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Demircioğlu A, Bos D, Demircioğlu E, Qaadan S, Glasmachers T, Bruder O, Umutlu L, Nassenstein K. Deep learning-based scan range optimization can reduce radiation exposure in coronary CT angiography. Eur Radiol 2024; 34:411-421. [PMID: 37552254 DOI: 10.1007/s00330-023-09971-9] [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: 12/27/2022] [Revised: 04/24/2023] [Accepted: 05/28/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Cardiac computed tomography (CT) is essential in diagnosing coronary heart disease. However, a disadvantage is the associated radiation exposure to the patient which depends in part on the scan range. This study aimed to develop a deep neural network to optimize the delimitation of scan ranges in CT localizers to reduce the radiation dose. METHODS On a retrospective training cohort of 1507 CT localizers randomly selected from calcium scoring and angiography scans and acquired between 2010 and 2017, optimized scan ranges were delimited by two radiologists in consensus. A neural network was trained to reproduce the scan ranges and was tested on two randomly selected and independent validation cohorts: an internal cohort of 233 CT localizers (January 2018-June 2020) and an external cohort from a nearby hospital of 298 CT localizers (July 2020-December 2020). Localizers where a bypass surgery was visible were excluded. The effective radiation dose to the patient was simulated using a Monte Carlo simulation. Scan ranges of radiographers, radiologists, and the network were compared using an equivalence test; likewise, the reduction in effective dose was tested using a superior test. RESULTS The network replicated the radiologists' scan ranges with a Dice score of 96.5 ± 0.02 (p < 0.001, indicating equivalence). The generated scan ranges resulted in an effective dose reduction of 10.0% (p = 0.002) in the internal cohort and 12.6% (p < 0.001) in the external cohort compared to the scan ranges delimited by radiographers in clinical routine. CONCLUSIONS Automatic delimitation of the scan range can result in a radiation dose reduction to the patient. CLINICAL RELEVANCE STATEMENT Fully automated delimitation of the scan range using a deep neural network enables a significant reduction in radiation exposure during CT coronary angiography compared to manual examination planning. It can also reduce the workload of the radiographers. KEY POINTS • Scan range delimitation for coronary computed tomography angiography could be performed with high accuracy by a deep neural network. • Automated scan ranges showed a high agreement of 96.5% with the scan ranges of radiologists. • Using a Monte Carlo simulation, automated scan ranges reduced the effective dose to the patient by up to 12.6% (0.9 mSv) compared to the scan ranges of radiographers in clinical routine.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ender Demircioğlu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, 45147, Essen, Germany
| | - Sahar Qaadan
- Department of Mechatronics and Artificial Intelligence Engineering, German Jordanian University, Madaba, JO-11180, Jordan
| | - Tobias Glasmachers
- Faculty of Computer Science, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, 45138, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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Leiknes JB, Hiorth A, Havnen J, Greve OJ, Kurz KD, Larsen AI. Estimating cardiac output from coronary CT angiography: an individualized compartment model in comparison to the Stewart-Hamilton method. Front Cardiovasc Med 2023; 10:1156332. [PMID: 38054087 PMCID: PMC10694230 DOI: 10.3389/fcvm.2023.1156332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/10/2023] [Indexed: 12/07/2023] Open
Abstract
Background Attenuation is correlated with the concentration of contrast medium (CM) in the arteries. The cardiac output (CO) affects the concentration of CM in the circulatory system; therefore, CO affects the time-density curve (TDC). Thus, estimating CO using TDC from test-bolus images acquired in computed tomography (CT) is possible. In this study, we compare two methods of estimating CO, namely, an individualized mathematical compartment model, integrating patient, contrast, and scanning factors with TDC, and the Stewart-Hamilton method based on the area under the curve of the TDC. Materials and methods Attenuation in the aorta was measured during test-bolus in 40 consecutive patients with a clinical indication for coronary CT angiography (CCTA). Each participant underwent cardiac magnetic resonance imaging following CCTA to validate the estimated CO. The individual compartment model used TDC in conjunction with scanning and patient-specific parameters to estimate the concentration of CM and CO over time. This was compared to the CO calculated from the area under the curve using the Stewart-Hamilton method. Results Both CO estimated with our individualized compartment model (r = 0.66, p < 0.01) and the Stewart-Hamilton method (r = 0.53, p < 0.01) were moderately correlated with CO measured with cardiac MRI. Body surface area (BSA) and time to peak (TTP) affected the accuracy of our model. Lower BSA resulted in overestimation, and lower TTP resulted in CO underestimation, respectively. We found no gender-specific difference in the accuracy of our model when correcting for BSA. The Stewart-Hamilton method performed better with a more complete TDC, whereas the compartment model performed better overall with a partial TDC. Conclusion The TDC acquired in CCTA allows for CO estimation. Both the Stewart-Hamilton method and our mathematical compartment model show moderate correlation when applied to our data, although each method has its strengths and limitations. If the majority of the TDC is known, the Stewart-Hamilton method may be more reliable, but an individual compartment model is preferable when there are insufficient data points in the TDC. Regardless, both methods can potentially increase the diagnostic information acquired from a CCTA, which is increasingly recommended in clinical guidelines.
