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Hu B, Shi Z, Lu L, Miao Z, Wang H, Zhou Z, Zhang F, Wang R, Luo X, Xu F, Li S, Fang X, Wang X, Yan G, Lv F, Zhang M, Sun Q, Cui G, Liu Y, Zhang S, Pan C, Hou Z, Liang H, Pan Y, Chen X, Li X, Zhou F, Schoepf UJ, Varga-Szemes A, Garrison Moore W, Yu Y, Hu C, Zhang LJ. A deep-learning model for intracranial aneurysm detection on CT angiography images in China: a stepwise, multicentre, early-stage clinical validation study. Lancet Digit Health 2024; 6:e261-e271. [PMID: 38519154 DOI: 10.1016/s2589-7500(23)00268-6] [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: 02/07/2023] [Revised: 10/23/2023] [Accepted: 12/29/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Artificial intelligence (AI) models in real-world implementation are scarce. Our study aimed to develop a CT angiography (CTA)-based AI model for intracranial aneurysm detection, assess how it helps clinicians improve diagnostic performance, and validate its application in real-world clinical implementation. METHODS We developed a deep-learning model using 16 546 head and neck CTA examination images from 14 517 patients at eight Chinese hospitals. Using an adapted, stepwise implementation and evaluation, 120 certified clinicians from 15 geographically different hospitals were recruited. Initially, the AI model was externally validated with images of 900 digital subtraction angiography-verified CTA cases (examinations) and compared with the performance of 24 clinicians who each viewed 300 of these cases (stage 1). Next, as a further external validation a multi-reader multi-case study enrolled 48 clinicians to individually review 298 digital subtraction angiography-verified CTA cases (stage 2). The clinicians reviewed each CTA examination twice (ie, with and without the AI model), separated by a 4-week washout period. Then, a randomised open-label comparison study enrolled 48 clinicians to assess the acceptance and performance of this AI model (stage 3). Finally, the model was prospectively deployed and validated in 1562 real-world clinical CTA cases. FINDINGS The AI model in the internal dataset achieved a patient-level diagnostic sensitivity of 0·957 (95% CI 0·939-0·971) and a higher patient-level diagnostic sensitivity than clinicians (0·943 [0·921-0·961] vs 0·658 [0·644-0·672]; p<0·0001) in the external dataset. In the multi-reader multi-case study, the AI-assisted strategy improved clinicians' diagnostic performance both on a per-patient basis (the area under the receiver operating characteristic curves [AUCs]; 0·795 [0·761-0·830] without AI vs 0·878 [0·850-0·906] with AI; p<0·0001) and a per-aneurysm basis (the area under the weighted alternative free-response receiver operating characteristic curves; 0·765 [0·732-0·799] vs 0·865 [0·839-0·891]; p<0·0001). Reading time decreased with the aid of the AI model (87·5 s vs 82·7 s, p<0·0001). In the randomised open-label comparison study, clinicians in the AI-assisted group had a high acceptance of the AI model (92·6% adoption rate), and a higher AUC when compared with the control group (0·858 [95% CI 0·850-0·866] vs 0·789 [0·780-0·799]; p<0·0001). In the prospective study, the AI model had a 0·51% (8/1570) error rate due to poor-quality CTA images and recognition failure. The model had a high negative predictive value of 0·998 (0·994-1·000) and significantly improved the diagnostic performance of clinicians; AUC improved from 0·787 (95% CI 0·766-0·808) to 0·909 (0·894-0·923; p<0·0001) and patient-level sensitivity improved from 0·590 (0·511-0·666) to 0·825 (0·759-0·880; p<0·0001). INTERPRETATION This AI model demonstrated strong clinical potential for intracranial aneurysm detection with improved clinician diagnostic performance, high acceptance, and practical implementation in real-world clinical cases. FUNDING National Natural Science Foundation of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Bin Hu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhao Shi
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Li Lu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongchang Miao
- Department of Medical Imaging, the First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Hao Wang
- Deepwise Artificial Intelligence (AI) Lab, Deepwise, Beijing, China
| | - Zhen Zhou
- Deepwise Artificial Intelligence (AI) Lab, Deepwise, Beijing, China
| | - Fandong Zhang
- Deepwise Artificial Intelligence (AI) Lab, Deepwise, Beijing, China
| | - Rongpin Wang
- Department of Medical Imaging, Guizhou Province People's Hospital, Guiyang, Guizhou, China
| | - Xiao Luo
- Department of Radiology, Ma'anshan People's Hospital, Ma'anshan, Anhui, China
| | - Feng Xu
- Department of Medical Imaging, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Sheng Li
- Department of Radiology, People's Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xiangming Fang
- Department of Medical Imaging, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiaodong Wang
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ge Yan
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fajin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Meng Zhang
- Department of Radiology, People's Hospital of Sanya, Sanya, Hainan, China
| | - Qiu Sun
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Guangbin Cui
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China
| | - Yubao Liu
- Medical Imaging Center, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| | - Shu Zhang
- Deepwise Artificial Intelligence (AI) Lab, Deepwise, Beijing, China
| | - Chengwei Pan
- Institute of Artificial Intelligence, Beihang University, Beijing, China
| | - Zhibo Hou
- Department of Radiology, Medical Imaging Center, Peking University Shougang Hospital, Beijing, China
| | - Huiying Liang
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou Guangdong, China
| | - Yuning Pan
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Xiaoxia Chen
- Department of Radiology, Third Center Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaorong Li
- Department of Radiology, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong, China
| | - Fei Zhou
- Department of Radiology, Central Hospital of Jilin City, Jilin, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - W Garrison Moore
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Yizhou Yu
- Department of Computer Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chunfeng Hu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Zsarnoczay E, Pinos D, Schoepf UJ, Fink N, O'Doherty J, Gnasso C, Griffith J, Vecsey-Nagy M, Suranyi P, Maurovich-Horvat P, Emrich T, Varga-Szemes A. Intra-individual comparison of coronary CT angiography-based FFR between energy-integrating and photon-counting detector CT systems. Int J Cardiol 2024; 399:131684. [PMID: 38151162 DOI: 10.1016/j.ijcard.2023.131684] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-based fractional flow reserve (CT-FFR) allows for noninvasive determination of the functional severity of anatomic lesions in patients with coronary artery disease. The aim of this study was to intra-individually compare CT-FFR between photon-counting detector (PCD) and conventional energy-integrating detector (EID) CT systems. METHODS In this single-center prospective study, subjects who underwent clinically indicated CCTA on an EID-CT system were recruited for a research CCTA on PCD-CT within 30 days. Image reconstruction settings were matched as closely as possible between EID-CT (Bv36 kernel, iterative reconstruction strength level 3, slice thickness 0.5 mm) and PCD-CT (Bv36 kernel, quantum iterative reconstruction level 3, virtual monoenergetic level 55 keV, slice thickness 0.6 mm). CT-FFR was measured semi-automatically using a prototype on-site machine learning algorithm by two readers. CT-FFR analysis was performed per-patient and per-vessel, and a CT-FFR ≤ 0.75 was considered hemodynamically significant. RESULTS A total of 22 patients (63.3 ± 9.2 years; 7 women) were included. Median time between EID-CT and PCD-CT was 5.5 days. Comparison of CT-FFR values showed no significant difference and strong agreement between EID-CT and PCD-CT in the per-vessel analysis (0.88 [0.74-0.94] vs. 0.87 [0.76-0.93], P = 0.096, mean bias 0.02, limits of agreement [LoA] -0.14/0.19, r = 0.83, ICC = 0.92), and in the per-patient analysis (0.81 [0.60-0.86] vs. 0.76 [0.64-0.86], P = 0.768, mean bias 0.02, LoA -0.15/0.19, r = 0.90, ICC = 0.93). All included patients were classified into the same category (CT-FFR > 0.75 vs ≤0.75) with both CT systems. CONCLUSIONS CT-FFR evaluation is feasible with PCD-CT and it shows a strong agreement with EID-CT-based evaluation when images are similarly reconstructed.
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Affiliation(s)
- Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Siemens Medical Solutions USA Inc, Malvern, USA
| | - Chiara Gnasso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
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Tóth A, Chamberlin JH, Mendez S, Varga-Szemes A, Hardie AD. Iodine quantification of renal lesions: Preliminary results using spectral-based material extraction on photon-counting CT. J Clin Imaging Sci 2024; 14:7. [PMID: 38628606 PMCID: PMC11021115 DOI: 10.25259/jcis_1_2024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/13/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives To assess the range of quantitative iodine values in renal cysts (RC) (with a few renal neoplasms [RNs] as a comparison) to develop an expected range of values for RC that can be used in future studies for their differentiation. Material and Methods Consecutive patients (n = 140) with renal lesions who had undergone abdominal examination on a clinical photon-counting computed tomography (PCCT) were retrospectively included. Automated iodine quantification maps were reconstructed, and region of interest (ROI) measurements of iodine concentration (IC) (mg/cm3) were performed on whole renal lesions. In addition, for heterogeneous lesions, a secondary ROI was placed on the area most suspicious for malignancy. The discriminatory values of minimum, maximum, mean, and standard deviation for IC were compared using simple logistic regression and receiver operating characteristic curves (area under the curve [AUC]). Results A total of 259 renal lesions (243 RC and 16 RN) were analyzed. There were significant differences between RC and RN for all IC measures with the best-performing metrics being mean and maximum IC of the entire lesion ROI (AUC 0.912 and 0.917, respectively) but also mean and minimum IC of the most suspicious area in heterogeneous lesions (AUC 0.983 and 0.992, respectively). Most RC fell within a range of low measured iodine values although a few had higher values. Conclusion Automated iodine quantification maps reconstructed from clinical PCCT have a high diagnostic ability to differentiate RCs and neoplasms. The data from this pilot study can be used to help establish quantitative values for clinical differentiation of renal lesions.
