1
|
Fletcher JG, Inoue A, Bratt A, Horst KK, Koo CW, Rajiah PS, Baffour FI, Ko JP, Remy-Jardin M, McCollough CH, Yu L. Photon-counting CT in Thoracic Imaging: Early Clinical Evidence and Incorporation Into Clinical Practice. Radiology 2024; 310:e231986. [PMID: 38501953 DOI: 10.1148/radiol.231986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Photon-counting CT (PCCT) is an emerging advanced CT technology that differs from conventional CT in its ability to directly convert incident x-ray photon energies into electrical signals. The detector design also permits substantial improvements in spatial resolution and radiation dose efficiency and allows for concurrent high-pitch and high-temporal-resolution multienergy imaging. This review summarizes (a) key differences in PCCT image acquisition and image reconstruction compared with conventional CT; (b) early evidence for the clinical benefit of PCCT for high-spatial-resolution diagnostic tasks in thoracic imaging, such as assessment of airway and parenchymal diseases, as well as benefits of high-pitch and multienergy scanning; (c) anticipated radiation dose reduction, depending on the diagnostic task, and increased utility for routine low-dose thoracic CT imaging; (d) adaptations for thoracic imaging in children; (e) potential for further quantitation of thoracic diseases; and (f) limitations and trade-offs. Moreover, important points for conducting and interpreting clinical studies examining the benefit of PCCT relative to conventional CT and integration of PCCT systems into multivendor, multispecialty radiology practices are discussed.
Collapse
Affiliation(s)
- Joel G Fletcher
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Akitoshi Inoue
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Alex Bratt
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Kelly K Horst
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Chi Wan Koo
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Francis I Baffour
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Jane P Ko
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Martine Remy-Jardin
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Cynthia H McCollough
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Lifeng Yu
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| |
Collapse
|
2
|
Sica G, Rea G, Scaglione M. Editorial for the Special Issue "Cardiothoracic Imaging: Recent Techniques and Applications in Diagnostics". Diagnostics (Basel) 2024; 14:461. [PMID: 38472934 DOI: 10.3390/diagnostics14050461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
Technology is making giant strides and is increasingly improving the diagnostic imaging of both frequent and rare acute and chronic diseases [...].
Collapse
Affiliation(s)
- Giacomo Sica
- Department of Radiology, Azienda Ospedaliera dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Gaetano Rea
- Department of Radiology, Azienda Ospedaliera dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
3
|
刘 田, 朱 健, 李 宝. [Research progress on the identification of central lung cancer and atelectasis using multimodal imaging]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2023; 40:1255-1260. [PMID: 38151951 PMCID: PMC10753321 DOI: 10.7507/1001-5515.202304016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/23/2023] [Indexed: 12/29/2023]
Abstract
Central lung cancer is a common disease in clinic which usually occurs above the segmental bronchus. It is commonly accompanied by bronchial stenosis or obstruction, which can easily lead to atelectasis. Accurately distinguishing lung cancer from atelectasis is important for tumor staging, delineating the radiotherapy target area, and evaluating treatment efficacy. This article reviews domestic and foreign literatures on how to define the boundary between central lung cancer and atelectasis based on multimodal images, aiming to summarize the experiences and propose the prospects.