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Affiliation(s)
- Jon Bjarne Leiknes
- Stavanger Medical Imaging Laboratory, Department of Radiology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Aksel Hiorth
- Department of Energy Resources, University of Stavanger, Stavanger, Norway
| | - Jorunn Havnen
- Stavanger Medical Imaging Laboratory, Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Ole Jacob Greve
- Stavanger Medical Imaging Laboratory, Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Kathinka Dæhli Kurz
- Stavanger Medical Imaging Laboratory, Department of Radiology, Stavanger University Hospital, Stavanger, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Integrating Coronary Atherosclerosis Burden and Progression with Coronary Artery Disease Risk Factors to Guide Therapeutic Decision Making. Am J Med 2023; 136:260-269.e7. [PMID: 36509122 DOI: 10.1016/j.amjmed.2022.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Although atherosclerosis represents the primary driver of coronary artery disease, evaluation and treatment approaches have historically relied upon indirect markers of atherosclerosis that include surrogates (cholesterol), signs (angina), and sequelae (ischemia) of atherosclerosis. Direct quantification and characterization of atherosclerosis may encourage a precision heart care paradigm that improves diagnosis, risk stratification, therapeutic decision-making, and longitudinal disease tracking in a personalized fashion. OBSERVATIONS The American College of Cardiology Innovations in Prevention Working Group introduce the Atherosclerosis Treatment Algorithms that personalize medical interventions based upon atherosclerosis findings from coronary computed tomography angiography (CTA) and cardiovascular risk factors. Through integration of coronary CTA-based atherosclerosis evaluation, clinical practice guidelines, and contemporary randomized controlled trial evidence, the Atherosclerosis Treatment Algorithms leverage patient-specific atherosclerosis burden and progression as primary targets for therapeutic intervention. After defining stages of atherosclerosis severity by coronary CTA, Atherosclerosis Treatment Algorithms are described for worsening stages of atherosclerosis for patients with lipid disorders, diabetes, hypertension, obesity, and tobacco use. The authors anticipate a rapid pace of research in the field, and conclude by providing perspectives on future needs that may improve efforts to optimize precision prevention of coronary artery disease. Importantly, the Atherosclerosis Treatment Algorithms are not endorsed by the American College of Cardiology, and should not be interpreted as a statement of American College of Cardiology policy. CONCLUSIONS AND RELEVANCE We describe a precision heart care approach that emphasizes atherosclerosis as the primary disease target for evaluation and treatment. To our knowledge, this is the first proposal to use coronary atherosclerosis burden and progression to personalize therapy selection and therapy changes, respectively. DISCLOSURE The American College of Cardiology Foundation has made an investment in Cleerly, Inc., makers of a software solution that utilizes coronary CT angiography findings to evaluate coronary artery disease.