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Affiliation(s)
- Adrienn Tóth
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Jordan H. Chamberlin
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Salvador Mendez
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Andrew D. Hardie
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, United States
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Brandt V, Fischer A, Schoepf UJ, Bekeredjian R, Tesche C, Aquino GJ, O'Doherty J, Sharma P, Gülsün MA, Klein P, Ali A, Few WE, Emrich T, Varga-Szemes A, Decker JA. Deep Learning-Based Automated Labeling of Coronary Segments for Structured Reporting of Coronary Computed Tomography Angiography in Accordance With Society of Cardiovascular Computed Tomography Guidelines. J Thorac Imaging 2024; 39:93-100. [PMID: 37889562 DOI: 10.1097/rti.0000000000000753] [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: 10/28/2023]
Abstract
PURPOSE To evaluate a novel deep learning (DL)-based automated coronary labeling approach for structured reporting of coronary artery disease according to the guidelines of the Society of Cardiovascular Computed Tomography (CT) on coronary CT angiography (CCTA). PATIENTS AND METHODS A retrospective cohort of 104 patients (60.3 ± 10.7 y, 61% males) who had undergone prospectively electrocardiogram-synchronized CCTA were included. Coronary centerlines were automatically extracted, labeled, and validated by 2 expert readers according to Society of Cardiovascular CT guidelines. The DL algorithm was trained on 706 radiologist-annotated cases for the task of automatically labeling coronary artery centerlines. The architecture leverages tree-structured long short-term memory recurrent neural networks to capture the full topological information of the coronary trees by using a two-step approach: a bottom-up encoding step, followed by a top-down decoding step. The first module encodes each sub-tree into fixed-sized vector representations. The decoding module then selectively attends to the aggregated global context to perform the local assignation of labels. To assess the performance of the software, percentage overlap was calculated between the labels of the algorithm and the expert readers. RESULTS A total number of 1491 segments were identified. The artificial intelligence-based software approach yielded an average overlap of 94.4% compared with the expert readers' labels ranging from 87.1% for the posterior descending artery of the right coronary artery to 100% for the proximal segment of the right coronary artery. The average computational time was 0.5 seconds per case. The interreader overlap was 96.6%. CONCLUSIONS The presented fully automated DL-based coronary artery labeling algorithm provides fast and precise labeling of the coronary artery segments bearing the potential to improve automated structured reporting for CCTA.
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Affiliation(s)
- Verena Brandt
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart
- Department of Cardiology, German Heart Centre Munich
| | - Andreas Fischer
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Cardiology, Clinic Augustinum Munich
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich
| | - Gilberto J Aquino
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Jim O'Doherty
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Siemens Medical Solutions USA, Siemens Healthineers, Malvern, PA
| | - Puneet Sharma
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Mehmet A Gülsün
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Paul Klein
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Asik Ali
- Department of Digital Technology and Innovation, Siemens Healthineers, Bangalore, KA, India
| | - William Evans Few
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Gohannes Gutenberg University Mainz, Mainz
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Josua A Decker
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
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Xiong F, Emrich T, Schoepf UJ, Jin N, Hall S, Ruddy JM, Giese D, Lautenschlager C, Emrich AL, Varga-Szemes A. Highly accelerated free-breathing real-time 2D flow imaging using compressed sensing and shared velocity encoding. Eur Radiol 2024; 34:1692-1703. [PMID: 37658887 DOI: 10.1007/s00330-023-10157-6] [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] [Received: 08/11/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES 2D real-time (RT) phase-contrast (PC) MRI is a promising alternative to conventional PC MRI, which overcomes problems due to irregular heartbeats or poor respiratory control. This study aims to evaluate a prototype compressed sensing (CS)-accelerated 2D RT-PC MRI technique with shared velocity encoding (SVE) for accurate beat-to-beat flow measurements. METHODS The CS RT-PC technique was implemented using a single-shot fast RF-spoiled gradient echo with SVE by symmetric velocity encoding, and acquired with a temporal resolution of 51-56.5 ms in 1-5 heartbeats. Both aortic dissection phantom (n = 8) and volunteer (n = 7) studies were conducted using the prototype CS RT (CS, R = 8), the conventional (GRAPPA, R = 2), and the fully sampled PC sequences on a 3T clinical system. Flow parameters including peak velocity, peak flow rate, net flow rate, and maximum velocity were calculated to compare the performance between different methods using linear regression, intraclass correlation (ICC), and Bland-Altman analyses. RESULTS Comparisons of the flow measurements at all locations in the phantoms demonstrated an excellent correlation (all R2 ≥ 0.93) and agreement (all ICC ≥ 0.97) with negligible means of differences. In healthy volunteers, a similarly good correlation (all R2 ≥ 0.80) and agreement (all ICC ≥ 0.90) were observed; however, CS RT slightly underestimated the maximum velocities and flow rates (~ 12%). CONCLUSION The highly accelerated CS RT-PC technique is feasible for the evaluation of flow patterns without requiring breath-holding, and it allows for rapid flow assessment in patients with arrhythmia or poor breath-hold capacity. CLINICAL RELEVANCE STATEMENT The free-breathing real-time flow MRI technique offers improved spatial and temporal resolutions, as well as the ability to image individual cardiac cycles, resulting in superior image quality compared to the conventional PC technique when imaging patients with arrhythmias, especially those with atrial fibrillation. KEY POINTS • The highly accelerated prototype CS RT-PC MRI technique with improved temporal resolution by the concept of SVE is feasible for beat-to-beat flow evaluation without requiring breath-holding. • The results of the phantom and in vivo quantitative flow evaluation show the ability of the prototype CS RT-PC technique to obtain reliable flow measurements similarly to the conventional PC MRI. • With less than 12% underestimation, excellent agreements between the two techniques were shown for the measurements of peak velocities and flow rates.
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Affiliation(s)
- Fei Xiong
- Siemens Medical Solutions USA Inc, Cardiovascular MR R&D, Chicago, IL, USA
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC, 29425-2260, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC, 29425-2260, USA.
| | - Ning Jin
- Siemens Medical Solutions USA Inc, Cardiovascular MR R&D, Chicago, IL, USA
| | - SarahRose Hall
- Division of Vascular Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jean Marie Ruddy
- Division of Vascular Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Carla Lautenschlager
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC, 29425-2260, USA
| | - Anna Lena Emrich
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC, 29425-2260, USA
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Halfmann MC, Klimzak T, Schoepf UJ, Kloeckner R, Chitiboi T, Schmidt M, Wenzel P, Müller L, Geyer M, Varga-Szemes A, Kreitner KF, Dueber C, Emrich T. Feature-Tracking Strain Parameters Differ Between Highly Accelerated and Conventional Acquisitions: A Multisoftware Assessment. J Thorac Imaging 2024; 39:127-135. [PMID: 37982533 DOI: 10.1097/rti.0000000000000762] [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: 11/21/2023]
Abstract
BACKGROUND Cardiac magnetic resonance imaging protocols have been adapted to fit the needs for faster, more efficient acquisitions, resulting in the development of highly accelerated, compressed sensing-based (CS) sequences. The aim of this study was to evaluate intersoftware and interacquisition differences for postprocessing software applied to both CS and conventional cine sequences. MATERIALS AND METHODS A total of 106 individuals (66 healthy volunteers, 40 patients with dilated cardiomyopathy, 51% female, 38±17 y) underwent cardiac magnetic resonance at 3T with retrospectively gated conventional cine and CS sequences. Postprocessing was performed using 2 commercially available software solutions and 1 research prototype from 3 different developers. The agreement of clinical and feature-tracking strain parameters between software solutions and acquisition types was assessed by Bland-Altmann analyses and intraclass correlation coefficients. Differences between softwares and acquisitions were assessed using Kruskal-Wallis analysis of variances. In addition, receiver operating characteristic curve-derived cutoffs were used to evaluate whether sequence-specific cutoffs influence disease classification. RESULTS There were significant intersoftware ( P <0.002 for all except LV end-diastolic volume per body surface area) and interacquisition differences ( P <0.02 for all except end-diastolic volume per body surface area from Neosoft, left ventricular mass per body surface area from cvi42 and TrufiStrain and global circumferential strain from Neosoft). However, the intraclass correlation coefficients between acquisitions were strong-to-excellent for all parameters (all ≥0.81). In comparing individual softwares to a pooled mean, Bland-Altmann analyses revealed smaller magnitudes of bias for cine acquisition than for CS acquisition. In addition, the application of conventional cutoffs to CS measurements did not result in the false reclassification of patients. CONCLUSION Significantly lower magnitudes of strain and volumetric parameters were observed in retrospectively gated CS acquisitions, despite strong-to-excellent agreement amongst software solutions and acquisition types. It remains important to be aware of the acquisition type in the context of follow-up examinations, where different cutoffs might lead to misclassifications.
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Affiliation(s)
- Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main
| | - Tim Klimzak
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
- Department for Interventional Radiology, University Hospital of Lübeck, Lübeck
| | | | | | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Mainz
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Mainz
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
| | - Christoph Dueber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main
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Wolf EV, Halfmann MC, Varga-Szemes A, Fink N, Kloeckner R, Bockius S, Allmendinger T, Hagenauer J, Koehler T, Kreitner KF, Schoepf UJ, Münzel T, Düber C, Gori T, Yang Y, Hell MM, Emrich T. Photon-Counting Detector CT Virtual Monoenergetic Images for Coronary Artery Stenosis Quantification: Phantom and In Vivo Evaluation. AJR Am J Roentgenol 2024; 222:e2330481. [PMID: 38197760 DOI: 10.2214/ajr.23.30481] [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: 01/11/2024]
Abstract
BACKGROUND. Calcium blooming causes stenosis overestimation on coronary CTA. OBJECTIVE. The purpose of this article was to evaluate the impact of virtual monoenergetic imaging (VMI) reconstruction level on coronary artery stenosis quantification using photon-counting detector (PCD) CT. METHODS. A phantom containing two custom-made vessels (representing 25% and 50% stenosis) underwent PCD CT acquisitions without and with simulated cardiac motion. A retrospective analysis was performed of 33 patients (seven women, 26 men; mean age, 71.3 ± 9.0 [SD] years; 64 coronary artery stenoses) who underwent coronary CTA by PCD CT followed by invasive coronary angiography (ICA). Scans were reconstructed at nine VMI energy levels (40-140 keV). Percentage diameter stenosis (PDS) was measured, and bias was determined from the ground-truth stenosis percentage in the phantom and ICA-derived quantitative coronary angiography measurements in patients. Extent of blooming artifact was measured in the phantom and in calcified and mixed plaques in patients. RESULTS. In the phantom, PDS decreased for 25% stenosis from 59.9% (40 keV) to 13.4% (140 keV) and for 50% stenosis from 81.6% (40 keV) to 42.3% (140 keV). PDS showed lowest bias for 25% stenosis at 90 keV (bias, 1.4%) and for 50% stenosis at 100 keV (bias, -0.4%). Blooming artifacts decreased for 25% stenosis from 61.5% (40 keV) to 35.4% (140 keV) and for 50% stenosis from 82.7% (40 keV) to 52.1% (140 keV). In patients, PDS for calcified plaque decreased from 70.8% (40 keV) to 57.3% (140 keV), for mixed plaque decreased from 69.8% (40 keV) to 56.3% (140 keV), and for noncalcified plaque was 46.6% at 40 keV and 54.6% at 140 keV. PDS showed lowest bias for calcified plaque at 100 keV (bias, 17.2%), for mixed plaque at 140 keV (bias, 5.0%), and for noncalcified plaque at 40 keV (bias, -0.5%). Blooming artifacts decreased for calcified plaque from 78.4% (40 keV) to 48.6% (140 keV) and for mixed plaque from 73.1% (40 keV) to 44.7% (140 keV). CONCLUSION. For calcified and mixed plaque, stenosis severity measurements and blooming artifacts decreased at increasing VMI reconstruction levels. CLINICAL IMPACT. PCD CT with VMI reconstruction helps overcome current limitations in stenosis quantification on coronary CTA.