Collapse
Affiliation(s)
- 田野 刘
- 山东第一医科大学 山东省医学科学院 研究生部(济南 250117)Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, P. R. China
- 山东省肿瘤防治研究院 山东省肿瘤医院 放射物理技术科(济南 250117)Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Jinan 250117, P. R. China
| | - 健 朱
- 山东第一医科大学 山东省医学科学院 研究生部(济南 250117)Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, P. R. China
- 山东省肿瘤防治研究院 山东省肿瘤医院 放射物理技术科(济南 250117)Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Jinan 250117, P. R. China
| | - 宝生 李
- 山东第一医科大学 山东省医学科学院 研究生部(济南 250117)Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, P. R. China
- 山东省肿瘤防治研究院 山东省肿瘤医院 放射物理技术科(济南 250117)Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Jinan 250117, P. R. China
| |
Collapse
|
4
|
Karim KS, Tilley Ii S. Portable Single-Exposure Dual-Energy X-ray Detector for Improved Point-of-Care Diagnostic Imaging. Mil Med 2023; 188:84-91. [PMID: 37948245 DOI: 10.1093/milmed/usad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Dual-energy subtraction (DES) imaging is well known to reduce anatomical noise and enable material classification. The current approaches to DES imaging have trade-offs, such as motion artifacts, low sensitivity because of losses in a mid-filter, and lack of portability. Recently, a portable triple-layer flat-panel detector (FPD) was proposed for use in single-shot DES imaging that can provide improved sensitivity and removal of motion artifacts in a point-of-care setting. The purpose of this study is to evaluate the feasibility of such a detector. Various image quality metrics and clinical images are provided. MATERIALS AND METHODS An FDA-cleared single-exposure DES FPD consisting of three stacked sensors was used for all measurements. This detector generates three images per exposure: A digital radiography (DR) image, i.e., as would be produced with a conventional detector, and two DES images, bone and soft tissue. To evaluate DR image quality, detective quantum efficiency (DQE) and modulation transfer function were measured for multiple radiation quality beams. Digital radiography and DES images obtained from this FPD were evaluated in previously reported fixed and portable clinical studies. Digital radiography and DES images from case studies are presented for qualitative assessment. RESULTS Modulation transfer function and DQE were measured across multiple radiation quality beams for the DR image. The DES images showed good tissue separation and uniformity with no visible motion or alignment artifacts. The DES images, when read in conjunction with the DR image, resulted in increased reader confidence and revealed abnormalities or details that were sometimes overlooked in the DR image. CONCLUSIONS The proposed panel produces high-quality DR images as indicated by the DQE and modulation transfer function. The DES images have been shown to improve sensitivity in clinical applications and increase reader confidence. This detector can enable DES in portable or otherwise difficult applications, opening new doors for improved patient care.
Collapse
Affiliation(s)
- Karim S Karim
- Electrical and Computer Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- KA Imaging, Waterloo, ON N2L 5Z4, Canada
| | | |
Collapse
|
5
|
Ozawa Y, Ohno Y, Nagata H, Tamokami K, Nishikimi K, Oshima Y, Hamabuchi N, Matsuyama T, Ueda T, Toyama H. Advances for Pulmonary Functional Imaging: Dual-Energy Computed Tomography for Pulmonary Functional Imaging. Diagnostics (Basel) 2023; 13:2295. [PMID: 37443688 DOI: 10.3390/diagnostics13132295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Dual-energy computed tomography (DECT) can improve the differentiation of material by using two different X-ray energy spectra, and may provide new imaging techniques to diagnostic radiology to overcome the limitations of conventional CT in characterizing tissue. Some techniques have used dual-energy imaging, which mainly includes dual-sourced, rapid kVp switching, dual-layer detectors, and split-filter imaging. In iodine images, images of the lung's perfused blood volume (PBV) based on DECT have been applied in patients with pulmonary embolism to obtain both images of the PE occluding the pulmonary artery and the consequent perfusion defects in the lung's parenchyma. PBV images of the lung also have the potential to indicate the severity of PE, including chronic thromboembolic pulmonary hypertension. Virtual monochromatic imaging can improve the accuracy of diagnosing pulmonary vascular diseases by optimizing kiloelectronvolt settings for various purposes. Iodine images also could provide a new approach in the area of thoracic oncology, for example, for the characterization of pulmonary nodules and mediastinal lymph nodes. DECT-based lung ventilation imaging is also available with noble gases with high atomic numbers, such as xenon, which is similar to iodine. A ventilation map of the lung can be used to image various pulmonary diseases such as chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Keigo Tamokami
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Keitaro Nishikimi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| |
Collapse
|
6
|
