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Carney JP, Bianco RW. Multimodal preoperative imaging for transcatheter mitral valve replacement in the domestic sheep model. Sci Rep 2024; 14:11745. [PMID: 38778204 PMCID: PMC11111800 DOI: 10.1038/s41598-024-62646-3] [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: 02/23/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
Preclinical in vivo evaluation is an essential step in the progression of new cardiac devices into patient use, with studies predominantly performed in the domestic sheep model. A growing area of interest in cardiac device development is transcatheter mitral valve replacement (TMVR). Clinically, multimodal imaging, or computed tomography (CT) and echocardiography (echo) are used extensively to preoperatively determine mitral valve morphology prior to an intervention, but there is no description on how these modalities can be implemented to support preclinical studies. The purpose of this study is to apply clinically relevant CT and echo acquisition and assessment techniques to a large group of naive research sheep in order to analyze and report modality-related effects on mitral valve dimensional reference intervals in the sheep model. To this end, fifty-five adult domestic sheep underwent preoperative CT and echo exams and resultant images were analyzed using a landmark-based multiplanar measurement protocol and compiled into a master dataset for statistical analysis. We found moderate agreement between CT and echo-derived measurements of the mitral valve in sheep and propose the first clinically-relevant dimensional indices for the sheep's naive mitral valve which can be used to guide future studies evaluating novel TMVR devices. This study is the first of its kind in proposing a reproducible method for detailed examination of the mitral valve in the sheep model using clinically-relevant multimodal imaging. As in patients, CT and echo can reveal accurate native mitral valve dimensions in the sheep prior to preclinical TMVR studies.
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Affiliation(s)
- John P Carney
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota Minneapolis, 425 East River Parkway KE B18, Minneapolis, MN, 55455, USA.
| | - Richard W Bianco
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota Minneapolis, 425 East River Parkway KE B18, Minneapolis, MN, 55455, USA
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2
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Condliffe R, Durrington C, Hameed A, Lewis RA, Venkateswaran R, Gopalan D, Dorfmüller P. Clinical-radiological-pathological correlation in pulmonary arterial hypertension. Eur Respir Rev 2023; 32:230138. [PMID: 38123231 PMCID: PMC10731450 DOI: 10.1183/16000617.0138-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023] Open
Abstract
Pulmonary hypertension (PH) is defined by the presence of a mean pulmonary arterial pressure >20 mmHg. Current guidelines describe five groups of PH with shared pathophysiological and clinical features. In this paper, the first of a series covering all five PH classification groups, the clinical, radiological and pathological features of pulmonary arterial hypertension (PAH) will be reviewed. PAH may develop in the presence of associated medical conditions or a family history, following exposure to certain medications or drugs, or may be idiopathic in nature. Although all forms of PAH share common histopathological features, the presence of certain pulmonary arterial abnormalities, such as plexiform lesions, and extent of co-existing pulmonary venous involvement differs between the different subgroups. Radiological investigations are key to diagnosing the correct form of PH and a systematic approach to interpretation, especially of computed tomography, is essential.