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Affiliation(s)
- Elias V Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Nicola Fink
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany
| | - Stefanie Bockius
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | | | | | | | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Thomas Münzel
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Tommaso Gori
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
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8
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Halfmann MC, Bockius S, Emrich T, Hell M, Schoepf UJ, Laux GS, Kavermann L, Graafen D, Gori T, Yang Y, Kloeckner R, Maurovich-Horvat P, Ricke J, Müller L, Varga-Szemes A, Fink N. Ultrahigh-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment. Radiology 2024; 310:e231956. [PMID: 38376407 DOI: 10.1148/radiol.231956] [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: 02/21/2024]
Abstract
Background Coronary CT angiography is a first-line test in coronary artery disease but is limited by severe calcifications. Photon-counting-detector (PCD) CT improves spatial resolution. Purpose To investigate the effect of improved spatial resolution on coronary stenosis assessment and reclassification. Materials and Methods Coronary stenoses were evaluated prospectively in a vessel phantom (in vitro) containing two stenoses (25%, 50%), and retrospectively in patients (in vivo) who underwent ultrahigh-spatial-resolution cardiac PCD CT (from July 2022 to April 2023). Images were reconstructed at standard resolution (section thickness, 0.6 mm; increment, 0.4 mm; Bv44 kernel), high spatial resolution (section thickness, 0.4 mm; increment, 0.2 mm; Bv44 kernel), and ultrahigh spatial resolution (section thickness, 0.2; increment, 0.1 mm; Bv64 kernel). Percentages of diameter stenosis (DS) were compared between reconstructions. In vitro values were compared with the manufacturer specifications of the phantom and patient results were assessed regarding effects on Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification. Results The in vivo sample included 114 patients (mean age, 68 years ± 9 [SD]; 71 male patients). In vitro percentage DS measurements were more accurate with increasing spatial resolution for both 25% and 50% stenoses (mean bias for standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 10.1%, 8.0%, and 2.3%; P < .001). In vivo results confirmed decreasing median percentage DS with increasing spatial resolution for calcified stenoses (n = 161) (standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 41.5% [IQR, 27.3%-58.2%], 34.8% [IQR, 23.7%-55.1%], and 26.7% [IQR, 18.6%-44.3%]; P < .001), whereas noncalcified (n = 13) and mixed plaques (n = 19) did not show evidence of a difference (P ≥ .88). Ultrahigh-spatial-resolution reconstructions led to reclassification of 62 of 114 (54.4%) patients to lower CAD-RADS category than that assigned using standard resolution. Conclusion In vivo and in vitro coronary stenosis assessment improved for calcified stenoses by using ultrahigh-spatial-resolution PCD CT reconstructions, leading to lower percentage DS compared with standard resolution and clinically relevant rates of reclassification. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by McCollough in this issue.
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Affiliation(s)
- Moritz C Halfmann
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Stefanie Bockius
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Tilman Emrich
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Michaela Hell
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - U Joseph Schoepf
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Gerald S Laux
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Larissa Kavermann
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Dirk Graafen
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Tomasso Gori
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Yang Yang
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Roman Kloeckner
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Pál Maurovich-Horvat
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Jens Ricke
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Lukas Müller
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Akos Varga-Szemes
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
| | - Nicola Fink
- From the Department of Diagnostic and Interventional Radiology (M.C.H., S.B., T.E., D.G., Y.Y., L.M.) and Department of Cardiology (M.H., G.S.L., L.K., T.G.), University Medical Center of the Johannes Gutenberg-University, Langenbeckstr 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany (M.C.H., T.E., T.G.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (T.E., U.J.S., A.V.S.); Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany (R.K.); Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary (P.M.H.); and Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.R., N.F.)
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9
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Vecsey-Nagy M, Kolossváry M, Varga-Szemes A, Boussoussou M, Vattay B, Nagy M, Juhász D, Merkely B, Radovits T, Szilveszter B. Low-attenuation coronary plaque burden and troponin release in chronic coronary syndrome: A mediation analysis. J Cardiovasc Comput Tomogr 2024; 18:18-25. [PMID: 37867127 DOI: 10.1016/j.jcct.2023.10.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Coronary low-attenuation plaque (LAP) burden is a strong predictor of myocardial infarction in patients with stable chest pain. We aimed to assess the relationship between LAP burden and circulating levels of high-sensitivity cardiac troponin T (hs-cTnT), and to explore the potential underlying etiology in patients undergoing clinically indicated coronary CT angiography (CCTA). METHODS A comprehensive metabolic and lipid panel, as well as C-reactive protein (CRP) and hs-cTnT tests were obtained from consecutive patients with stable chest pain at the time of CCTA. Qualitative and quantitative coronary plaque analysis, CT-derived fractional flow reserve (FFR) calculation, and pericoronary adipose tissue (PCAT) attenuation measurement around the right coronary artery were performed on CCTA images. Linear regression analyses were performed to identify independent associations with hs-cTnT concentration and mediation analysis was used to assess whether ischemia or markers of inflammation mediate hs-cTnT elevation. RESULTS In total, 114 patients (56.3 ± 10.6 years, 44.7 % female) were enrolled. In multivariable analysis, age (β = 0.04 [95%CI: 0.02; 0.06], p < 0.001), female sex (β = -0.77 [95%CI: -1.20; 0.33], p < 0.001), and LAP burden (β = 0.03 [95%CI: 0.001; 0.06], p = 0.04) were independently associated with hs-cTnT levels. Mediation analysis, on the other hand, did not identify a significant mediating effect of lesion-specific ischemia based on CT-FFR, circulating CRP levels, or PCAT values between LAP burden and hs-cTnT levels (all p > 0.05). CONCLUSION Although ischemia and inflammation have previously been proposed to mediate the association between LAP burden and hs-cTnT levels, our results did not confirm the role of these pathophysiological pathways in patients with stable chest pain.
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Affiliation(s)
- Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, Budapest, Hungary
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | | | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Martin Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dénes Juhász
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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10
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Simon J, Hrenkó Á, Kerkovits NM, Nagy K, Vértes M, Balogh H, Nagy N, Munkácsi T, Emrich T, Varga-Szemes A, Boussoussou M, Vattay B, Vecsey-Nagy M, Kolossváry M, Szilveszter B, Merkely B, Maurovich-Horvat P. Photon-counting detector CT reduces the rate of referrals to invasive coronary angiography as compared to CT with whole heart coverage energy-integrating detector. J Cardiovasc Comput Tomogr 2024; 18:69-74. [PMID: 38097408 DOI: 10.1016/j.jcct.2023.11.079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/19/2023] [Accepted: 11/24/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND We sought to compare the degree of maximal stenosis and the rate of invasive coronary angiography (ICA) recommendations in patients who underwent coronary CT angiography (CCTA) with photon-counting detector CT (PCD-CT) versus those who underwent CCTA with whole heart coverage energy-integrating detector CT (EID-CT). METHODS In our retrospective single-center study, we included consecutive patients with suspected CAD who underwent CCTA performed with either PCD-CT or a 280-slice EID-CT. The degree of coronary stenosis was classified as no CAD, minimal (1-24 %), mild (25-49 %), moderate (50-69 %), severe stenosis (70-99 %), or occlusion. RESULTS A total of 812 consecutive patients were included in the analysis, 401 patients scanned with EID-CT and 411 patients with PCD-CT (mean age: 58.4 ± 12.4 years, 45.4 % female). Despite the higher total coronary artery calcium score (CACS) in the PCD-CT group (10 [interquartile range (IQR) = 0-152.8] vs 1 [IQR = 0-94], p < 0.001), obstructive CAD was more frequently reported in the EID-CT vs PCD-CT group (no CAD: 28.7 % vs 26.0 %, minimal: 23.2 % vs 30.9 %, mild: 19.7 % vs 23.4 %, moderate: 14.5 % vs 9.7 %, severe: 11.5 % vs 8.5 % and occlusion: 2.5 % vs 1.5 %, respectively, p = 0.025). EID-CT was independently associated with downstream ICA (OR = 2.76 [95%CI = 1.58-4.97] p < 0.001) in the overall patient population, in patients with CACS<400 (OR = 2.18 [95%CI = 1.13-4.39] p = 0.024) and in patients with CACS≥400 (OR = 3.83 [95%CI = 1.42-11.05] p = 0.010). CONCLUSION In patients who underwent CCTA with PCD-CT the number of subsequent ICAs was lower as compared to patients who were scanned with EID-CT. This difference was greater in patients with extensive coronary calcification.