Alizadeh LS, Vogl TJ, Waldeck SS, Overhoff D, D'Angelo T, Martin SS, Yel I, Gruenewald LD, Koch V, Fulisch F, Booz C. Dual-Energy CT in Cardiothoracic Imaging: Current Developments. Diagnostics (Basel) 2023; 13:2116. [PMID: 37371011 DOI: 10.3390/diagnostics13122116] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This article describes the technical principles and clinical applications of dual-energy computed tomography (DECT) in the context of cardiothoracic imaging with a focus on current developments and techniques. Since the introduction of DECT, different vendors developed distinct hard and software approaches for generating multi-energy datasets and multiple DECT applications that were developed and clinically investigated for different fields of interest. Benefits for various clinical settings, such as oncology, trauma and emergency radiology, as well as musculoskeletal and cardiovascular imaging, were recently reported in the literature. State-of-the-art applications, such as virtual monoenergetic imaging (VMI), material decomposition, perfused blood volume imaging, virtual non-contrast imaging (VNC), plaque removal, and virtual non-calcium (VNCa) imaging, can significantly improve cardiothoracic CT image workflows and have a high potential for improvement of diagnostic accuracy and patient safety.
Collapse
Affiliation(s)
- Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Stephan S Waldeck
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Daniel Overhoff
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Mannheim, 68167 Mannheim, Germany
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, 98124 Messina, Italy
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Florian Fulisch
- Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| |
Collapse
|
7
|
Xu JJ, Ulriksen PS, Bjerrum CW, Achiam MP, Resch TA, Lönn L, Lindskov Hansen K. Characterizing incidental mass lesions in abdominal dual-energy CT compared to conventional contrast-enhanced CT. Acta Radiol 2023; 64:945-950. [PMID: 35918808 DOI: 10.1177/02841851221116306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Incidental findings are common in abdominal computed tomography (CT) and often warrant further investigations with economic implications as well as implications for patients. PURPOSE To evaluate the potential of dual-energy CT (DECT) in the identification and/or characterization of abdominal incidental mass lesions compared to conventional contrast-enhanced CT. MATERIAL AND METHODS This retrospective study from a major tertiary hospital included 96 patients, who underwent contrast-enhanced abdominal DECT. Incidental lesions in adrenals, kidneys, liver, and pancreas were evaluated by two board-certified abdominal radiologists. Observer 1 only had access to standard CT reconstructions, while observer 2 had access to standard CT as well as DECT reconstructions. Disagreements were resolved by consensus review and used as a reference for observers using McNemar's test. RESULTS Observers 1 and 2 identified a total of 40 and 34 findings, respectively. Furthermore, observer 1 registered 13 lesions requiring follow-up, of which seven (two renal and five adrenal lesions) were resolved following consensus review using DECT (P = 0.008). The inter-observer agreement was near perfect (κ = 0.82). CONCLUSION DECT has the potential to improve the immediate characterization of incidental findings when compared to conventional CT for abdominal imaging.
Collapse
Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Sommer Ulriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
| | - Camilla Wium Bjerrum
- Department of Diagnostic Radiology, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
| | - Michael Patrick Achiam
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Surgical Gastroenterology, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Vascular Surgery, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Hunter JG, Prajapati P, Bera K, Gupta A, Gupta A. Imaging Depiction of Hypoxic Pulmonary Vasoconstriction Using Dual-Energy CT. Cureus 2023; 15:e36551. [PMID: 37102002 PMCID: PMC10123221 DOI: 10.7759/cureus.36551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
In this article, we aim to highlight the utility of dual-energy computed tomography (DECT) in demonstrating imaging changes due to hypoxic pulmonary vasoconstriction (HPV). DECT allows detailed image reconstructions that have been shown to better characterize cardiothoracic pathologies, as compared to conventional CT techniques. DECT simultaneously detects two different X-ray energies, which enables generation of iodine density maps, virtual monoenergetic images, and effective atomic number maps (Zeff), among others. DECT has been shown to have utility in the assessment of benign versus malignant pulmonary nodules, pulmonary embolism, myocardial perfusion defects, and other conditions. Herein, we describe four cases of indeterminate pulmonary pathology when imaged with conventional CT in which subsequent use of DECT-derived image reconstructions demonstrated HPV as the underlying pathophysiological mechanism. The goal of this article is to understand the imaging appearance of HPV on DECT and discuss how HPV may mimic other causes of perfusion defects.
