0-5.3] versus the preintervention period (4.1 mSv [2.1-6.6] (P = .005). The proportion of high-dose outliers was also decreased in the postintervention period and late control period (exams <10 mSv were 88.0% preintervention vs. 97.3% postintervention vs. 95.3% late control; exams <15 mSv were 98.0% preintervention vs. 100.0% postintervention vs. 98.7% late control; exams <20.0 mSv were 98.7% preintervention vs. 100.0% postintervention vs. 100.0% late control). CONCLUSION Weekly dose report feedback of site radiation doses to patients undergoing physician-supervised cCTA resulted in significant overall dose reduction and reduction of high-dose outliers. Overall dose reductions were maintained beyond the initial study period.
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Affiliation(s)
- Leif-Christopher Engel
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St., Suite 400, Boston, MA 02114, USA
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Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, Forrester J, Janowitz W, Kaufmann PA, Mahmarian J, Moore SC, Stabin MG, Shreve P. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013; 54:1485-507. [PMID: 23781013 DOI: 10.2967/jnumed.112.105155] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Quantitative analysis of motion artifacts in high-pitch dual-source computed tomography of the thorax. J Thorac Imaging 2013; 27:382-6. [PMID: 22627616 DOI: 10.1097/rti.0b013e3182575729] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to objectively analyze motion artifacts on thoracic computed tomography (CT) with dual-source high-pitch and single-source techniques when using a no-breath-hold technique to examine patients who have difficulty complying with breath-holding instructions. MATERIALS AND METHODS A total of 120 patients who received CT of the thorax with a free-breathing technique in single-source (16 slices and 128 slices; pitch = 1.2) and dual-source (pitch = 3.0) manners were evaluated retrospectively. In each of the 3 study groups, movements of the diaphragm and pulsations of the aortic root and main pulmonary artery were analyzed for their number and severity (blurred distance). RESULTS No motion artifacts of the diaphragm were identified using a pitch of 3.0 (compared with n = 14 for single-source CT using 128 slices and n = 24 using 16-slice CT). In single-source examinations, the severity of artifacts was similar between 128-slice CT and 16-slice CT: blurring distance of the lung parenchyma due to diaphragm movements was 14 versus 16 mm, and double contours of the aorta were measured as 8 and 9 mm, respectively. CONCLUSIONS A high-pitch, dual-source mode is potentially advantageous for evaluating the lung parenchyma and vascular structures in patients who have difficulty complying with breath-holding instructions. Increasing from 16 to 128 slices can significantly reduce the number and severity of motion artifacts.
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IYENGAR S, ROOBOTTOM CA. Cardiac multidetector CT: method, indications and applications. IMAGING 2013. [DOI: 10.1259/imaging.20100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schuhbäck A, Marwan M, Cury RC, Achenbach S. Current status of cardiac CT for the detection of myocardial ischemia. Herz 2013; 38:359-66. [PMID: 23588608 DOI: 10.1007/s00059-013-3805-3] [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
Stress and rest myocardial perfusion imaging using computed tomography (CT) can be accurately and safely performed. CT angiography allows for the anatomic visualization of coronary lesions and the components of atherosclerotic plaque, whereas according to currently available data, CT perfusion imaging improves the diagnostic accuracy for detecting ischemic lesions. However, the radiation exposure and contrast load that are involved cannot be neglected. Owing to the limited number of trials that have been published so far, and the fact that they used a wide variety of image acquisition and stress protocols, a standard acquisition protocol for CT perfusion imaging still needs to be found and evaluated in larger multicenter trials. Therefore, CT perfusion imaging, as opposed to other modalities such as magnetic resonance perfusion, SPECT, or positron emission tomography, cannot yet be regarded as clinical routine, but may be considered in patients with contraindications for other imaging modalities.
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Affiliation(s)
- A Schuhbäck
- Department of Cardiology, University of Erlangen, Ulmenweg 18, Erlangen, Germany.