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Radiation Dose Reduction Opportunities in Vascular Imaging. Tomography 2022; 8:2618-2638. [PMID: 36287818 PMCID: PMC9607049 DOI: 10.3390/tomography8050219] [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: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for vascular pathology. However, the radiation dose experienced by the patient during imaging has long been a concern of this image acquisition method. Advancements in CT image acquisition techniques in combination with advancements in non-ionizing radiation imaging techniques including magnetic resonance angiography (MRA) and contrast-enhanced ultrasound (CEUS) present growing opportunities to reduce total radiation dose to patients. This review provides an overview of advancements in imaging technology and acquisition techniques that are helping to minimize radiation dose associated with vascular imaging.
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Huang Z, Guo S, Fu C, Zhou W, Stalin A, Zhang J, Liu X, Jia S, Wu C, Lu S, Li B, Wu Z, Tan Y, Fan X, Cheng G, Mou Y, Wu J. Identification of molecular mechanisms underlying the therapeutic effects of Xintong granule in coronary artery disease by a network pharmacology and molecular docking approach. Medicine (Baltimore) 2022; 101:e29829. [PMID: 35801781 PMCID: PMC9259182 DOI: 10.1097/md.0000000000029829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Coronary artery disease (CAD) is a cardiovascular disease characterized by atherosclerosis, angiogenesis, thrombogenesis, inflammation, etc. Xintong granule (XTG) is considered a practical therapeutic strategy in China for CAD. Although its therapeutic role in CAD has been reported, the molecular mechanisms of XTG in CAD have not yet been explored. A network pharmacology approach including drug-likeness (DL) evaluation, oral bioavailability (OB) prediction, protein-protein interaction (PPI) network construction and analysis, and Gene Ontology term and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses was used to predict the active ingredients, potential targets, and molecular mechanisms of XTG associated with the treatment of CAD. Molecular docking analysis was performed to investigate the interactions between the active compounds and the underlying targets. Fifty-one active ingredients of XTG and 294 CAD-related targets were screened for analysis. Gene Ontology enrichment analysis showed that the therapeutic targets of XTG in CAD are mainly involved in blood circulation and vascular regulation. KEGG pathway analysis indicated that XTG intervenes in CAD mainly through the regulation of fluid shear stress and atherosclerosis, the AGE-RAGE signaling pathway in diabetic complications, and the relaxin signaling pathway. Molecular docking analysis showed that each key active ingredient (quercetin, luteolin, kaempferol, stigmasterol, resveratrol, fisetin, gamma-sitosterol, and beta-sitosterol) of XTG can bind to the core targets of CAD (AKT1, JUN, RELA, MAPK8, NFKB1, EDN1, and NOS3). The present study revealed the CAD treatment-related active ingredients, underlying targets, and potential molecular mechanisms of XTG acting by regulating fluid shear stress and atherosclerosis, AGE-RAGE signaling pathway in diabetic complications, and relaxin signaling pathway.
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Affiliation(s)
- Zhihong Huang
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Siyu Guo
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Changgeng Fu
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Zhou
- China-Japan Friendship Hospital, Beijing, China
| | - Antony Stalin
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingyuan Zhang
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xinkui Liu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Shanshan Jia
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Wu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Shan Lu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Bingbing Li
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhishan Wu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yingying Tan
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaotian Fan
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Guoliang Cheng
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Shandong Lunan Pharmaceutical Group Co. Ltd., Linyi, China
- College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yanfang Mou
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Shandong Lunan Pharmaceutical Group Co. Ltd., Linyi, China
| | - Jiarui Wu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jiarui Wu (e-mail: )
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Low-Dose High-Resolution Photon-Counting CT of the Lung: Radiation Dose and Image Quality in the Clinical Routine. Diagnostics (Basel) 2022; 12:diagnostics12061441. [PMID: 35741251 PMCID: PMC9221815 DOI: 10.3390/diagnostics12061441] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 01/09/2023] Open
Abstract
This study aims to investigate the qualitative and quantitative image quality of low-dose high-resolution (LD-HR) lung CT scans acquired with the first clinical approved photon counting CT (PCCT) scanner. Furthermore, the radiation dose used by the PCCT is compared to a conventional CT scanner with an energy-integrating detector system (EID-CT). Twenty-nine patients who underwent a LD-HR chest CT scan with dual-source PCCT and had previously undergone a LD-HR chest CT with a standard EID-CT scanner were retrospectively included in this study. Images of the whole lung as well as enlarged image sections displaying a specific finding (lesion) were evaluated in terms of overall image quality, image sharpness and image noise by three senior radiologists using a 5-point Likert scale. The PCCT images were reconstructed with and without a quantum iterative reconstruction algorithm (PCCT QIR+/−). Noise and signal-to-noise (SNR) were measured and the effective radiation dose was calculated. Overall, image quality and image sharpness were rated best in PCCT (QIR+) images. A significant difference was seen particularly in image sections of PCCT (QIR+) images compared to EID-CT images (p < 0.005). Image noise of PCCT (QIR+) images was significantly lower compared to EID-CT images in image sections (p = 0.005). In contrast, noise was lowest on EID-CT images (p < 0.001). The PCCT used significantly less radiation dose compared to the EID-CT (p < 0.001). In conclusion, LD-HR PCCT scans of the lung provide better image quality while using significantly less radiation dose compared to EID-CT scans.