Collapse
Affiliation(s)
- Joshua G Hunter
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Priyanka Prajapati
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Kaustav Bera
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Aekta Gupta
- Internal Medicine, Mercy Health - St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Amit Gupta
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
| |
Collapse
|
9
|
Langenbach IL, Wienemann H, Klein K, Scholtz JE, Pennig L, Langzam E, Pahn G, Holz JA, Maintz D, Naehle CP, Langenbach MC. Coronary calcium scoring using virtual non-contrast reconstructions on a dual-layer spectral CT system: Feasibility in the clinical practice. Eur J Radiol 2023; 159:110681. [PMID: 36592582 DOI: 10.1016/j.ejrad.2022.110681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the clinical applicability of a prototype virtual non-contrast (VNC) reconstruction algorithm based on coronary CT angiography (cCTA) to assess calcified coronary plaques by calcium scoring (CACS). METHODS Eighty consecutive patients suspected of coronary artery disease were retrospectively included. All patients underwent a cardiac CT using a dual-layer spectral-detector CT system. The standardized acquisition protocol included unenhanced CACS and cCTA. Datasets were acquired using 120 keV. VNC-reconstructions were calculated from the cCTA images at 2.5 mm (VNC group 1), 2.5 of 0.9 mm (group 2), and 0.9 mm (group 3) slice thickness. We compared the Agatston score and Coronary Artery Calcium Data and Reporting System (CAC-DRS) of all VNC reconstructions with the true non-contrast (TNC)-dataset as the gold standard. RESULTS In total, 73 patients were evaluated. Fifty patients (68.5 %) had a CACS > 0 based on TNC. We found a significant difference in the Agatston score comparing all VNC-reconstructions (1: 1.35, 2: 3.7, 3: 10.4) with the TNC dataset (3.8) (p < 0.001). Correlation analysis of the datasets showed an excellent correlation of the TNC results with the different VNC-reconstructions (r = 0.904-0.974, p < 0.001) with a slope of 1.89-2.53. Mean differences and limits of agreement by Bland-Altman analysis between TNC and group 1 were 83 and -196 to 362, respectively. By using the VNC-reconstructions, in group 1 23 patients (31.5 %), in group 2 10 (13.7 %), and in group 3 23 (31.5 %) were reclassified according to CAC-DRS compared to TNC. Classification according to CAC-DRS revealed a significant difference between TNC and group 1 (p = 0.024) and no significance compared to groups 2 and 3 (p = 0.670 and 0.273). CONCLUSION The investigated VNC reconstruction algorithm of routine cCTA allows the detection and evaluation of coronary calcium burden without the requirement for an additional acquisition of an unenhanced CT scan for CACS and, therefore, a reduction of radiation exposure.