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Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Áron Hrenkó
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Nóra Melinda Kerkovits
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Kristóf Nagy
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Miklós Vértes
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Hanna Balogh
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Norbert Nagy
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Munkácsi
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | | | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
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11
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Chamberlin JH, Smith CD, Maisuria D, Parrish J, van Swol E, Mah E, Emrich T, Schoepf UJ, Varga-Szemes A, O'Doherty J, Munden RF, Tipnis SV, Baruah D, Kabakus IM. Ultra-high-resolution photon-counting detector computed tomography of the lungs: Phantom and clinical assessment of radiation dose and image quality. Clin Imaging 2023; 104:110008. [PMID: 37862910 DOI: 10.1016/j.clinimag.2023.110008] [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] [Received: 05/28/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Photon-counting-detector computed tomography (PCD-CT) offers enhanced noise reduction, spatial resolution, and image quality in comparison to energy-integrated-detectors CT (EID-CT). These hypothesized improvements were compared using PCD-CT ultra-high (UHR) and standard-resolution (SR) scan-modes. METHODS Phantom scans were obtained with both EID-CT and PCD-CT (UHR, SR) on an adult body-phantom. Radiation dose was measured and noise levels were compared at a minimum achievable slice thickness of 0.5 mm for EID-CT, 0.2 mm for PCD-CT-UHR and 0.4 mm for PCD-CT-SR. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were calculated for five tissue densities. Additionally, data from 25 patients who had PCD-CT of chest were reconstructed at 1 mm and 0.2 mm (UHR) slice-thickness and compared quantitatively (SNR) and qualitatively (noise, quality, sharpness, bone details). RESULTS Phantom PCD-CT-UHR and PCD-CT-SR scans had similar measured radiation dose (16.0mGy vs 15.8 mGy). Phantom PCD-CT-SR (0.4 mm) had lower noise level in comparison to EID-CT (0.5 mm) (9.0HU vs 9.6HU). PCD-CT-UHR (0.2 mm) had slightly higher noise level (11.1HU). Phantom PCD-CT-SR (0.4 mm) had higher SNR in comparison to EID-CT (0.5 mm) while achieving higher resolution (Bone 115 vs 96, Acrylic 14 vs 14, Polyethylene 11 vs 10). SNR was slightly lower across all densities for PCD-CT UHR (0.2 mm). Interestingly, CNR was highest in the 0.2 mm PCD-CT group; PCD-CT CNR was 2.45 and 2.88 times the CNR for 0.5 mm EID-CT for acrylic and poly densities. Clinical comparison of SNR showed predictably higher SNR for 1 mm (30.3 ± 10.7 vs 14.2 ± 7, p = 0.02). Median subjective ratings were higher for 0.2 mm UHR vs 1 mm PCD-CT for nodule contour (4.6 ± 0.3 vs 3.6 ± 0.1, p = 0.02), bone detail (5 ± 0 vs 4 ± 0.1, p = 0.001), image quality (5 ± 0.1 vs 4.6 ± 0.4, p = 0.001), and sharpness (5 ± 0.1 vs 4 ± 0.2). CONCLUSION Both UHR and SR PCD-CT result in similar radiation dose levels. PCD-CT can achieve higher resolution with lower noise level in comparison to EID-CT.
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Affiliation(s)
- Jordan H Chamberlin
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Carter D Smith
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Dhruw Maisuria
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Joe Parrish
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Elizabeth van Swol
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Eugene Mah
- Department of Radiology and Radiological Science, Division of Medical Physics, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Jim O'Doherty
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA; Siemens Medical Solutions, Malvern, PA, USA
| | - Reginald F Munden
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Sameer V Tipnis
- Department of Radiology and Radiological Science, Division of Medical Physics, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Dhiraj Baruah
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA
| | - Ismail M Kabakus
- Department of Radiology and Radiological Science, Divisions of Cardiovascular and Thoracic Imaging, Medical University of South Carolina, Charleston, SC 29407, USA.
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12
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Böttcher B, Zsarnoczay E, Varga-Szemes A, Schoepf UJ, Meinel FG, van Assen M, De Cecco CN. Dual-Energy Computed Tomography in Cardiac Imaging. Radiol Clin North Am 2023; 61:995-1009. [PMID: 37758366 DOI: 10.1016/j.rcl.2023.05.004] [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: 10/03/2023]
Abstract
Dual-energy computed tomography (DECT) acquires images using two energy spectra and offers a variation of reconstruction techniques for improved cardiac imaging. Virtual monoenergetic images decrease artifacts improving coronary plaque and stent visualization. Further, contrast attenuation is increased allowing significant reduction of contrast dose. Virtual non-contrast reconstructions enable coronary artery calcium scoring from contrast-enhanced scans. DECT provides advanced plaque imaging with detailed analysis of plaque components, indicating plaque stability. Extracellular volume assessment using DECT offers noninvasive detection of myocardial fibrosis. This review aims to outline the current cardiac applications of DECT, summarize recent literature, and discuss their findings.
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Affiliation(s)
- Benjamin Böttcher
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Uwe Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging and Imaging Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc. 1365 Clifton Road NE, Suite - AT503, Atlanta, GA 30322, USA.
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13
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Pontone G, Guaricci AI, Fusini L, Baggiano A, Guglielmo M, Muscogiuri G, Volpe A, Abete R, Aquaro G, Barison A, Bogaert J, Camastra G, Carigi S, Carrabba N, Casavecchia G, Censi S, Cicala G, De Cecco CN, De Lazzari M, Di Giovine G, Di Roma M, Dobrovie M, Focardi M, Gaibazzi N, Gismondi A, Gravina M, Lanzillo C, Lombardi M, Lorenzoni V, Lozano-Torres J, Martini C, Marzo F, Masi A, Memeo R, Moro C, Nese A, Palumbo A, Pavon AG, Pedrotti P, Marra MP, Pica S, Pradella S, Presicci C, Rabbat MG, Raineri C, Rodriguez-Palomares JF, Sbarbati S, Schoepf UJ, Squeri A, Sverzellati N, Symons R, Tat E, Timpani M, Todiere G, Valentini A, Varga-Szemes A, Masci PG, Schwitter J. Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry. JACC Cardiovasc Imaging 2023; 16:1387-1400. [PMID: 37227329 DOI: 10.1016/j.jcmg.2023.03.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. OBJECTIVES The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. METHODS A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. RESULTS During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). CONCLUSIONS The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.
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Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | | | - Raffaele Abete
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Giovanni Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Andrea Barison
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | | | - Samuela Carigi
- Department of Cardiology, Infermi Hospital, Rimini, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department, Careggi Hospital, Florence, Italy
| | - Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Censi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Gloria Cicala
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Emory University, Atlanta, Georgia, USA
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | | | - Mauro Di Roma
- Radiology Department, Policlinico Casilino, Rome, Italy
| | - Monica Dobrovie
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Annalaura Gismondi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Jordi Lozano-Torres
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red-CV, CIBER CV, Spain
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Ambra Masi
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Memeo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Claudio Moro
- Department of Cardiology, ASST Monza, P.O. Desio, Italy
| | - Alberto Nese
- Dipartimento Neuro-Cardiovascolare, Ospedale Ca' Foncello Treviso, Treviso, Italy
| | - Alessandro Palumbo
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Giulia Pavon
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
| | - Patrizia Pedrotti
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Cristina Presicci
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois, USA; Edward Hines Jr VA Hospital, Hines, Illinois, USA
| | - Claudia Raineri
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - José F Rodriguez-Palomares
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red-CV, CIBER CV, Spain
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rolf Symons
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Emily Tat
- Loyola University of Chicago, Chicago, Illinois, USA
| | - Mauro Timpani
- U.O.C. Radiologia, "F. Spaziani" Hospital, Frosinone, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Juerg Schwitter
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland; Faculty of Medicine and Biology, University of Lausanne, UniL, Lausanne, Switzerland
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14
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Luo S, Xu ST, Zhang J, Schoepf UJ, Varga-Szemes A, Carpenter CRT, Zhang LY, Ma Y, Li Z, Wang Y, Huang WW, Zhi BB, Dou WQ, Qi L, Zhang LJ. Multiparametric cardiac magnetic resonance reveals persistent myocardial inflammation in patients with exertional heat illness. Eur Radiol 2023; 33:8165-8176. [PMID: 37145150 DOI: 10.1007/s00330-023-09706-w] [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] [Received: 10/07/2022] [Revised: 02/26/2023] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI). METHODS This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups. RESULTS Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042). CONCLUSIONS With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI. CLINICAL RELEVANCE STATEMENT This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients. KEY POINTS • EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis. • ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). • EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042).
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Affiliation(s)
- Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Shu Tian Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jun Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | | | - Ling Yan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Yan Ma
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Zhe Li
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yang Wang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wei Wei Huang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Bei Bei Zhi
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | | | - Li Qi
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China.
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China.
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15
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Wolf EV, Müller L, Schoepf UJ, Fink N, Griffith JP, Zsarnoczay E, Baruah D, Suranyi P, Kabakus IM, Halfmann MC, Emrich T, Varga-Szemes A, O'Doherty J. Photon-counting detector CT-based virtual monoenergetic reconstructions: repeatability and reproducibility of radiomics features of an organic phantom and human myocardium. Eur Radiol Exp 2023; 7:59. [PMID: 37875769 PMCID: PMC10597903 DOI: 10.1186/s41747-023-00371-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/17/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Photon-counting detector computed tomography (PCD-CT) may influence imaging characteristics for various clinical conditions due to higher signal and contrast-to-noise ratio in virtual monoenergetic images (VMI). Radiomics analysis relies on quantification of image characteristics. We evaluated the impact of different VMI reconstructions on radiomic features in in vitro and in vivo PCD-CT datasets. METHODS An organic phantom consisting of twelve samples (four oranges, four onions, and four apples) was scanned five times. Twenty-three patients who had undergone coronary computed tomography angiography on a first generation PCD-CT system with the same image acquisitions were analyzed. VMIs were reconstructed at 6 keV levels (40, 55, 70, 90, 120, and 190 keV). The phantoms and the patients' left ventricular myocardium (LVM) were segmented for all reconstructions. Ninety-three original radiomic features were extracted. Repeatability and reproducibility were evaluated through intraclass correlations coefficient (ICC) and post hoc paired samples ANOVA t test. RESULTS There was excellent repeatability for radiomic features in phantom scans (all ICC = 1.00). Among all VMIs, 36/93 radiomic features (38.7%) in apples, 28/93 (30.1%) in oranges, and 33/93 (35.5%) in onions were not significantly different. For LVM, the percentage of stable features was high between VMIs ≥ 90 keV (90 versus 120 keV, 77.4%; 90 versus 190 keV, 83.9%; 120 versus 190 keV, 89.3%), while comparison to lower VMI levels led to fewer reproducible features (40 versus 55 keV, 8.6%). CONCLUSIONS VMI levels influence the stability of radiomic features in an organic phantom and patients' LVM; stability decreases considerably below 90 keV. RELEVANCE STATEMENT Spectral reconstructions significantly influence radiomic features in vitro and in vivo, necessitating standardization and careful attention to these reconstruction parameters before clinical implementation. KEY POINTS • Radiomic features have an excellent repeatability within the same PCD-CT acquisition and reconstruction. • Differences in VMI lead to decreased reproducibility for radiomic features. • VMI ≥ 90 keV increased the reproducibility of the radiomic features.