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He W, Chen X, Hu R, Sun W, Tan W. Influence of Contrast Agent Injection Scheme Customized by Dual-Source CT Based on Automatic Tube Voltage Technology on Image Quality and Radiation Dose of Coronary Artery Imaging. Front Surg 2022; 9:862697. [PMID: 35449554 PMCID: PMC9018106 DOI: 10.3389/fsurg.2022.862697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the influence of a contrast agent injection scheme customized by dual-source CT based on automatic tube voltage technology on coronary imaging image quality and radiation dose. Methods A total of 205 patients who underwent coronary CT angiography (CCTA) in our hospital from June 2021 to September 2021 were selected. 105 patients in the control group who underwent routine scanning according to body mass (BMI) and 100 patients in the observation group who set tube voltage and contrast agent dosage according to automatic tube voltage selection technology. CT values of the aortic root (AO); left anterior descending (LAD) branch; proximal, middle, and distal segments of the right coronary artery (RCA); and proximal and distal segments of left circumflex (LCX) branch were measured. We calculated the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the image. Image quality scoring and effective dose (ED) calculation were carried out. Results There was no significant difference in the CT value, SNR value, and CNR value of each part of the artery between the two groups (P > 0.05). Image quality scores of the control group and the observation group were 1.28 ± 0.25 and 1.25 ± 0.23, respectively, and there was no significant difference in scores (P > 0.05). In the control group, the dosage of comparator was 43.81 ± 6.74 ml, and the ED was 4.92 ± 1.26 mSv. The dosage of contrast agent in the observation group was 34.23 ± 6.39 ml, and ED was 3.05 ± 0.94 mSv. The dosage of contrast agent and ED in the observation group were lower than those in the control group (P < 0.05). Conclusion The contrast agent injection scheme customized by dual-source CT based on automatic tube voltage technology can meet the clinical requirements of coronary image quality, reduce the radiation dose and contrast agent consumption, and help doctors choose a more accurate and reasonable examination scheme, which has certain clinical application value.
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Affiliation(s)
- Weiling He
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xin Chen
- Diagnostic Radiology Department, Hunan Cancer Hospital, Changsha, China
| | - Rui Hu
- Interventional Vascular Surgery Department, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wenjie Sun
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Weili Tan
- Diagnostic Radiology Department, Hunan Cancer Hospital, Changsha, China
- *Correspondence: Weili Tan
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Pandya A, Yu YJ, Ge Y, Nagel E, Kwong RY, Bakar RA, Grizzard JD, Merkler AE, Ntusi N, Petersen SE, Rashedi N, Schwitter J, Selvanayagam JB, White JA, Carr J, Raman SV, Simonetti OP, Bucciarelli-Ducci C, Sierra-Galan LM, Ferrari VA, Bhatia M, Kelle S. Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease. J Cardiovasc Magn Reson 2022; 24:1. [PMID: 34986851 PMCID: PMC8734365 DOI: 10.1186/s12968-021-00833-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs. METHODS We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR Cost-Effectiveness Calculator) based on a larger CMR cost-effectiveness simulation model that can approximate CMR lifetime discount cost, QALY, and cost effectiveness compared to relevant comparators [such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA)] or invasive coronary angiography. RESULTS CMR was cost-effective for evaluation of significant CAD (either health-improving and cost saving or having a cost-per-QALY or cost-per-life-year result lower than the cost-effectiveness threshold) versus its relevant comparator in 10 out of 15 studies, with 3 studies reporting uncertain cost effectiveness, and 2 studies showing CCTA was optimal. Our cost-effectiveness calculator showed that CCTA was not cost-effective in the US compared to CMR when the most recent publications on imaging performance were included in the model. CONCLUSIONS Based on current world-wide evidence in the literature, CMR usually represents a cost-effective option compared to relevant comparators to assess for significant CAD.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA.