Collapse
Affiliation(s)
- I L Langenbach
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - H Wienemann
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - K Klein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - J E Scholtz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Frankfurt, University of Frankfurt, Frankfurt, Germany
| | - L Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - E Langzam
- Philips Healthcare, Best, the Netherlands
| | - G Pahn
- Philips CT Clinical Science, Hamburg, Germany
| | - J A Holz
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - D Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C P Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Radiologische Allianz, Hamburg, Germany
| | - M C Langenbach
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Vliegenthart R, Fouras A, Jacobs C, Papanikolaou N. Innovations in thoracic imaging: CT, radiomics, AI and x-ray velocimetry. Respirology 2022; 27:818-833. [PMID: 35965430 PMCID: PMC9546393 DOI: 10.1111/resp.14344] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/08/2022] [Indexed: 12/11/2022]
Abstract
In recent years, pulmonary imaging has seen enormous progress, with the introduction, validation and implementation of new hardware and software. There is a general trend from mere visual evaluation of radiological images to quantification of abnormalities and biomarkers, and assessment of ‘non visual’ markers that contribute to establishing diagnosis or prognosis. Important catalysts to these developments in thoracic imaging include new indications (like computed tomography [CT] lung cancer screening) and the COVID‐19 pandemic. This review focuses on developments in CT, radiomics, artificial intelligence (AI) and x‐ray velocimetry for imaging of the lungs. Recent developments in CT include the potential for ultra‐low‐dose CT imaging for lung nodules, and the advent of a new generation of CT systems based on photon‐counting detector technology. Radiomics has demonstrated potential towards predictive and prognostic tasks particularly in lung cancer, previously not achievable by visual inspection by radiologists, exploiting high dimensional patterns (mostly texture related) on medical imaging data. Deep learning technology has revolutionized the field of AI and as a result, performance of AI algorithms is approaching human performance for an increasing number of specific tasks. X‐ray velocimetry integrates x‐ray (fluoroscopic) imaging with unique image processing to produce quantitative four dimensional measurement of lung tissue motion, and accurate calculations of lung ventilation. See relatedEditorial
Collapse
Affiliation(s)
- Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Data Science in Health (DASH), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nickolas Papanikolaou
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal.,AI Hub, The Royal Marsden NHS Foundation Trust, London, UK.,The Institute of Cancer Research, London, UK
| |
Collapse
|
11
|
Vulasala SSR, Wynn GC, Hernandez M, Kadambi I, Gopireddy DR, Bhosale P, Virarkar MK. Dual-Energy Imaging of the Chest. Semin Ultrasound CT MR 2022; 43:311-319. [PMID: 35738816 DOI: 10.1053/j.sult.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy computed tomography (DECT) is a contemporary development by which the tissue can be characterized beyond conventional computed tomography. It improves tissue differentiation by exploiting the X-ray absorptive property of the tissues. Although still in its early stages, DECT utilization in pulmonary and cardiovascular pathologies is emerging. It includes applications such as pulmonary embolism, pulmonary hypertension, myocardial perfusion, and coronary artery assessment. This article discusses DECT principles and their current and emerging applications in thoracic imaging.
Collapse
Affiliation(s)
- Sai Swarupa R Vulasala
- Research Assistant, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Gregory Carl Wynn
- Associate Professor, Division of Cardiovascular and Thoracic Imaging, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Mauricio Hernandez
- Radiology Research Manager II, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States.
| | - Isiri Kadambi
- Observer, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Dheeraj Reddy Gopireddy
- Associate Professor & Associate Chair, Clinical Operations, and Quality Assurance., Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Priya Bhosale
- Professor, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, United States
| | - Mayur K Virarkar
- Assistant Professor, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| |
Collapse
|
12
|
Yan H, Hua Y, Zhang T, Liu W, Hussein AF. Differential Diagnosis of Preinvasive Lesions in Small Pulmonary Nodules by Dual Source Computed Tomography Imaging. Computational and Mathematical Methods in Medicine 2022; 2022:1-7. [PMID: 35832127 PMCID: PMC9273420 DOI: 10.1155/2022/6255024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 12/02/2022]
Abstract