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Computed tomography to diagnose coronary artery disease: A reduction in radiation dose increases applicability. Clin Radiol 2013; 68:340-5. [DOI: 10.1016/j.crad.2012.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/07/2012] [Accepted: 05/17/2012] [Indexed: 11/20/2022]
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Ajlan AM, Heilbron BG, Leipsic J. Coronary Computed Tomography Angiography for Stable Angina: Past, Present, and Future. Can J Cardiol 2013; 29:266-74. [DOI: 10.1016/j.cjca.2012.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 01/02/2023] Open
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Srichai MB, Barreto M, Lim RP, Donnino R, Babb JS, Jacobs JE. Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: a feasibility study. J Cardiovasc Comput Tomogr 2013; 7:102-9. [PMID: 23545461 DOI: 10.1016/j.jcct.2013.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obtaining diagnostic coronary CT angiography with low radiation exposure in patients with irregular heart rhythms such as atrial fibrillation (AF) remains challenging. OBJECTIVE We evaluated image quality and inter-reader variability with the use of prospective electrocardiographic (ECG)-triggered sequential dual-source acquisition at end systole for coronary artery disease (CAD) evaluation in patients with AF. METHODS Thirty consecutive patients with AF who underwent prospective ECG-triggered sequential dual-source acquisition were evaluated. Images were reconstructed every 50 milliseconds from 250 to 400 milliseconds after the R wave. Two independent, blinded readers evaluated the coronaries for image quality on a 5-point scale (worst to best) and stenosis on 5-point semiquantitative (none to severe) and binary scales (>50% or <50%). Diagnostic image quality was graded for each reconstruction. RESULTS Eleven patients (37%) had significant (≥50% stenosis) CAD. Average heart rate was 82 ± 20 beats/min and variability range was 71 ± 22 beats/min. Mean effective radiation dose was 6.5 ± 2.4 mSv. Diagnostic image quality was noted in 97.9% of 304 coronary segments with median image quality of 3.0. The 300-millisecond reconstruction phase provided the highest image quality; 70% of patients showed diagnostic image quality. Combination of all phases (250-400 milliseconds) performed significantly better than single or other phase combinations (P < 0.0005 for all comparisons). Inter-reader variability for stenosis detection was excellent, with 98.4% concordance by using a binary scale (50% stenosis cutoff). CONCLUSIONS Prospective ECG-triggered sequential dual-source CT acquisition with the use of end-systolic acquisition provides diagnostic image quality with potentially low radiation doses for evaluation of CAD in patients with AF. Use of multiple end-systolic phases over a 150-millisecond window improves diagnostic image quality.
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Affiliation(s)
- Monvadi B Srichai
- Department of Medicine, Cardiology Division, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 5PHC, Washington, DC 20007, USA.
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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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Methodological quality of diagnostic accuracy studies on non-invasive coronary CT angiography: influence of QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) items on sensitivity and specificity. Eur Radiol 2013; 23:1603-22. [PMID: 23322410 DOI: 10.1007/s00330-012-2763-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/29/2012] [Accepted: 12/10/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the methodological quality of diagnostic accuracy studies on coronary computed tomography (CT) angiography using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) tool. METHODS Each QUADAS item was individually defined to adapt it to the special requirements of studies on coronary CT angiography. Two independent investigators analysed 118 studies using 12 QUADAS items. Meta-regression and pooled analyses were performed to identify possible effects of methodological quality items on estimates of diagnostic accuracy. RESULTS The overall methodological quality of coronary CT studies was merely moderate. They fulfilled a median of 7.5 out of 12 items. Only 9 of the 118 studies fulfilled more than 75 % of possible QUADAS items. One QUADAS item ("Uninterpretable Results") showed a significant influence (P = 0.02) on estimates of diagnostic accuracy with "no fulfilment" increasing specificity from 86 to 90 %. Furthermore, pooled analysis revealed that each QUADAS item that is not fulfilled has the potential to change estimates of diagnostic accuracy. CONCLUSIONS The methodological quality of studies investigating the diagnostic accuracy of non-invasive coronary CT is only moderate and was found to affect the sensitivity and specificity. An improvement is highly desirable because good methodology is crucial for adequately assessing imaging technologies. KEY POINTS • Good methodological quality is a basic requirement in diagnostic accuracy studies. • Most coronary CT angiography studies have only been of moderate design quality. • Weak methodological quality will affect the sensitivity and specificity. • No improvement in methodological quality was observed over time. • Authors should consider the QUADAS checklist when undertaking accuracy studies.
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Patient-specific predictors of image noise in coronary CT angiography. J Cardiovasc Comput Tomogr 2013; 7:39-45. [DOI: 10.1016/j.jcct.2012.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/02/2012] [Accepted: 10/05/2012] [Indexed: 01/23/2023]
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