| | - Yuan-Jui Yu
- National Taiwan University Hospital, Taipei, Taiwan
| | - Yin Ge
- Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, Partner Site RheinMain, University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Raymond Y Kwong
- Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rafidah Abu Bakar
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University Medical Center, Main Hospital, Richmond, VA, USA
| | - Alexander E Merkler
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Nina Rashedi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juerg Schwitter
- Division of Cardiology, Cardiovascular Department, CMR Center University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, UniL, Lausanne, Switzerland
| | - Joseph B Selvanayagam
- Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Orlando P Simonetti
- Departments of Internal Medicine and Radiology, The Ohio State University, Columbus, OH, USA
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals and School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lilia M Sierra-Galan
- Cardiovascular Division, Department of Cardiology, American British Cowdray Medical Center, Mexico City, Mexico
| | - Victor A Ferrari
- Cardiovascular Division and Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
- Department of Internal Medicine and Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, German Heart Institute Berlin (DHZB), Berlin, Germany
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Aslam A, Stojanovska J, Khokhar US, Weinberg RL, Ganesh SK, Labounty T, Sutton NR, Patel S. Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity-A Primer for Cardiac Imagers. Radiographics 2021; 41:1897-1915. [PMID: 34652974 DOI: 10.1148/rg.2021210062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction in young and middle-aged women that has gained increasing awareness in recent years. Its diagnosis presents a challenge. Invasive coronary angiography is the primary imaging modality for diagnosing SCAD; however, it carries risk in these patients, who have an increased predisposition to complications. Advances in CT technology enable robust noninvasive evaluation of the coronary arteries at low radiation doses and have been increasingly utilized for the diagnosis or resolution of SCAD, in hemodynamically stable patients or when diagnosis of SCAD is uncertain at invasive angiography, particularly in proximal vessels. However, criteria for the diagnosis of SCAD with use of coronary CT angiography (CCTA) have not been currently established, and sensitivity and specificity for diagnosis have not yet been defined. The appearance of SCAD at CCTA can be subtle and can be missed, especially in distal small-caliber coronary arteries; hence utilization of other noninvasive imaging multimodalities may help solve this diagnostic challenge. Accurate and prompt diagnosis is vital, as management of SCAD differs significantly from that of traditional atherosclerotic acute coronary syndromes, with conservative management preferred for the majority of SCAD patients, and invasive treatment reserved for those with ongoing or recurrent ischemia, heart failure, or hemodynamic compromise. The goal of this review is twofold: (a) to discuss the potential role of CCTA in the diagnosis of SCAD, and (b) to discuss the role of multimodality imaging that may improve diagnostic yield, guide management, and enable subsequent surveillance. An invited commentary by Ordovas is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Anum Aslam
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Jadranka Stojanovska
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Usman S Khokhar
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Richard L Weinberg
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Santhi K Ganesh
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Troy Labounty
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Nadia R Sutton
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Smita Patel
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
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10
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Computed tomography of coronary artery atherosclerosis: A review. J Med Imaging Radiat Sci 2021; 52:S19-S39. [PMID: 34479831 DOI: 10.1016/j.jmir.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022]
Abstract
Coronary artery atherosclerosis resulting in ischemic cardiac disease is the leading cause of mortality in the United States. In symptomatic patients, invasive diagnostic methods like catheter angiography, intravascular ultrasound, or vascular endoscopy may be used. However, for primary prevention of atherosclerotic coronary artery disease in asymptomatic patients, non-invasive methods are more commonly utilized like stress imaging, single-photon emission computed tomography (SPECT) and coronary artery calcification scoring. Coronary computed tomographic angiography (CCTA) is an excellent diagnostic tool for detection of coronary artery plaque and ability to identify resultant stenoses with an excellent negative predictive value which can potentially result in optimal exclusion of the presence of coronary artery disease. Long term follow up after a negative CCTA has repeatedly demonstrated very low incidence of future adverse coronary events, attesting its predictive value. CCTA based management is associated with improved CAD outcome in stable angina. Coronary CTA is valuable in acute chest pain evaluation in the emergency department helping in better triage. CT perfusion and CT-FFR are both very promising tools for assessment of hemodynamic significance of coronary artery stenosis.