This study was aimed to explore the differential diagnosis value of preinvasive lesions/minimally invasive adenocarcinoma and invasive adenocarcinoma manifesting as small pulmonary nodules under dual source computed tomography (DSCT) imaging. The patients with nodular manifestations of adenocarcinoma in situ (AIS)/microinfiltrating adenocarcinoma (MIA) were selected as group X, including 14 cases. A total of 31 cases with nodular infiltrating adenocarcinoma were selected as group Y. The enhanced dual-energy image obtained by DSCT dual-energy scan was transferred to the software to obtain the energy image and iodine distribution map. SPSS 18.0 was used for statistical analysis. P < 0.05 was considered statistically significant. All measurements were labeled as mean x͞±S standard deviation. In the CT findings of microinfiltrating adenocarcinoma and infiltrating adenocarcinoma, lobulation sign, burr sign, vacuole sign, and pleural depression sign can help the diagnosis of infiltrating adenocarcinoma. The results showed that lobulation sign, burr sign, vacuole sign, and pleural depression sign could be used as the distinguishing feature of preinvasive lesion/microinvasive adenocarcinoma and invasive adenocarcinoma. Receiver-operating characteristic (ROC) curve analysis showed that the critical value, sensitivity, and specificity of lesion diameter ≥1.4 cm and CT value ≥14.14HU for diagnosis of invasive lung adenocarcinoma were 1.32 and 14.14, 88.4% and 94.4%, and 67.3% and 75.8%, respectively. There were substantial differences in CT values between the two groups under low energy level (42-99 kev) (P < 0.05). DSCT dual-energy imaging can quantitatively identify preinvasive pulmonary nodules with multiple parameters.
Collapse
|
13
|
Kallstrom E, Rampoldi M, Hartwell C. Echocardiographic Assessment of Mitral Annular Disjunction With Cross-Correlation by Computed Tomography and Magnetic Resonance Imaging: A Case Series. Journal of Diagnostic Medical Sonography 2022. [DOI: 10.1177/87564793221091257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mitral valve (MV) pathology, along with its associated peripheral anatomy, is one of the most common categories of heart disease. Two-dimensional (2D) transthoracic echocardiography (TTE) plays a prominent role in the detection and management of various types MV disease, specifically mitral annular disjunction (MAD). MAD is defined as a structural abnormality of the mitral annulus fibrosus, causing a noticeable gap between the atrial wall-mitral valve junction and the basilar portion of the left ventricular free wall (LV). The integral role that cardiac sonographers play in identifying MAD cannot be underscored, as well as the risk of easily overlooking this unique abnormality. Often associated with mitral valve prolapse (MVP), accurate documentation of MAD amid an echocardiographic study can have positive implications on patient prognosis. This case series highlights the echocardiographic characteristics of MAD, to raise awareness of this often forgotten feature of myxomatous mitral valves, which can indeed cause adverse patient outcomes. It is important to demonstrate correlational features with additional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT).
Collapse
Affiliation(s)
| | - Michael Rampoldi
- The Heart Hospital Baylor Plano, Non-Invasive Cardiology, Plano, TX, USA
| | | |
Collapse
|
14
|
Shim E, Kim BH, Kang WY, Hong SJ, Kang CH, Ahn KS, Lee H, Kwack TJ. Diagnostic performance of electron-density dual-energy CT in detection of cervical disc herniation in comparison with standard gray-scale CT and virtual non-calcium images. Eur Radiol 2022; 32:2209-2220. [PMID: 35064315 PMCID: PMC8782689 DOI: 10.1007/s00330-021-08374-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/07/2023]
Abstract
Objectives To assess the diagnostic performance of dual-energy CT (DECT) with electron-density (ED) image reconstruction compared with standard CT (SC) and virtual non-calcium (VNCa) image CT reconstruction for detecting cervical disc herniation. Methods This cross-sectional study was approved by the IRB. We enrolled 64 patients (336 intervertebral discs from C2/3 to C7/T1; mean age, 55 years; 17 women and 47 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks between January 2018 and June 2020. Four radiologists independently evaluated the first image set of randomized SC, VNCa, and ED images to detect cervical disc herniation. After 8 weeks, the readers re-evaluated the second and the last image sets with an 8-week interval. MRI evaluations performed by two other experienced served as the reference standard. Comparing diagnostic performance between each images set was evaluated by a generalized estimating equation. Results A total of 233 cervical disc herniations were noted on MRI. For detecting cervical disc herniation, electron-density images showed higher sensitivity (94% [219/233; 95% CI, 90–97] vs. 76% [177/233; 70–81] vs. 69% [160/233; 62–76]) (p < 0.001) and similar specificity (90% [93/103; 83–95] vs. 89% [92/103; 82–96] vs. 90% [93/103; 83–95]) (p > 0.05) as SC and VNCa images, respectively. Inter-reader agreement for cervical disc herniation calculated among the four readers was moderate for all image sets (κ = 0.558 for ED, κ = 0.422 for SC, and κ = 0.449 for VNCa). Conclusion DECT with ED reconstruction can improve cervical disc herniation detection and diagnostic confidence compared with SC and VNCa images. Key Points • Intervertebral discs with high material density are well visualized on electron-density images obtained from dual-energy CT. • Electron-density images showed much higher sensitivity and diagnostic accuracy than standard CT and virtual non-calcium images for the detection of cervical disc herniation. • Electron-density images can have false-negative results, especially for disc herniation with high signal intensity on T2W images and can show pseudo-disc extrusion at the lower cervical spine. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08374-y.