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Affiliation(s)
- Elias V Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Ismael M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Siemens Medical Solutions USA Inc, Malvern, PA, USA
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16
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Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Halfmann MC, Allmendinger T, Hagenauer J, Griffith JP, Vecsey-Nagy M, Pinos D, Ebersberger U, Ricke J, Varga-Szemes A, Emrich T. Impact of Cardiac Motion on coronary artery calcium scoring using a virtual non-iodine algorithm on photon-counting detector CT: a dynamic phantom study. Int J Cardiovasc Imaging 2023; 39:2083-2092. [PMID: 37452987 DOI: 10.1007/s10554-023-02912-z] [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] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
This study assessed the impact of cardiac motion and in-vessel attenuation on coronary artery calcium (CAC) scoring using virtual non-iodine (VNI) against virtual non-contrast (VNC) reconstructions on photon-counting detector CT. Two artificial vessels containing calcifications and different in-vessel attenuations (500, 800HU) were scanned without (static) and with cardiac motion (60, 80, 100 beats per minute [bpm]). Images were post-processed using a VNC and VNI algorithm at 70 keV and quantum iterative reconstruction (QIR) strength 2. Calcium mass, Agatston scores, cardiac motion susceptibility (CMS)-indices were compared to physical mass, static scores as well as between reconstructions, heart rates and in-vessel attenuations. VNI scores decreased with rising heart rate (p < 0.01) and showed less underestimation than VNC scores (p < 0.001). Only VNI scores were similar to the physical mass at static measurements, and to static scores at 60 bpm. Agatston scores using VNI were similar to static scores at 60 and 80 bpm. Standard deviation of CMS-indices was lower for VNI-based than for VNC-based CAC scoring. VNI scores were higher at 500 than 800HU (p < 0.001) and higher than VNC scores (p < 0.001) with VNI scores at 500 HU showing the lowest deviation from the physical reference. VNI-based CAC quantification is influenced by cardiac motion and in-vessel attenuation, but least when measuring Agatston scores, where it outperforms VNC-based CAC scoring.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Siemens Medical Solutions, Malvern, PA, 19355, USA
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg- University, Langenbeckstr. 1, Mainz, 55131, Germany
| | | | - Junia Hagenauer
- Siemens Healthcare GmbH, Siemensstr. 1, Forchheim, 91301, Germany
- Faculty of Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Krankenhausstr. 12, Erlangen, 91054, Germany
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor utca 68, Budapest, 1122, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Ullrich Ebersberger
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, 80636, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg- University, Langenbeckstr. 1, Mainz, 55131, Germany
- German Centre for Cardiovascular Research, Mainz, 55131, Germany
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17
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Varga-Szemes A, Emrich T. Editorial for "Cine MRI-Derived Radiomics Features of the Cardiac Blood Pool: Periodicity, Specificity, and Reproducibility". J Magn Reson Imaging 2023; 58:815-816. [PMID: 36661373 DOI: 10.1002/jmri.28605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
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18
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Vecsey-Nagy M, Varga-Szemes A, Emrich T, Zsarnoczay E, Nagy N, Fink N, Schmidt B, Nowak T, Kiss M, Vattay B, Boussoussou M, Kolossváry M, Kubovje A, Merkely B, Maurovich-Horvat P, Szilveszter B. Calcium scoring on coronary computed angiography tomography with photon-counting detector technology: Predictors of performance. J Cardiovasc Comput Tomogr 2023; 17:328-335. [PMID: 37635032 DOI: 10.1016/j.jcct.2023.08.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/10/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Obtaining accurate coronary artery calcium (CAC) score measurements from CCTA datasets with virtual non-iodine (VNI) algorithms would reduce acquisition time and radiation dose. We aimed to assess the agreement of VNI-derived and conventional true non-contrast (TNC)-based CAC scores and to identify the predictors of accuracy. METHODS CCTA datasets were acquired with either 120 or 140 kVp. CAC scores and volumes were calculated from TNC and VNI images in 197 consecutive patients undergoing CCTA. CAC density score, mean volume/lesion, aortic Hounsfield units and standard deviations were then measured. Finally, percentage deviation (VNI - TNC/TNC∗100) of CTA-derived CAC scores from non-enhanced scans was calculated for each patient. Predictors (including anthropometric and acquisition parameters, as well as CAC characteristics) of the degree of discrepancy were evaluated using linear regression analysis. RESULTS While the agreement between TNC and VNI was substantial (mean bias, 6.6; limits of agreement, 178.5/145.3), a non-negligible proportion of patients (36/197, 18.3%) were falsely reclassified as CAC score = 0 on VNI. The use of higher tube voltage significantly decreased the percentage deviation relative to TNC-based values (β = -0.21 [95%CI: 0.38 to -0.03], p = 0.020) and a higher CAC density score also proved to be an independent predictor of a smaller difference (β = -0.22 [95%CI: 0.37 to -0.07], p = 0.006). CONCLUSION The performance of VNI-based calcium scoring may be improved by increased tube voltage protocols, while the accuracy may be compromised for calcified lesions of lower density. The implementation of VNI in clinical routine, however, needs to be preceded by a solution for detecting smaller lesions as well.
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Affiliation(s)
- M Vecsey-Nagy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - A Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - T Emrich
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - E Zsarnoczay
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Medical Imaging Center of Semmelweis University, Budapest, Hungary
| | - N Nagy
- Medical Imaging Center of Semmelweis University, Budapest, Hungary
| | - N Fink
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - B Schmidt
- Siemens Healthcare GmbH, Forchheim, Germany
| | - T Nowak
- Siemens Healthcare GmbH, Forchheim, Germany
| | - M Kiss
- Siemens Healthcare GmbH, Forchheim, Germany
| | - B Vattay
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - M Boussoussou
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - M Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, Budapest, Hungary
| | - A Kubovje
- Medical Imaging Center of Semmelweis University, Budapest, Hungary
| | - B Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | | | - B Szilveszter
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary.
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19
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Pinos D, Griffith J, Emrich T, Schoepf UJ, O'Doherty J, Zsarnoczay E, Fink N, Vecsey-Nagy M, Suranyi P, Tesche C, Aquino GJ, Varga-Szemes A, Brandt V. Intra-individual comparison of image quality of the coronary arteries between photon-counting detector and energy-integrating detector CT systems. Eur J Radiol 2023; 166:111008. [PMID: 37542817 DOI: 10.1016/j.ejrad.2023.111008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To intra-individually compare the objective and subjective image quality of coronary computed tomography angiography (CCTA) between photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT). METHOD Consecutive patients undergoing clinically indicated CCTA on an EID-CT system were prospectively enrolled for a research CCTA performed on a PCD-CT system within 30 days. Polychromatic images were reconstructed for both EID- and PCD-CT, while virtual monoenergetic images (VMI) were generated at 40, 45, 50, 55, 60 and 70 keV for PCD-CT. Two blinded readers calculated contrast-to-noise ratio (CNR) for each major coronary artery and rated image noise, vessel attenuation, vessel sharpness, and overall quality on a 1-5 Likert scale. Patients were then stratified by body mass index (BMI) [high (>30 kg/m2) vs low (<30 kg/m2)] for subgroup analysis. RESULTS A total of 20 patients (67.5 ± 9.0 years, 75% male) were included in the study. Compared with EID-CT, coronary artery CNR values from PCD-CT monoenergetic and polychromatic reconstructions were all significantly higher than CNR values from EID-CT, with incrementally greater differences in obese subjects (all p < 0.008). Subjective image noise and sharpness were also significantly higher for all VMI reconstructions compared to EID-CT (all p < 0.008). All subjective scores were significantly higher for 55, 60, and 70 keV PCD-CT than EID-CT values (all p < 0.05). CONCLUSIONS The improved objective and subjective image quality of PCD-CT compared to EID-CT may provide better visualization of the coronary arteries for a wide array of patients, especially those with a high BMI.
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Affiliation(s)
- Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz (1 Langenbeckstraße, 55131 Mainz, Germany); German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (1 Langenbeckstraße, 55131 Mainz, Germany)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA).
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Siemens Medical Solutions USA (40 Liberty Boulevard, 19355 Malvern, PA, USA)
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Medical Imaging Center, Semmelweis University (Korányi Sándor utca 2, Budapest, 1083, Hungary)
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany (15 Marchioninistr., 81377 München, Germany)
| | - Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University (18 Hataror ut, 1122 Budapest, Hungary)
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Cardiology, Clinic Augustinum Munich (16 Wolkerweg, 81375 München, Germany); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University (Lazarettstraße 36, 80636 München, Germany)
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Cardiology and Angiology, Robert-Bosch-Hospital (Auerbachstraße 110, 70376 Stuttgart, Germany)
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20
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Chamberlin JH, Kocher MR, Aquino G, Fullenkamp A, Dennis DJ, Waltz J, Stringer N, Wortham A, Varga-Szemes A, Rieter WJ, James WE, Houston BA, Hardie AD, Kabakus I, Baruah D, Kemeyou L, Burt JR. Quantitative myocardial T2 mapping adds value to Japanese circulation society diagnostic criteria for active cardiac sarcoidosis. Int J Cardiovasc Imaging 2023; 39:1535-1546. [PMID: 37148449 DOI: 10.1007/s10554-023-02863-5] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
Noninvasive identification of active myocardial inflammation in patients with cardiac sarcoidosis plays a key role in management but remains elusive. T2 mapping is a proposed solution, but the added value of quantitative myocardial T2 mapping for active cardiac sarcoidosis is unknown. Retrospective cohort analysis of 56 sequential patients with biopsy-confirmed extracardiac sarcoidosis who underwent cardiac MRI for myocardial T2 mapping. The presence or absence of active myocardial inflammation in patients with CS was defined using a modified Japanese circulation society criteria within one month of MRI. Myocardial T2 values were obtained for the 16 standard American Heart Association left ventricular segments. The best model was selected using logistic regression. Receiver operating characteristic curves and dominance analysis were used to evaluate the diagnostic performance and variable importance. Of the 56 sarcoidosis patients included, 14 met criteria for active myocardial inflammation. Mean basal T2 value was the best performing model for the diagnosis of active myocardial inflammation in CS patients (pR2 = 0.493, AUC = 0.918, 95% CI 0.835-1). Mean basal T2 value > 50.8 ms was the most accurate threshold (accuracy = 0.911). Mean basal T2 value + JCS criteria was significantly more accurate than JCS criteria alone (AUC = 0.981 vs. 0.887, p = 0.017). Quantitative regional T2 values are independent predictors of active myocardial inflammation in CS and may add additional discriminatory capability to JCS criteria for active disease.