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Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
- National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, UK
- These authors contributed equally to this work
| | - Charlotte Durrington
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Robert A Lewis
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Rajamiyer Venkateswaran
- Department of Heart and Lung Transplantation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
- These authors contributed equally to this work
| | - Peter Dorfmüller
- Department of Pathology, University Hospital of Giessen and Marburg, Giessen, Germany
- Institute for Lung Health, Giessen, Germany
- These authors contributed equally to this work
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Xu Y, Hrybouski S, Paterson DI, Li Z, Lan Y, Luo L, Shen X, Xu L. Comparison of epicardial adipose tissue volume quantification between ECG-gated cardiac and non-ECG-gated chest computed tomography scans. BMC Cardiovasc Disord 2022; 22:545. [PMID: 36513994 PMCID: PMC9746017 DOI: 10.1186/s12872-022-02958-2] [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: 04/04/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study investigated accuracy and consistency of epicardial adipose tissue (EAT) quantification in non-ECG-gated chest computed tomography (CT) scans. METHODS EAT volume was semi-automatically quantified using a standard Hounsfield unit threshold (- 190, - 30) in three independent cohorts: (1) Cohort 1 (N = 49): paired 120 kVp ECG-gated cardiac non-contrast CT (NCCT) and 120 kVp non-ECG-gated chest NCCT; (2) Cohort 2 (N = 34): paired 120 kVp cardiac NCCT and 100 kVp non-ECG-gated chest NCCT; (3) Cohort 3 (N = 32): paired non-ECG-gated chest NCCT and chest contrast-enhanced CT (CECT) datasets (including arterial phase and venous phase). Images were reconstructed with the slice thicknesses of 1.25 mm and 5 mm in the chest CT datasets, and 3 mm in the cardiac NCCT datasets. RESULTS In Cohort 1, the chest NCCT-1.25 mm EAT volume was similar to the cardiac NCCT EAT volume, while chest NCCT-5 mm underestimated the EAT volume by 7.5%. In Cohort 2, 100 kVp chest NCCT-1.25 mm were 13.2% larger than 120 kVp cardiac NCCT EAT volumes. In Cohort 3, the chest arterial CECT and venous CECT dataset underestimated EAT volumes by ~ 28% and ~ 18%, relative to chest NCCT datasets. All chest CT-derived EAT volumes were similarly associated with significant coronary atherosclerosis with cardiac CT counterparts. CONCLUSION The 120 kVp non-ECG-gated chest NCCT-1.25 mm images produced EAT volumes comparable to cardiac NCCT. Chest CT EAT volumes derived from consistent imaging settings are excellent alternatives to the cardiac NCCT to investigate their association with coronary artery disease.
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Affiliation(s)
- Yuancheng Xu
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Stanislau Hrybouski
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - D. Ian Paterson
- Department of Cardiology, Mackenzie Health Science Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Zhiyang Li
- Department of General Surgery, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yulong Lan
- Department of Cardiology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Lin Luo
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xinping Shen
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lingyu Xu
- Department of Cardiology, Mackenzie Health Science Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta, 2C2, Mackenzie Health Science Centre, 8440 - 112 St, Edmonton, Alberta, T6G 2B7, Canada
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Krueger M, Cronin P, Sayyouh M, Kelly AM. Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know. Insights Imaging 2019; 10:10. [PMID: 30725202 PMCID: PMC6365314 DOI: 10.1186/s13244-019-0693-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT. Conclusion This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.
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Affiliation(s)
- Maren Krueger
- Fulford Radiology, Base Hospital, Private Bag 2016, New Plymouth, Taranaki, 4342, New Zealand
| | - Paul Cronin
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mohamed Sayyouh
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aine Marie Kelly
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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The Left Atrio-Vertebral Ratio: a new simple means for assessing left atrial enlargement on Computed Tomography. Eur Radiol 2017; 28:1310-1317. [PMID: 28956130 DOI: 10.1007/s00330-017-5041-3] [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: 03/03/2017] [Revised: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. METHODS Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m2 was chosen for maximal normal LA volume. RESULTS 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). CONCLUSION A left atrium area superior to three times the vertebral area indicates LAE with high specificity. KEY POINTS • Left atrial enlargement is a frequent condition associated with poor cardiac outcome. • Left atrial enlargement is highly time-consuming to diagnose on CT. • The left atrio-vertebral ratio quickly assesses left atrial enlargement. • A left atrial area > three times vertebral area is highly specific.
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Mazzei MA, Guerrini S, Gentili F, Galzerano G, Setacci F, Benevento D, Mazzei FG, Volterrani L, Setacci C. Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence? World J Radiol 2017; 9:304-311. [PMID: 28794826 PMCID: PMC5529319 DOI: 10.4329/wjr.v9.i7.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/16/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.
METHODS We conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years’ experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.
RESULTS There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.
CONCLUSION HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.