Collapse
|
15
|
Li Z, Cao J, Bai X, Gao P, Zhang D, Lu X, Sui B. Utility of Dual-Layer Spectral-Detector CTA to Characterize Carotid Atherosclerotic Plaque Components: An Imaging-Histopathology Comparison in Patients Undergoing Endarterectomy. AJR Am J Roentgenol 2021. [PMID: 34549604 DOI: 10.2214/AJR.21.26540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The composition of non-calcified portions of carotid atherosclerotic plaque represents an important marker of plaque vulnerability and ischemia risk. Objective: To assess the utility of dual-layer spectral-detector CTA (DLCTA) parameters for carotid plaque component characterization, using histologic results from carotid endarterectomy (CEA) as reference. Methods: Seven patients (5 male, 2 female; 61.6±8.5 years old) with carotid plaque awaiting CEA were prospectively enrolled and underwent preoperative supra-aortic DLCTA. A neuroradiologist and pathologist performed joint slice-by-slice review of histologic slices of resected plaques and CTA images. ROIs were placed on non-calcified components [lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), fibrous tissue, loose matrix (LM)] on CTA images in comparison with corresponding histologic slices using anatomic landmarks. For each ROI, attenuation was recorded for polyenergetic images (CTPI) and virtual monoenergetic images with keV ranging from 40-140 (CT40-140keV); attenuation spectrum curve slope was calculated; and Z-effective value (representing effective atomic number) was recorded. DLCTA parameters were compared among plaque components. Results: Seven plaques with a total of 65 slices and 364 ROIs (159 fibrous tissue, 96 LRNC, 86 loose matrix, 23 IPH) were analyzed. All parameters (CTPI, CT40-140keV, slope from 40 to 140 keV, Z-effective value) showed significant differences between LRNC and the other components (all p<.001). For example, mean CTPI was 37.1±15.1 HU for LRNC, 58.4±21.6 HU for IPH, 69.7±20.5 HU for fibrous tissue, and 69.6±19.6 HU for loose matrix; mean CT40keV was 28.1±36.7 HU for LRNC, 87.5±48.9 HU for IPH, 106.3±47.5 HU for fibrous tissue, and 102.6±48.0 HU for loose matrix. AUC for differentiating LRNC from other components was highest (0.945) for CT40kev and decreased with higher keV; AUC for CTPI was 0.908. CT40kev also had highest accuracy (90.4%); at cutoff of 55.7 HU, CT40kev had 88.5% sensitivity and 90.9% specificity. For differentiating IPH from fibrous tissue and loose matrix, AUC was highest at 0.652 for CTPI and 0.645 for CT40kev. Conclusion: DLCTA showed strong performance in differentiating LRNC from other non-calcified plaque components; CT40kev had highest accuracy, outperforming conventional polyenergetic images. Clinical Impact: DLCTA parameters may help characterize carotid plaque composition as a marker of vulnerable plaque and ischemia risk.