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Affiliation(s)
- Jordan H Chamberlin
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Madison R Kocher
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Gilberto Aquino
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Austin Fullenkamp
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - D Jameson Dennis
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey Waltz
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Natalie Stringer
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Wortham
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - William J Rieter
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - W Ennis James
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
- Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, SC, USA
| | - Brian A Houston
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew D Hardie
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ismail Kabakus
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Dhiraj Baruah
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Line Kemeyou
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremy R Burt
- Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
- Division of Cardiothoracic Imaging, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Hinen SP, Griffith JP, Chamberlin J, Waltz J, Kocher M, Krull V, Young T, Litvin CB, Varga-Szemes A, Hardie AD. Dual-energy CT iodine overlay improves efficiency of oral contrast leak assessment. Acta Radiol 2023; 64:2357-2362. [PMID: 37157189 DOI: 10.1177/02841851231172771] [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: 05/10/2023]
Abstract
BACKGROUND Evaluation for gastrointestinal leak is a frequent imaging indication, and dual-energy computed tomography (DECT) with oral or rectally administered contrast can be used to improve efficiency and diagnostic confidence. PURPOSE To assess the value of the DECT iodine overlay (IO) reconstruction as a stand-alone image set compared to routine CT in assessing oral or rectal contrast leak from the gastrointestinal system. MATERIAL AND METHODS A blinded, retrospective audit study was performed by three readers who each interpreted 50 studies performed for assessment of oral or rectal contrast leak that were acquired using DECT. Each reader independently assessed both the routine CT images and the images of the reconstructed IO for contrast leak in random order with a six-week "wash-out period" between readings. Clinical follow-up provided the reference standard. Readers recorded the presence/absence of a leak, diagnostic confidence, image quality score, and interpretation time for each image set. RESULTS Pooled data for overall accuracy in identification of a leak increased from 0.81 (95% confidence interval [CI]=0.74-0.87) for routine CT to 0.91 (95% CI=0.85-0.95) with IO, and the area under the curve (AUC) was significantly higher for IO than routine CT (P = 0.015). Readers required significantly less time to interpret IO than routine CT (median improvement of 12.5 s per image using pooled data; P < 0.001) while maintaining diagnostic confidence and perceived image quality. CONCLUSION Use of DECT IO reconstructions for identification of oral or rectal contrast leak requires less time to interpret than routine CT with improved accuracy and maintained diagnostic confidence and perceived image quality.
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Affiliation(s)
- Shaun P Hinen
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Joseph P Griffith
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Chamberlin
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey Waltz
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Madison Kocher
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Veronica Krull
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Tristan Young
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Cara B Litvin
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Andrew D Hardie
- Department of Radiology and Radiological Sciences, The Medical University of South Carolina, Charleston, SC, USA
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Luo S, Dou WQ, Schoepf UJ, Varga-Szemes A, Pridgen WT, Zhang LJ. Cardiovascular magnetic resonance imaging in myocardial involvement of systemic lupus erythematosus. Trends Cardiovasc Med 2023; 33:346-354. [PMID: 35150849 DOI: 10.1016/j.tcm.2022.02.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that primarily affects young women. Myocardial involvement in SLE frequently occurs and it is rather challenging to make the diagnosis in current clinical settings, mainly due to the extensive clinical presentation of signs and symptoms. As a noninvasive imaging reference in diagnosing cardiomyopathy and myocarditis, cardiovascular magnetic resonance (CMR) imaging can provide new insight into myocardial abnormalities including inflammation, fibrosis, and microcirculation. Therefore, the main aim of this work was to systematically review the pathology, clinical features, and diagnosis, while illustrating the clinical role of CMR on myocardial involvement of SLE.
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Affiliation(s)
- Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Wanya T Pridgen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
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23
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Patel P, Emrich T, Schoepf UJ, Mehta V, Bayer RR, von Assen M, Giovagnoli V, Jeudy J, Varga-Szemes A, White C. Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia. J Thorac Imaging 2023; 38:212-225. [PMID: 34029280 DOI: 10.1097/rti.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/21/2022]
Abstract
Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.
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Affiliation(s)
- Pratik Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Varun Mehta
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Richard R Bayer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Marly von Assen
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA
| | - Vincent Giovagnoli
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Charles White
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
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24
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Varga-Szemes A, Maurovich-Horvat P, Schoepf UJ, Zsarnoczay E, Pelberg R, Stone GW, Budoff MJ. Computed Tomography Assessment of Coronary Atherosclerosis: From Threshold-Based Evaluation to Histologically Validated Plaque Quantification. J Thorac Imaging 2023; 38:226-234. [PMID: 37115957 PMCID: PMC10287054 DOI: 10.1097/rti.0000000000000711] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/30/2023]
Abstract
Arterial plaque rupture and thrombosis is the primary cause of major cardiovascular and neurovascular events. The identification of atherosclerosis, especially high-risk plaques, is therefore crucial to identify high-risk patients and to implement preventive therapies. Computed tomography angiography has the ability to visualize and characterize vascular plaques. The standard methods for plaque evaluation rely on the assessment of plaque burden, stenosis severity, the presence of positive remodeling, napkin ring sign, and spotty calcification, as well as Hounsfield Unit (HU)-based thresholding for plaque quantification; the latter with multiple shortcomings. Semiautomated threshold-based segmentation techniques with predefined HU ranges identify and quantify limited plaque characteristics, such as low attenuation, non-calcified, and calcified plaque components. Contrary to HU-based thresholds, histologically validated plaque characterization, and quantification, an emerging Artificial intelligence-based approach has the ability to differentiate specific tissue types based on a biological correlate, such as lipid-rich necrotic core and intraplaque hemorrhage that determine plaque vulnerability. In this article, we review the relevance of plaque characterization and quantification and discuss the benefits and limitations of the currently available plaque assessment and classification techniques.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Robert Pelberg
- Heart and Vascular Institute at The Christ Hospital Health Network, Cincinnati, OH
| | - Gregg W. Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
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25
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Zsarnóczay E, Varga-Szemes A, Emrich T, Szilveszter B, van der Werf NR, Mastrodicasa D, Maurovich-Horvat P, Willemink MJ. Characterizing the Heart and the Myocardium With Photon-Counting CT. Invest Radiol 2023; 58:505-514. [PMID: 36822653 DOI: 10.1097/rli.0000000000000956] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/25/2023]
Abstract
ABSTRACT Noninvasive cardiac imaging has rapidly evolved during the last decade owing to improvements in computed tomography (CT)-based technologies, among which we highlight the recent introduction of the first clinical photon-counting detector CT (PCD-CT) system. Multiple advantages of PCD-CT have been demonstrated, including increased spatial resolution, decreased electronic noise, and reduced radiation exposure, which may further improve diagnostics and may potentially impact existing management pathways. The benefits that can be obtained from the initial experiences with PCD-CT are promising. The implementation of this technology in cardiovascular imaging allows for the quantification of coronary calcium, myocardial extracellular volume, myocardial radiomics features, epicardial and pericoronary adipose tissue, and the qualitative assessment of coronary plaques and stents. This review aims to discuss these major applications of PCD-CT with a focus on cardiac and myocardial characterization.
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Affiliation(s)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston
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26
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Halfmann MC, Müller L, von Henning U, Kloeckner R, Schöler T, Kreitner KF, Düber C, Wenzel P, Varga-Szemes A, Göbel S, Emrich T. Cardiac MRI-based right-to-left ventricular blood pool T2 relaxation times ratio correlates with exercise capacity in patients with chronic heart failure. J Cardiovasc Magn Reson 2023; 25:33. [PMID: 37331991 PMCID: PMC10278263 DOI: 10.1186/s12968-023-00943-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND MRI T2 mapping has been proven to be sensitive to the level of blood oxygenation. We hypothesized that impaired exercise capacity in chronic heart failure is associated with a greater difference between right (RV) to left ventricular (LV) blood pool T2 relaxation times due to a higher level of peripheral blood desaturation, compared to patients with preserved exercise capacity and to healthy controls. METHODS Patients with chronic heart failure (n = 70) who had undergone both cardiac MRI (CMR) and a 6-min walk test (6MWT) were retrospectively identified. Propensity score matched healthy individuals (n = 35) served as control group. CMR analyses included cine acquisitions and T2 mapping to obtain blood pool T2 relaxation times of the RV and LV. Following common practice, age- and gender-adjusted nominal distances and respective percentiles were calculated for the 6MWT. The relationship between the RV/LV T2 blood pool ratio and the results from 6MWT were evaluated by Spearman's correlation coefficients and regression analyses. Inter-group differences were assessed by independent t-tests and univariate analysis of variance. RESULTS The RV/LV T2 ratio moderately correlated with the percentiles of nominal distances in the 6MWT (r = 0.66) while ejection fraction, end-diastolic and end-systolic volumes showed no correlation (r = 0.09, 0.07 and - 0.01, respectively). In addition, there were significant differences in the RV/LV T2 ratio between patients with and without significant post-exercise dyspnea (p = 0.001). Regression analyses showed that RV/LV T2 ratio was an independent predictor of the distance walked and the presence of post-exercise dyspnea (p < 0.001). CONCLUSION The proposed RV/LV T2 ratio, obtained by two simple measurements on a routinely acquired four-chamber T2 map, was superior to established parameters of cardiac function to predict exercise capacity and the presence of post-exercise dyspnea in patients with chronic heart failure.