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Secchi F, Di Leo G, Zanardo M, Alì M, Cannaò PM, Sardanelli F. Detection of incidental cardiac findings in noncardiac chest computed tomography. Medicine (Baltimore) 2017; 96:e7531. [PMID: 28723768 PMCID: PMC5521908 DOI: 10.1097/md.0000000000007531] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim of the study was to estimate the rate of incidental cardiac findings (ICF) in patients undergoing noncardiac chest CT.An experienced radiologist retrospectively reviewed 237 consecutive patients (147 males and 90 females with median age of 69 years) undergoing a noncardiac chest CT. ICF at targeted review were compared to those mentioned in original reports (χ test).At review, ≥1 ICF was detected in 124/237 patients (52%), for a total of 229 ICF, 158 of them (69%) not originally mentioned. Valvular calcifications were unmentioned in 23/23 (100%) patients, main pulmonary artery dilation in 21/22 (96%), coronary calcifications in 69/86 (80%), right or left atrial dilation in 7/11 (64%), aortic atherosclerosis in 29/62 (47%), and ascending aorta dilatation in 8/18 (44%). All 6 pericardial effusions were originally mentioned. No association with sex (P ≥ .189); positive correlation with age (P < .001).Half of patients undergoing noncardiac chest CT presented ≥1 ICF, independently from sex but increasing with age. Moreover, 69% of detectable ICFs were not originally mentioned.
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Affiliation(s)
- Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
| | - Moreno Zanardo
- Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli, Milan
| | - Marco Alì
- Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli, Milan
| | - Paola Maria Cannaò
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, Italy
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8
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Every second counts: signs of a failing heart on thoracic CT in the ED. Emerg Radiol 2017; 24:311-317. [PMID: 28243766 DOI: 10.1007/s10140-017-1485-7] [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: 12/27/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
Impending cardiac failure is often difficult to recognize and requires a multidisciplinary approach. Upon arrival in the emergency department, patients are promptly screened for potentially life-threatening conditions through a history and physical examination. In many cases, the diagnosis is not clear until confirmatory laboratory or imaging tests are performed. Unfortunately, patients can rapidly decompensate as this diagnostic information is being obtained. Emergent CT plays a key role in identifying conditions that may result in cardiovascular collapse, including severe congestive heart failure, myocardial infarction, cardiac tamponade, and impending cardiac failure. Characteristic imaging findings can prompt the physician to take immediate action and prepare for resuscitation.
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Verdini D, Lee AM, Prabhakar AM, Abbara S, Ghoshhajra B. Detection of Cardiac Incidental Findings on Routine Chest CT: The Impact of Dedicated Training in Cardiac Imaging. J Am Coll Radiol 2016; 15:1153-1157. [PMID: 27039002 DOI: 10.1016/j.jacr.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Routine chest CT and cardiac CT angiography (CTA) both image the heart, albeit with different precision and intent. The aim of this study was to evaluate the diagnostic ability of radiologists with different levels of cardiac training to identify cardiac findings on chest CT without electrocardiographic gating compared with a reference standard of electrocardiographically gated cardiac CTA. METHODS Electrocardiographically gated cardiac CT angiographic studies performed between January 2005 to January 2010 in patients with routine chest CT within six months were retrospectively identified. Fourteen radiologists at four stages of training (stage 1, residents with no cardiac training [n = 4]; stage 2, residents who had completed at least one dedicated rotation of cardiac imaging [n = 3]; stage 3, radiologists without cardiac training [n = 3]; and stage 4, radiologists with formal cardiac fellowship training [n = 4]) performed blinded, anonymized cardiac readings of chest CT images. Findings were categorized (coronary arterial, noncoronary vessel, cardiac chamber, myocardial, pericardial, and valve findings) with cardiac CTA as a reference standard. RESULTS Overall, 140 cardiac CT angiographic findings were reported in 63 of 77 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of nongated CTA were 43.6%, 96.8%, 83.0%, 81.6%, and 81.8%, respectively, for all readers. Increasing training was associated with higher sensitivity (30.3%, 35.7%, 45.7%, and 61.2% from stages 1 to 4) but similar specificity (96.4%, 96.7%, 96.3%, and 97.6% from stages 1 to 4). Frequently missed findings categories were coronary arterial, myocardial, and cardiac chamber findings. CONCLUSIONS Increasing cardiac imaging training correlates with increased sensitivity and stable specificity to detect cardiac findings on routine chest CT without electrocardiographic gating. Cardiac findings should be noted on chest CT when observed, and cardiac training should be encouraged.