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11
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Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-1203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [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: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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12
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Yang T, Yu H. Diagnostic Value of Multi-Row Spiral CT Imaging in Emergency Connoisseurs Injury Combined with Shock. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this paper, multi-slice spiral CT imaging is used to diagnose emergency connoisseurs injury hemorrhagic shock and brain perfusion scans in patients with the connoisseur’s injury. The EDS spectrum of multi-slice spiral CT obtained Perfusion imaging as the perfusion parameters.
The patient’s CTA and volume reproduction images can be displayed at the same time. The patient’s diagnostic relationship can be visually observed. The best results set up two recommended schemes and compare the perfusion parameters and radiation dose with the standard control
group. Ensuring the image quality required for diagnosis and effectively reducing the radiation, it had great diagnostic value in emergency connoisseurs injury which combined with shock. Three-dimensional image reconstruction results of this study can observe the anatomical positional relationship
between intracranial lesions and surrounding skulls, skulls, and other important structures before surgery. The design of the bony window provides a more intuitive and convenient basis and guarantee for the preoperative evaluation of the neurosurgery operation and the smooth operation of the
operation.
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Affiliation(s)
- Ting Yang
- Jiangnan University Affiliated Hospital (Formerly Wuxi Third People’s Hospital), WuXi, Jiangsu 214000, China
| | - Hui Yu
- Jiangnan University Affiliated Hospital (Formerly Wuxi Third People’s Hospital), WuXi, Jiangsu 214000, China
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13
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Bays HE, Khera A, Blaha MJ, Budoff MJ, Toth PP. Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging"). Am J Prev Cardiol 2021; 6:100176. [PMID: 34327499 PMCID: PMC8315431 DOI: 10.1016/j.ajpc.2021.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published "Ten Things to Know About Ten Cardiovascular Disease Risk Factors." Similarly, this "ASPC Top Ten Imaging" summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk - both important in preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville KY 40213 USA
| | - Amit Khera
- UT Southwestern Medical Center, Dallas, TX USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore MD USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA USA
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081 USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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14
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Boden WE, Stone PH. To stent or not to stent? Treating angina after ISCHEMIA-why a conservative approach with optimal medical therapy is the preferred initial management strategy for chronic coronary syndromes: insights from the ISCHEMIA trial. Eur Heart J 2021; 42:1394-1400. [PMID: 33827137 DOI: 10.1093/eurheartj/ehab069.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- William E Boden
- VA New England Healthcare System, Boston University School of Medicine, VA Boston Campus, 150 S. Huntington Avenue, Boston, MA 02130, USA
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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15
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Zhao Y, Li D, Liu Z, Geng X, Zhang T, Xu Y. Comparison of image quality and radiation dose using different pre-ASiR-V and post-ASiR-V levels in coronary computed tomography angiography. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:125-134. [PMID: 33164983 DOI: 10.3233/xst-200754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine the optimal pre-adaptive and post-adaptive level statistical iterative reconstruction V (ASiR-V) for improving image quality and reducing radiation dose in coronary computed tomography angiography (CCTA). METHODS The study was divided into two parts. In part I, 150 patients for CCTA were prospectively enrolled and randomly divided into 5 groups (A, B, C, D, and E) with progressive scanning from 40% to 80% pre-ASiR-V with 10% intervals and reconstructing with 70% post-ASiR-V. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was assessed using a 5-point scale. The CT dose index volume (CTDIvol) and dose-length product (DLP) of each patient were recorded and the effective radiation dose (ED) was calculated after statistical analysis by optimizing for the best pre-ASiR-V value with the lowest radiation dose while maintaining overall image quality. In part II, the images were reconstructed with the recommended optimal pre-ASiR-V values in part I (D group) and 40%-90% of post-ASiR-V. The reconstruction group (D group) was divided into 6 subgroups (interval 10%, D0:40% post-ASiR-V, D1:50% post - ASiR-V, D2:60% post-ASiR-V, D3:70% post-ASiR-V, D4:80% post-ASiR-V, and D5:90% post-ASiR-V).The SNR and CNR of D0-D5 subgroups were calculated and analyzed using one-way analysis of variance, and the consistency of the subjective scores used the k test. RESULTS There was no significant difference in the SNRs, CNRs, and image quality scores among A, B, C, and D groups (P > 0.05). The SNR, CNR, and image quality scores of the E group were lower than those of the A, B, C, and D groups (P < 0.05). The mean EDs in the B, C, and D groups were reduced by 7.01%, 13.37%, and 18.87%, respectively, when compared with that of the A group. The SNR and CNR of the D4-D5 subgroups were higher than the D0-D3 subgroups, and the image quality scores of the D4 subgroups were higher than the other subgroups (P < 0.05). CONCLUSION The wide-detector combined with 70% pre-ASiR-V and 80% post-ASiR-V significantly reduces the radiation dose of CCTA while maintaining overall image quality as compared with the manufacture's recommendation of 40% pre-ASiR-V.
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Affiliation(s)
- Yongxia Zhao
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Dongxue Li
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Zhichao Liu
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Xue Geng
- Department of Radiology, Baoding No. 2 Hospital, Baoding, China
| | - Tianle Zhang
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Yize Xu
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
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16
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Schicchi N, Fogante M, Palumbo P, Agliata G, Esposto Pirani P, Di Cesare E, Giovagnoni A. The sub-millisievert era in CTCA: the technical basis of the new radiation dose approach. Radiol Med 2020; 125:1024-1039. [PMID: 32930945 DOI: 10.1007/s11547-020-01280-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit-risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose.
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Affiliation(s)
- Nicolò Schicchi
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
| | - Marco Fogante
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy.
| | - Pierpaolo Palumbo
- Radiology Department, Azienda Ospedaliero Universitaria "San Salvatore", 60126, L'Aquila, Italy
| | - Giacomo Agliata
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
| | - Paolo Esposto Pirani
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
| | - Ernesto Di Cesare
- Radiology Department, Azienda Ospedaliero Universitaria "San Salvatore", 60126, L'Aquila, Italy
| | - Andrea Giovagnoni
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
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17
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Cho MS, Roh JH, Park H, Cho SC, Kang DY, Lee PH, Ahn JM, Koo HJ, Yang DH, Kang JW, Park SJ, Patel MR, Park DW. Practice Pattern, Diagnostic Yield, and Long-Term Prognostic Impact of Coronary Computed Tomographic Angiography. J Am Heart Assoc 2020; 9:e016620. [PMID: 32896194 PMCID: PMC7726974 DOI: 10.1161/jaha.120.016620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic-therapeutic cascade and clinical outcomes. Methods and Results We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long-term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5-year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%; P<0.001; adjusted hazard ratio [95% CI], 1.34 [1.17-1.54]). However, obstructive CAD on CTA had limited added value over conventional risk factors for predicting death or myocardial infarction. Conclusions Although the use of coronary CTA had substantially increased, CTA had a low diagnostic yield for obstructive CAD, especially in asymptomatic patients. The use of CTA in asymptomatic patients seemed to have led to inappropriate subsequent diagnostic or therapeutic interventions without clinical benefit.