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Affiliation(s)
- Moritz C. Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Urs von Henning
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Langenbeckst.1, 55131 Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
- Department for Interventional Radiology, University Hospital of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Theresia Schöler
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Langenbeckst.1, 55131 Mainz, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC 29425-2260 USA
| | - Sebastian Göbel
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Langenbeckst.1, 55131 Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
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27
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Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Griffith JP, Pinos D, Tesche C, Ricke J, Willemink MJ, Varga-Szemes A, Emrich T. Radiation Dose Reduction for Coronary Artery Calcium Scoring Using a Virtual Noniodine Algorithm on Photon-Counting Detector Computed-Tomography Phantom Data. Diagnostics (Basel) 2023; 13:diagnostics13091540. [PMID: 37174932 PMCID: PMC10177425 DOI: 10.3390/diagnostics13091540] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Background: On the basis of the hypothesis that virtual noniodine (VNI)-based coronary artery calcium scoring (CACS) is feasible at reduced radiation doses, this study assesses the impact of radiation dose reduction on the accuracy of this VNI algorithm on a photon-counting detector (PCD)-CT. Methods: In a systematic in vitro setting, a phantom for CACS simulating three chest sizes was scanned on a clinical PCD-CT. The standard radiation dose was chosen at volumetric CT dose indices (CTDIVol) of 1.5, 3.3, 7.0 mGy for small, medium-sized, and large phantoms, and was gradually reduced by adjusting the tube current resulting in 100, 75, 50, and 25%, respectively. VNI images were reconstructed at 55 keV, quantum iterative reconstruction (QIR)1, and at 60 keV/QIR4, and evaluated regarding image quality (image noise (IN), contrast-to-noise ratio (CNR)), and CACS. All VNI results were compared to true noncontrast (TNC)-based CACS at 70 keV and standard radiation dose (reference). Results: INTNC was significantly higher than INVNI, and INVNI at 55 keV/QIR1 higher than at 60 keV/QIR4 (100% dose: 16.7 ± 1.9 vs. 12.8 ± 1.7 vs. 7.7 ± 0.9; p < 0.001 for every radiation dose). CNRTNC was higher than CNRVNI, but it was better to use 60 keV/QIR4 (p < 0.001). CACSVNI showed strong correlation and agreement at every radiation dose (p < 0.001, r > 0.9, intraclass correlation coefficient > 0.9). The coefficients of the variation in root-mean squared error were less than 10% and thus clinically nonrelevant for the CACSVNI of every radiation dose. Conclusion: This phantom study suggests that CACSVNI is feasible on PCD-CT, even at reduced radiation dose while maintaining image quality and CACS accuracy.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, 1083 Budapest, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Siemens Medical Solutions, 40 Liberty Boulevard, Malvern, PA 19355, USA
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes-Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, 55131 Mainz, Germany
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28
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Friedman S, Varga-Szemes A, Schoepf U, Johnson A, Johnson J, Baxley R, Houston B, Litwin S, Atkins J, Tedford R. Effect of Dobutamine on Rv Contractility and Rv-Pa Coupling in the Normal Rv. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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29
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Varga-Szemes A, Emrich T. Editorial for "Pediatric Cardiac Magnetic Resonance Reference Values for Biventricular Volumes Derived From Different Contouring Techniques". J Magn Reson Imaging 2023; 57:1287-1288. [PMID: 35818989 DOI: 10.1002/jmri.28348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
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30
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Decker JA, O'Doherty J, Schoepf UJ, Todoran TM, Aquino GJ, Brandt V, Baruah D, Fink N, Zsarnoczay E, Flohr T, Schmidt B, Allmendinger T, Risch F, Varga-Szemes A, Emrich T. Stent imaging on a clinical dual-source photon-counting detector CT system-impact of luminal attenuation and sharp kernels on lumen visibility. Eur Radiol 2023; 33:2469-2477. [PMID: 36462045 DOI: 10.1007/s00330-022-09283-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 06/15/2022] [Revised: 09/07/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To assess the impact of scan modes and reconstruction kernels using a novel dual-source photon-counting detector CT (PCD-CT) on lumen visibility and sharpness of different stent sizes. METHODS A phantom containing six balloon-expandable stents (2.5 to 9 mm diameter) in silicone tubing was scanned on a PCD-CT with standard (0.6 mm and 0.4 mm thicknesses) and ultra-high-resolution (0.2 mm thickness) modes. With the use of increasing contrast medium concentrations, densities of 0, 200, 400, and 600 HU were achieved. Standard-resolution scans were reconstructed using increasing sharpness kernels, using both polyenergetic quantitative soft tissue "conventional" ((Qr40c(0.6 mm), Qr40c(0.4 mm), Qr72c(0.2 mm)) and vascular (Bv) virtual monoenergetic reconstructions (Bv44m(0.4 mm), Bv60m(0.4 mm)) at 70 keV. In-stent lumen visibility, sharpness (max. ΔHU of the stent measured in profile plots), and in-stent noise (standard deviation of HU) were measured. RESULTS In-stent lumen visibility was highest for Qr72c(0.2 mm) (86.5 ± 2.8% to 88.3 ± 2.6%) and in Bv60m(0.4 mm) reconstructions (77.3 ± 2.9 to 82.7 ± 2.5%). Lumen visibility was lowest in the smallest stent (2.5 mm) ranging from 54.1% in Qr40c(0.6 mm) to 74.1% in Qr72c(0.2 mm) and highest in the largest stent (9 mm) ranging from 93.8% in Qr40c(0.6 mm) to 99.1% in the Qr72c(0.2 mm) series. Lumen visibility decreased by 2.1% for every 200-HU increase in lumen attenuation. Max. ΔHU between stents and stent lumen was highest in Qr72c(0.2 mm) (ΔHU 892 ± 504 to 1526 ± 517) and Bv60m(0.4 mm) series (ΔHU 480 ± 357 to 1030 ± 344). Improvement of lumen visibility and sharpness in UHR and Bv60m(0.4 mm) series was strongest in smaller stent sizes. CONCLUSION UHR acquisition mode and sharp reconstruction kernels on a novel PCD-CT system significantly improve in-stent lumen visibility and sharpness-especially for smaller stent sizes. KEY POINTS • In-stent lumen visibility and sharpness of stents significantly improve using sharp reconstruction kernels (Bv60) and ultra-high-resolution mode in photon-counting detector computed tomography. • The observed improvement of stent-lumen visibility was highest in smaller stent sizes.
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Affiliation(s)
- Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Siemens Medical Solutions, Malvern, PA, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Thomas M Todoran
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Cardiology and Angiology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Dhiraj Baruah
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | | | | | - Franka Risch
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
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31
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Zsarnoczay E, Fink N, Schoepf UJ, O'Doherty J, Allmendinger T, Hagenauer J, Wolf EV, Griffith JP, Maurovich-Horvat P, Varga-Szemes A, Emrich T. Ultra-high resolution photon-counting coronary CT angiography improves coronary stenosis quantification over a wide range of heart rates - A dynamic phantom study. Eur J Radiol 2023; 161:110746. [PMID: 36821957 DOI: 10.1016/j.ejrad.2023.110746] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To investigate the effect of using photon-counting detector (PCD)-CT with ultra-high resolution (UHR) on stenosis quantification accuracy and blooming artifacts from low to high heart rates in a dynamic motion phantom. METHOD Two vessel phantoms (diameter: 4 mm) containing solid calcified lesions (25%, 50% stenoses), filled with different concentrations of iodine, inside an anthropomorphic thorax phantom attached to a coronary motion simulator were used. Scanning was performed on a PCD-CT system using an ECG-gated mode at UHR and standard resolution (SR) (0.2, 0.6 mm slice thickness, respectively). Images were reconstructed at 60, 80 and 100 beats per minute (bpm) (UHR: Bv56 kernel, quantum iterative reconstruction (QIR) level 3; SR: 55 keV, Bv40 kernel, QIR3). Percent diameter stenosis (PDS) and blooming artifacts were measured by two readers. RESULTS PDS measurements derived from UHR were more accurate than SR for both lesions at every heart rate (p ≤ 0.005 for all, e.g. 50% lesion SR vs. UHR: at 60 bpm 57.1% [55.2-59.2] vs. 50.0% [48.5-51.2], at 100 bpm 61.0% [58.6-64.3] vs. 52.4% [51.3-54.3]). Overall mean difference across heart rates and lesions compared to the nominal stenoses was 9.2% (Limit of Agreement (LoA), 2.4%/16.0%) for SR vs. 2.4% (LoA, -2.8%/7.5%) for UHR. Blooming artifacts decreased with UHR compared to SR for both lesions at every heart rate (p < 0.001 for all, e.g. 50% lesion SR vs. UHR: at 60 bpm 63.8% [60.6-69.5] vs. 52.5% [50.0-57.5], at 100 bpm 70.2% [64.8-78.1] vs. 56.1% [51.2-60.8]). CONCLUSIONS This motion phantom study demonstrates improved stenosis quantification accuracy and reduced blooming artifacts with UHR-PCD-CT compared to SR, independent of heart rate.
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Affiliation(s)
- Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest 1083, Hungary.
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, Munich 81377, Germany.
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Siemens Medical Solutions USA Inc, 40 Liberty Boulevard, Malvern, PA 19355, United States.
| | | | - Junia Hagenauer
- Siemens Healthcare GmbH, Siemensstraße 1, Forchheim 91301, Germany; Faculty of Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Krankenhausstraße 12, Erlangen 91054, Germany.
| | - Elias V Wolf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany.
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest 1083, Hungary.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz 55131, Germany.
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Al'Aref SJ, Altibi AM, Malkawi A, Mansour M, Baskaran L, Masri A, Rahmouni H, Abete R, Andreini D, Aquaro G, Barison A, Bogaert J, Camastra G, Carigi S, Carrabba N, Casavecchia G, Censi S, Cicala G, Conte E, De Cecco CN, De Lazzari M, Di Giovine G, Di Roma M, Dobrovie M, Focardi M, Gaibazzi N, Gismondi A, Gravina M, Guglielmo M, Lanzillo C, Lombardi M, Lorenzoni V, Lozano-Torres J, Margonato D, Martini C, Marzo F, Masci P, Masi A, Memeo R, Moro C, Mushtaq S, Nese A, Palumbo A, Pavon AG, Pedrotti P, Pepi M, Perazzolo Marra M, Pica S, Pradella S, Presicci C, Rabbat MG, Raineri C, Rodriguez-Palomares JF, Sbarbati S, Schoepf UJ, Squeri A, Sverzellati N, Symons R, Tat E, Timpani M, Todiere G, Valentini A, Varga-Szemes A, Volpe A, Fusini L, Guaricci AI, Schwitter J, Pontone G. Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy. Eur Heart J Cardiovasc Imaging 2023; 24:472-482. [PMID: 35792682 PMCID: PMC10029842 DOI: 10.1093/ehjci/jeac124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan-Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560-1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09-1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function. CONCLUSION RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.