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Affiliation(s)
- Daniel Verdini
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashley M Lee
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand M Prabhakar
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Suhny Abbara
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian Ghoshhajra
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Left atrio-vertebral ratio: A new computed-tomography measurement to identify left atrial dilation. Eur J Radiol 2016; 85:255-260. [PMID: 26724674 DOI: 10.1016/j.ejrad.2015.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Left cardiac chambers dilation, interstitial lung changes and pleural effusions are the characteristics of cardiogenic pulmonary oedema on computed tomography (CT) of the chest but mensuration of the left atrial size is not routinely performed. Cardiac chambers normal dimensions are known to be proportional to the patient's build and anthropomorphic data but adjustment of chambers dimensions to available elements seen on the axial CT images has never been evaluated before. OBJECTIVES Our objective was to use data easily available on axial images to directly scale the left atrium. We chose to divide the left atrial diameter by the thoracic vertebral diameter, using the latter as a body-mass indicator. As a preliminary study, we aimed to evaluate the range of values of this left atrio-vertebral ratio (LAVR) by comparing patients suffering from cardiogenic pulmonary oedema with patients free of cardiac disease. We hypothesized that if the difference of values in these two populations of patients was significant enough, this ratio would be relevant and could be used as a quick criterion in different clinical situations. METHOD Two radiologists reviewed CT scans of 32 of patients free of cardiac disease and 40 patients in acute cardiac failure. The maximum diameter of the left atrium at the level of the right inferior pulmonary vein was divided by the vertebral transverse diameter to generate a left atrio-vertebral ratio. Receiver operating characteristic curves identified the threshold associated with pulmonary oedema. MEASUREMENTS AND MAIN RESULTS The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary oedema. A LAVR of 2.1 yielded 85% sensitivity and 88% specificity for the diagnosis of cardiogenic pulmonary oedema. CONCLUSIONS LAVR is a simple new measure directly scaling the left atrial diameter to the anthropomorphic characteristics of the patient. In our series, a ratio above 2.1 is strongly associated with cardiogenic pulmonary oedema indirectly suggesting left atrial dilation. The results were significantly different between the two populations of patients (no heart condition versus cardiogenic pulmonary oedema) suggesting a high potential for clinical application.
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Focal FDG Activity in the Region of Right Atrium: Coregistered CT Identifies Three Benign Etiologies. Radiol Case Rep 2015; 3:120. [PMID: 27303503 PMCID: PMC4896172 DOI: 10.2484/rcr.v3i1.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present the whole body FDG PET-CT images on 3 different patients with benign focal activity in the region of the right atrium. Co-registered CT correctly identified the cause of focal FDG activity as: right atrial appendage, lipomatous hypertrophy of the interatrial septum, and catheter-related activity. Although all these have been reported separately in the literature, we are presenting them together to emphasize the importance of recognizing the benign causes of FDG uptake in the region of right atrium and the role of co-registered CT in improving the accuracy and specificity of the FDG PET.
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12
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Under-reporting of cardiovascular findings on chest CT. Radiol Med 2015; 121:190-9. [DOI: 10.1007/s11547-015-0595-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/12/2015] [Indexed: 12/14/2022]
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Lewis G, Hoey ETD, Reynolds JH, Ganeshan A, Ment J. Multi-detector CT assessment in pulmonary hypertension: techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg 2015; 5:423-32. [PMID: 26029645 DOI: 10.3978/j.issn.2223-4292.2015.01.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/22/2015] [Indexed: 01/03/2023]
Abstract
Pulmonary arterial hypertension (PAH) may be suspected based on the clinical history, physical examination and electrocardiogram findings but imaging is usually central to confirming the diagnosis, establishing a cause and guiding therapy. The diagnostic pathway of PAH involves a variety of complimentary investigations of which computed tomography pulmonary angiography (CTPA) has established a central role both in helping identify an underlying cause for PAH and assessing resulting functional compromise. In particular CTPA is considered as the gold standard technique for the diagnosis of thromboembolic disease. This article reviews the CTPA evaluation in PAH, describing CTPA techniques, a systematic approach to interpretation and spectrum of key imaging findings.