Collapse
|
16
|
Pillenahalli Maheshwarappa R, Rajdev M, Nagpal P, Gholamrezanezhad A, Soni N, Gupta A. "Multimodality imaging of the extrapleural space lesions". Clin Imaging 2021; 79:64-84. [PMID: 33892397 DOI: 10.1016/j.clinimag.2021.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different pathologies including chronic inflammatory conditions, infections, trauma, neoplastic disease (both benign and malignant) as well as many infiltrative disorders can involve the EPS. It is one of the frequently overlooked entity on imaging due to relative lack of understanding of the anatomy and the imaging appearances of the diseases localized to this space. The knowledge of the EPS is essential for the radiologists as the pathologies which involve the EPS may require different treatment approach compared to pleural or parenchymal lung disease. Additionally, the EPS involvement may influence the staging and treatment planning for chest malignancies. In this review, we give an overview of the anatomy and various pathologies involving EPS, utility of different imaging modalities in the evaluation of EPS lesions with emphasis on cross sectional imaging and emerging technologies like spectral CT and its role in recognizing the imaging features which enable specific diagnosis of various pathologies.
Collapse
|
17
|
Tsianaka T, Matziris I, Kobe A, Euler A, Kuzo N, Erhart L, Leschka S, Manka R, Kasel AM, Tanner FC, Alkadhi H, Eberhard M. Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography. Eur J Radiol Open 2021; 8:100335. [PMID: 33748350 PMCID: PMC7960936 DOI: 10.1016/j.ejro.2021.100335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
Mitral annulus disjunction (MAD) is frequent in patients with severe aortic stenosis. Computed tomography enables a highly reproducible assessment of MAD. MAD patients significantly more often have mitral valve prolapse.
Objectives To determine with CT the prevalence and extent of mitral annular disjunction (MAD) in patients undergoing transcatheter aortic valve replacement (TAVR) and its association with mitral valve disease and arrhythmia. Methods We retrospectively evaluated 408 patients (median age, 82 years; 186 females) with severe aortic stenosis undergoing ECG-gated cardiac CT with end-systolic data acquisition. Baseline and follow-up data were collected in the context of a national registry. Two blinded, independent observers evaluated the presence of MAD on multi-planar reformations. Maximum MAD distance (left atrial wall-mitral leaflet junction to left ventricular myocardium) and circumferential extent of MAD were assessed on CT using dedicated post-processing software. Associated mitral valve disease was determined with echocardiography. Results 7.8 % (32/408) of patients with severe aortic stenosis had MAD. The maximum MAD was 3.5 mm (interquartile range: 3.0–4.0 mm). The circumferential extent of MAD comprised 34 ± 15 % of the posterior and 26 ± 12 % of the entire mitral annulus. Intra- and interobserver agreement for the detection of MAD on CT were excellent (kappa: 0.90 ± 0.02 and 0.92 ± 0.02). Mitral regurgitation (p = 1.00) and severe mitral annular calcification (p = 0.29) were similarly prevalent in MAD and non-MAD patients. Significantly more patients with MAD (6/32; 19 %) had mitral valve prolapse compared to those without (6/376; 2 %; p < 0.001). MAD was not associated with arrhythmia before and after TAVR (p > 0.05). Conclusions Using CT, MAD was found in 7.8 % of patients with severe aortic stenosis, with a higher prevalence in patients with mitral valve prolapse. We found no association of MAD with arrhythmia before or after TAVR.
Collapse
Affiliation(s)
- T Tsianaka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - I Matziris
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - A Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - A Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - N Kuzo
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - L Erhart
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - S Leschka
- Division of Radiology and Nuclear Medicine, Kantonsspital St.Gallen, Switzerland
| | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - A M Kasel
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - F C Tanner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| |
Collapse
|