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Affiliation(s)
- Min Soo Cho
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jae-Hyung Roh
- Department of Cardiology Chungnam National University Hospital Daejeon Korea
| | - Hanbit Park
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sang-Cheol Cho
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Do-Yoon Kang
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Pil Hyung Lee
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jung-Min Ahn
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seung-Jung Park
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Manesh R Patel
- Duke Clinical Research Institute Duke University Durham NC
| | - Duk-Woo Park
- Department of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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18
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Li RF, Hou CL, Zhou H, Dai YS, Jin LQ, Xi Q, Zhang JH. Comparison on radiation effective dose and image quality of right coronary artery on prospective ECG-gated method between 320 row CT and 2nd generation (128-slice) dual source CT. J Appl Clin Med Phys 2020; 21:256-262. [PMID: 32510768 PMCID: PMC7484880 DOI: 10.1002/acm2.12911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/09/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
This retrospective study was to compare the image quality of right coronary artery (RCA) and effective radiation dose on prospective ECG‐gated method between 320 row computed tomography (CT) and 2nd generation (128‐slice) dual source CT. A total of 215 candidates underwent CT coronary angiography using prospective ECG‐gated method, 120 patients enrolled in 320 row CT group, and 95 patients in dual source CT group. We divided RCA image quality scores as 1/2/3/4, which means excellent/good/adequate/not assessable and heart rates were considered, as well as the radiation dose. There is no statistically significant difference of RCA image quality of Score 1/2 between 320 row CT and 2nd generation dual source CT, but lower heart rate (<70/min) improved RCA image quality. Meanwhile, the 2nd generation dual source CT scan have significant lower radiation dose. For patients with high level heart rate variation, both prospective ECG‐gated method of 320 row CT scan (Toshiba) and 2nd generation dual source CT scan (Siemens) basically provided good image quality on RCA. There is an advantage of effective radiation dose reduction in prospective ECG‐gated method using the 2nd generation dual source CT scan. After the iodine contrast agent was injected into elbow vein, the threshold triggering method was used to carry out prospective gated scanning, and the acquired fault image was reconstructed by the standard post‐processing software of each manufacturer. The radiation dose value is obtained through the dose report automatically generated after each scan.
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Affiliation(s)
- Ren-Feng Li
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang-Long Hou
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huang Zhou
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Shan Dai
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Qin Jin
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian Xi
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian-Hua Zhang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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19
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Rehani MM, Szczykutowicz TP, Zaidi H. CT is still not a low‐dose imaging modality. Med Phys 2020; 47:293-296. [DOI: 10.1002/mp.14000] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Madan M. Rehani
- Radiology Department Massachusetts General Hospital 175 Cambridge Str., Suite 244 Boston MA 02114USA
| | - Timothy P. Szczykutowicz
- Departments of Radiology, Medical Physics, and Biomedical Engineering University of Wisconsin‐Madison Madison WI USA
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20
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Li JJ, Zeng M. Clinical impact of low-radiation computed tomography coronary angiography diagnosis for coronary artery stenosis: Study Protocol. Medicine (Baltimore) 2019; 98:e17474. [PMID: 31725604 PMCID: PMC6867739 DOI: 10.1097/md.0000000000017474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this study aims to assess the clinic impact of low-radiation computed tomography coronary angiography (LR-CTCA) diagnosis for coronary artery stenosis (CAS). METHODS This study will comprehensively search the following electronic databases from inception to the present: PUBMED, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, VIP database, WANGFANG, and China National Knowledge Infrastructure. All these electronic databases will be searched without language restrictions. All case-controlled studies on assessing the clinical impact of LR-CTCA diagnosis for patients with CAS will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be utilized to evaluate the methodological quality for each qualified studies. RESULTS We will assess the clinic impact of LR-CTCA diagnosis for CAS by measuring sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION The results of this study will summarize the latest evidence of LR-CTCA diagnosis for CAS. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139336.
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Affiliation(s)
- Jian-Jun Li
- Department of CT Diagnosis, Yan’an People's Hospital, Yan’an, China
| | - Ming Zeng
- Department of Radiology, Yan’an Hospital of Traditional Chinese Medicine, Yan’an, China
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