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Affiliation(s)
- Gareth Lewis
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - John H Reynolds
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Jerome Ment
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
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14
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Marano R, Pirro F, Silvestri V, Merlino B, Savino G, Rutigliano C, Meduri A, Natale L, Bonomo L. Comprehensive CT cardiothoracic imaging: a new challenge for chest imaging. Chest 2015; 147:538-551. [PMID: 25644907 DOI: 10.1378/chest.14-1403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In the past, thoracic and cardiac imaging were two distinct specialties of radiology. The technical evolution, however, has changed their boundaries with an important impact on CT imaging practices and has opened the new era of "cardiothoracic" imaging, due to the strong anatomic, mechanical, physiologic, physiopathologic, and therapeutic cardiopulmonary correlations. Modern thoracic radiologists can no longer avoid the assessment of heart and coronary arteries, as they used to do with earlier generations of CT scanner. The advent of ECG gating and state-of-art CT scanner faster rotation speed, high spatial and temporal resolution, high-pitch mode, shorter acquisition time, and dedicated cardiac reconstruction algorithms has opened new possibilities for chest imaging, integrating cardiac morphologic and even functional information within a diagnostic chest CT scan. The aim of this review is to briefly show and summarize the concept of integrated cardiothoracic imaging, which redefines the boundaries of chest CT imaging, opening the door to a new radiologic specialty.
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Affiliation(s)
- Riccardo Marano
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy.
| | - Federica Pirro
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Valentina Silvestri
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Biagio Merlino
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Claudia Rutigliano
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Agostino Meduri
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Luigi Natale
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
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Abstract
Computed tomography (CT) is central to the detection and diagnosis of a wide variety of pulmonary, cardiovascular, and other diseases of the chest. Successful interpretation of thoracic CT requires both an appreciation of the spectrum of normal appearances of the chest and a systematic approach to the characterization of thoracic pathology. This article provides an introduction to basic CT techniques and protocols, a review of normal CT anatomy, and an overview of commonly encountered abnormalities.
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Affiliation(s)
- Brent P Little
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30309, USA.
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Multidetector computer tomography: evaluation of blunt chest trauma in adults. Radiol Res Pract 2014; 2014:864369. [PMID: 25295188 PMCID: PMC4175749 DOI: 10.1155/2014/864369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/21/2014] [Accepted: 08/13/2014] [Indexed: 12/26/2022] Open
Abstract
Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.
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Minkowitz S, Haramati LB, Zalta B, Spindola-Franco HF, Christos PJ, Levsky JM. Can left ventricular function be assessed on non-ECG-gated CT? Clin Imaging 2014; 38:669-74. [PMID: 24794203 DOI: 10.1016/j.clinimag.2014.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/25/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
To evaluate whether non-gated computed tomography (CT) can assess left ventricular (LV) function, 101 patients with both CT and echocardiography were selected, with ejection fraction <50% on echocardiography used as a reference standard. CTs were blindly reevaluated, and qualitative assessment of LV dysfunction on CT correlated with echocardiographic dysfunction, odds ratio of 21.0 (95% confidence interval=6.55-71.0), specificity of 86% (56/65). Systolic and diastolic images were identified on CT, and the ratio of systolic to diastolic LV internal diameters and ratio of LV to RV internal diameter were determined, both showing correlation with LV dysfunction on echocardiography (P<.0001). Non-gated CT can be used to predict LV dysfunction.
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Affiliation(s)
- Shlomo Minkowitz
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Linda B Haramati
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Benjamin Zalta
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Hugo F Spindola-Franco
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Paul J Christos
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
| | - Jeffrey M Levsky
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467
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Abstract
PURPOSE OF REVIEW Pneumothorax, a potentially life-threatening condition, is present in about one-third of chest trauma patients. Traditionally, pneumothorax has been diagnosed and managed by use of chest radiography, which has been found inaccurate and inconsistent. With the ubiquitous application of multidetector computed tomography (MDCT) in emergency care, MDCT quantification of pneumothoraces becomes an emerging technique for accurate determination of the size of pneumothoraces. The use of MDCT quantification provides a promising means to improve pneumothorax management. RECENT FINDINGS Recent studies have demonstrated that MDCT is the gold standard for detecting pneumothorax and MDCT provides an effective imaging modality for the accurate measurement of the volume of pneumothoraces. The use of MDCT volumetric quantification of pneumothoraces has been evidenced in the improvement of performance in pneumothorax management for clinically stable chest trauma patients. SUMMARY The MDCT volumetric quantification of pneumothoraces is a new concept in the care of chest trauma patients and has the potential to improve pneumothorax management. Further clinical studies are needed to establish a MDCT-based clinical guideline for pneumothorax management.
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Accuracy of Non-ECG–gated Computed Tomography Angiography of the Chest in Assessment of Left-sided Cardiac Chamber Enlargement. J Thorac Imaging 2012; 27:354-8. [DOI: 10.1097/rti.0b013e31822bddbb] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Ley S, Grünig E, Kiely DG, van Beek E, Wild J. Computed tomography and magnetic resonance imaging of pulmonary hypertension: Pulmonary vessels and right ventricle. J Magn Reson Imaging 2011; 32:1313-24. [PMID: 21105137 DOI: 10.1002/jmri.22373] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension (PH) is very heterogeneous and the classification identifies five major groups including many associated disease processes. The treatment of PH depends on the underlying cause and accurate classification is paramount. A comprehensive assessment to identify the cause and severity of PH is therefore needed. Furthermore, follow-up assessments are required to monitor changes in disease status and response to therapy. Traditionally, the diagnostic imaging work-up of PH comprised mainly echocardiography, invasive right heart catheterization, and ventilation/perfusion scintigraphy. Due to technical advances, multidetector row computed tomography (CT) and magnetic resonance imaging (MRI) have become important and complementary investigations in the evaluation of patients with suspected PH. Both modalities are reviewed and recommendations for clinical use are given.
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Affiliation(s)
- Sebastian Ley
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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21
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CT imaging of blunt chest trauma. Insights Imaging 2011; 2:281-295. [PMID: 22347953 PMCID: PMC3259405 DOI: 10.1007/s13244-011-0072-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/28/2010] [Accepted: 01/27/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND: Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects. METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted. RESULTS: The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care. CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.
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Navallas M, Orenes P, Sánchez Nistal MA, Jiménez López Guarch C. [Congenital heart disease in adults: the contribution of multidetector CT]. RADIOLOGIA 2010; 52:288-300; quiz 376-7. [PMID: 20416911 DOI: 10.1016/j.rx.2010.01.010] [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] [Received: 05/10/2009] [Revised: 01/09/2010] [Accepted: 01/12/2010] [Indexed: 11/17/2022]
Abstract
Congenital heart disease is relatively common among adults. Patients' conditions have generally been diagnosed previously and imaging tests are requested for follow-up or for complications of the anomaly or of its surgical correction. Classically, these patients were studied with echocardiography and cardiac catheterization, but multidetector CT and magnetic resonance imaging have changed the approach because these techniques show the anatomy of heart defects and their correction very clearly. We emphasize the importance of multidetector CT as a complementary technique for the study of congenital heart disease that is newly discovered in adults or for the follow-up of congenital heart disease that was surgically corrected during childhood. When vascular anomalies are present outside the heart or after palliative surgery, multidetector CT shows anatomical details that are difficult or impossible to see with echocardiography. We also emphasize the frequent association between pulmonary hypertension and congenital heart disease that can debut in adults.
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Affiliation(s)
- M Navallas
- Departamento de Radiología, Hospital Universitario 12 de Octubre, Madrid, España.
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25
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Navallas M, Orenes P, Sánchez Nistal M, Jiménez López Guarch C. Congenital heart disease in adults: The contribution of multidetector CT. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hoey ETD, Gopalan D, Agrawal SKB, Screaton NJ. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT. Eur Radiol 2009; 19:2557-68. [DOI: 10.1007/s00330-009-1460-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/19/2009] [Accepted: 04/27/2009] [Indexed: 11/29/2022]
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Moussa F, Kumar P, Pen V. Cardiac CT Scan for Preoperative Planning in a Patient with Bilateral Subclavian Stenosis Needing Coronary Artery Bypass. J Card Surg 2009; 24:196-7. [DOI: 10.1111/j.1540-8191.2008.00673.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gold MM, Spindola-Franco H, Jain VR, Spevack DM, Haramati LB. Coronary Sinus Compression. J Comput Assist Tomogr 2008; 32:72-7. [PMID: 18303292 DOI: 10.1097/rct.0b013e31815b3ebf] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salem R, Remy-Jardin M, Delhaye D, Khalil C, Teisseire A, Delannoy-Deken V, Duhamel A, Remy J. Integrated cardio-thoracic imaging with ECG-Gated 64-slice multidetector-row CT: initial findings in 133 patients. Eur Radiol 2006; 16:1973-81. [PMID: 16636804 DOI: 10.1007/s00330-006-0157-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 01/03/2006] [Accepted: 01/06/2006] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate the possibility of assessing the underlying respiratory disease as well as cardiac function during ECG-gated CT angiography of the chest with 64-slice multidetector-row CT (MDCT). One hundred thirty-three consecutive patients in sinus rhythm with known or suspected ventricular dysfunction underwent an ECG-gated CT angiographic examination of the chest without beta-blockers using the following parameters: (1) collimation: 32 x 0.6 mm with z-flying focal spot for the acquisition of 64 overlapping 0.6-mm slices (Sensation 64; Siemens); rotation time: 0.33 s; pitch: 0.3; 120 kV; 200 mAs; ECG-controlled dose modulation (ECG-pulsing) and (2) 120 ml of a 35% contrast agent. Data were reconstructed: (1) to evaluate the underlying respiratory disease (1-mm thick lung and mediastinal scans reconstructed at 55% of the R-R interval; i.e., "morphologic scans") and (2) to determine right (RVEF) and left (LVEF) ventricular ejection fractions (short-axis systolic and diastolic images; Argus software; i.e., "functional scans"). The mean heart rate was 73 bpm (range: 42-120) and the mean scan time was 18.11 +/- 2.67 s (range: 10-27). A total of 123 examinations (92%) had both lung and mediastinal images rated as diagnostic scans, whereas 10 examinations (8%) had non-diagnostic images altered by the presence of respiratory-motion artifacts (n = 4) or cyclic artifacts related to the use of a pitch value of 0.3 in patients with a very low heart rate during data acquisition (n = 6). Assessment of right and left ventricular function was achievable in 124 patients (93%, 95% CI: 88-97%). For these 124 examinations, the mean RVEF was 46.10% (+/- 9.5; range: 20-72) and the mean LVEF was 58.23% (+/- 10.88; range: 20-83). In the remaining nine patients, an imprecise segmentation of the right and left ventricular cavities was considered as a limiting factor for precise calculation of end-systolic and end-diastolic ventricular volumes. The mean (+/- SD) DLP value of the examinations was 279.86 (+/- 117.50) mGy.cm. Assessment of underlying respiratory disease and cardiac function from the same data set was achievable in 92% of the patients with ECG-gated 64-slice MDCT.
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Affiliation(s)
- Randa Salem
- Department of Thoracic Imaging, Hospital Calmette, University Center of Lille, Boulevard Jules Leclerc, 59037, LILLE cedex, France
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Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J. When, Why, and How to Examine the Heart During Thoracic CT: Part 2, Clinical Applications. AJR Am J Roentgenol 2006; 186:333-41. [PMID: 16423935 DOI: 10.2214/ajr.05.0718] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE CT examination of the thorax is often requested for the investigation of disorders that may have an important underlying cardiac cause or association that is not clinically obvious. Conditions such as idiopathic and acquired cardiomyopathy, ischemic heart disease, and valvular dysfunction may underlie symptoms such as dyspnea, chest pain, and hemoptysis that prompt the request for CT of the thorax. Other conditions such as pulmonary thromboembolic disease, chronic obstructive airways disease, pectus excavatum, sleep apnea, and many intrathoracic malignancies may have an important effect on cardiac structure and function. Patients undergoing thoracic surgery may have unsuspected coronary artery disease that can be detected in the course of preoperative evaluation by CT; similarly, postoperative complications often have a cardiogenic basis. CONCLUSION Examination of the heart in the course of CT of the chest often can provide important and clinically relevant information that is not otherwise easily available.
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Affiliation(s)
- John F Bruzzi
- Department of Radiology, Hospital Calmette, Boulevard Pr. J. Leclerq, Lille 59037, France
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