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Affiliation(s)
- Subhi J Al'Aref
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed M Altibi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Abdallah Malkawi
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Munthir Mansour
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lohendran Baskaran
- Department of Cardiovascular Medicine, National Heart Centre, Singapore, Singapore
| | - Ahmad Masri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Hind Rahmouni
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Raffaele Abete
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Giovanni Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Andrea Barison
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | | | - Samuela Carigi
- Department of Cardiology, Infermi Hospital, Rimini, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department of Careggi Hospital, Florence, Italy
| | - Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Censi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Gloria Cicala
- Radiology Department, Parma University Hospital, Via Gramsci, Parma, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | | | - Mauro Di Roma
- Radiology Department, Policlinico Casilino, Rome, Italy
| | - Monica Dobrovie
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Annalaura Gismondi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Jordi Lozano-Torres
- Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona, Barcelona, Spain
| | | | - Chiara Martini
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Piergiorgio Masci
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ambra Masi
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Memeo
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Claudio Moro
- Department of Cardiology, ASST Monza, P.O. Desio, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Alberto Nese
- Dipartimento Neuro-Cardiovascolare, Ospedale Ca' Foncello Treviso, Treviso, Italy
| | - Alessandro Palumbo
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
| | | | - Patrizia Pedrotti
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Pradella
- Division of Cardiology, Loyola University of Chicago, Chicago, IL, USA
| | - Cristina Presicci
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL, USA
| | - Claudia Raineri
- Department of Cardiology, Citta` della salute e della Scienza - Ospedale Molinette, Turin, Italy
| | - Jose' F Rodriguez-Palomares
- Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona, Barcelona, Spain
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rolf Symons
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Emily Tat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL, USA
| | - Mauro Timpani
- UOC Radiologia, Ospedale "F. Spaziani", Frosinone, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Alessandra Volpe
- Department of Cardiology, Citta` della salute e della Scienza - Ospedale Molinette, Turin, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Jurg Schwitter
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University, UniL, Lausanne, Switzerland
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
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Villines TC, Ali ZA, Kitagawa K, Pelberg RA, Varga-Szemes A, Schoepf UJ, Rodriguez P, Phillips M, Rajeev A, Ruda H, Nicolaou A, Buckler A. DIAGNOSTIC ACCURACY OF A PLAQUE-BASED CORONARY CTA FRACTIONAL FLOW RESERVE SOFTWARE IN MEN VERSUS WOMEN: RESULTS FROM A MULTI-CENTER STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Villines TC, Varga-Szemes A, Schoepf UJ, Ali ZA, Pelberg RA, Kitagawa K, Phillips M, Rajeev A, Ruda H, Nicolaou A, Buckler A. RELATIONSHIP BETWEEN NON-INVASIVE FRACTIONAL FLOW RESERVE AND HISTOLOGICALLY-DEFINED UNSTABLE PLAQUE: A MULTI-COHORT CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Villines TC, Ali ZA, Kitagawa K, Pelberg RA, Varga-Szemes A, Schoepf UJ, Phillips M, Rajeev A, Ruda H, Nicolaou A, Buckler A. PERFORMANCE OF COMPUTED TOMOGRAPHY FRACTIONAL FLOW RESERVE FROM PLAQUE-BASED MEASURES OF VASODILATORY CAPACITY: A MULTICENTER STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Chamberlin JH, Smith C, Schoepf UJ, Nance S, Elojeimy S, O'Doherty J, Baruah D, Burt JR, Varga-Szemes A, Kabakus IM. A deep convolutional neural network ensemble for composite identification of pulmonary nodules and incidental findings on routine PET/CT. Clin Radiol 2023; 78:e368-e376. [PMID: 36863883 DOI: 10.1016/j.crad.2023.01.014] [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: 08/02/2022] [Revised: 10/19/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
AIM To evaluate primary and secondary pathologies of interest using an artificial intelligence (AI) platform, AI-Rad Companion, on low-dose computed tomography (CT) series from integrated positron-emission tomography (PET)/CT to detect CT findings that might be overlooked. MATERIALS AND METHODS One hundred and eighty-nine sequential patients who had undergone PET/CT were included. Images were evaluated using an ensemble of convolutional neural networks (AI-Rad Companion, Siemens Healthineers, Erlangen, Germany). The primary outcome was detection of pulmonary nodules for which the accuracy, identity, and intra-rater reliability was calculated. For secondary outcomes (binary detection of coronary artery calcium, aortic ectasia, vertebral height loss), accuracy and diagnostic performance were calculated. RESULTS The overall per-nodule accuracy for detection of lung nodules was 0.847. The overall sensitivity and specificity for detection of lung nodules was 0.915 and 0.781. The overall per-patient accuracy for AI detection of coronary artery calcium, aortic ectasia, and vertebral height loss was 0.979, 0.966, and 0.840, respectively. The sensitivity and specificity for coronary artery calcium was 0.989 and 0.969. The sensitivity and specificity for aortic ectasia was 0.806 and 1. CONCLUSION The neural network ensemble accurately assessed the number of pulmonary nodules and presence of coronary artery calcium and aortic ectasia on low-dose CT series of PET/CT. The neural network was highly specific for the diagnosis of vertebral height loss, but not sensitive. The use of the AI ensemble can help radiologists and nuclear medicine physicians to catch CT findings that might be overlooked.
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Affiliation(s)
- J H Chamberlin
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - C Smith
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - U J Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - S Nance
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - S Elojeimy
- Division of Nuclear Medicine, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - J O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Siemens Medical Solutions, Malvern, PA, USA
| | - D Baruah
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - J R Burt
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - A Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - I M Kabakus
- Division of Thoracic Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Nuclear Medicine, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
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Aquino GJ, O'Doherty J, Schoepf UJ, Ellison B, Byrne J, Fink N, Zsarnoczay E, Wolf EV, Allmendinger T, Schmidt B, Flohr T, Baruah D, Suranyi P, Varga-Szemes A, Emrich T. Myocardial Characterization with Extracellular Volume Mapping with a First-Generation Photon-counting Detector CT with MRI Reference. Radiology 2023; 307:e222030. [PMID: 36719292 DOI: 10.1148/radiol.222030] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Photon-counting detector (PCD) CT provides comprehensive spectral data with every acquisition, but studies evaluating myocardial extracellular volume (ECV) quantification with use of PCD CT compared with an MRI reference remain lacking. Purpose To compare ECV quantification for myocardial tissue characterization between a first-generation PCD CT system and cardiac MRI. Materials and Methods In this single-center prospective study, adults without contraindication to iodine-based contrast media underwent same-day cardiac PCD CT and MRI with native and postcontrast T1 mapping and late gadolinium enhancement for various clinical indications for cardiac MRI (the reference standard) between July 2021 and January 2022. Global and midventricular ECV were assessed with use of three methods: single-energy PCD CT, dual-energy PCD CT, and MRI T1 mapping. Quantitative comparisons among all techniques were performed. Correlation and reliability between different methods of ECV quantification were assessed with use of the Pearson correlation coefficient (r) and the intraclass correlation coefficient. Results The final sample included 29 study participants (mean age ± SD, 54 years ± 17; 15 men). There was a strong correlation of ECV between dual- and single-energy PCD CT (r = 0.91, P < .001). Radiation dose was 40% lower with dual-energy versus single-energy PCD CT (volume CT dose index, 10.1 mGy vs 16.8 mGy, respectively; P < .001). In comparison with MRI, dual-energy PCD CT showed strong correlation (r = 0.82 and 0.91, both P < .001) and good to excellent reliability (intraclass correlation coefficients, 0.81 and 0.90) for midventricular and global ECV quantification, but it overestimated ECV by approximately 2%. Single-energy PCD CT showed similar relationship with MRI but underestimated ECV by 3%. Conclusion Myocardial tissue characterization with photon-counting detector CT-based quantitative extracellular volume analysis showed a strong correlation to MRI. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Gilberto J Aquino
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Jim O'Doherty
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Benjamin Ellison
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Jordan Byrne
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Nicola Fink
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Emese Zsarnoczay
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Elias V Wolf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Thomas Allmendinger
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Bernhard Schmidt
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Thomas Flohr
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Dhiraj Baruah
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Pal Suranyi
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Tilman Emrich
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (G.J.A., U.J.S., B.E., J.B., N.F., E.Z., E.V.W., D.B., P.S., A.V.S., T.E.); Department of Radiology, Upstate University Hospital, Syracuse, NY (G.J.A.); Siemens Medical Solutions, Malvern, Pa (J.O.); Department of Radiology, University Hospital LMU Munich, Munich, Germany (N.F.); Siemens Healthineers, Forchheim, Germany (T.A., B.S., T.F.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (T.E.)
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Wolf EV, Halfmann MC, Schoepf UJ, Zsarnoczay E, Fink N, Griffith JP, Aquino GJ, Willemink MJ, O’Doherty J, Hell MM, Suranyi P, Kabakus IM, Baruah D, Varga-Szemes A, Emrich T. Intra-individual comparison of coronary calcium scoring between photon counting detector- and energy integrating detector-CT: Effects on risk reclassification. Front Cardiovasc Med 2023; 9:1053398. [PMID: 36741832 PMCID: PMC9892711 DOI: 10.3389/fcvm.2022.1053398] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To compare coronary artery calcium volume and score (CACS) between photon-counting detector (PCD) and conventional energy integrating detector (EID) computed tomography (CT) in a phantom and prospective patient study. Methods A commercially available CACS phantom was scanned with a standard CACS protocol (120 kVp, slice thickness/increment 3/1.5 mm, and a quantitative Qr36 kernel), with filtered back projection on the EID-CT, and with monoenergetic reconstruction at 70 keV and quantum iterative reconstruction off on the PCD-CT. The same settings were used to prospectively acquire data in patients (n = 23, 65 ± 12.1 years), who underwent PCD- and EID-CT scans with a median of 5.5 (3.0-12.5) days between the two scans in the period from August 2021 to March 2022. CACS was quantified using a commercially available software solution. A regression formula was obtained from the aforementioned comparison and applied to simulate risk reclassification in a pre-existing cohort of 514 patients who underwent a cardiac EID-CT between January and December 2021. Results Based on the phantom experiment, CACS PCD-CT showed a more accurate measurement of the reference CAC volumes (overestimation of physical volumes: PCD-CT 66.1 ± 1.6% vs. EID-CT: 77.2 ± 0.5%). CACS EID-CT and CACS PCD-CT were strongly correlated, however, the latter measured significantly lower values in the phantom (CACS PCD-CT : 60.5 (30.2-170.3) vs CACS EID-CT 74.7 (34.6-180.8), p = 0.0015, r = 0.99, mean bias -9.7, Limits of Agreement (LoA) -36.6/17.3) and in patients (non-significant) (CACS PCD-CT : 174.3 (11.1-872.7) vs CACS EID-CT 218.2 (18.5-876.4), p = 0.10, r = 0.94, mean bias -41.1, LoA -315.3/232.5). The systematic lower measurements of Agatston score on PCD-CT system led to reclassification of 5.25% of our simulated patient cohort to a lower classification class. Conclusion CACS PCD-CT is feasible and correlates strongly with CACS EID-CT , however, leads to lower CACS values. PCD-CT may provide results that are more accurate for CACS than EID-CT.
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Affiliation(s)
- Elias V. Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Moritz C. Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Joseph P. Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Gilberto J. Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Martin J. Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States,Segmed, Inc., Palo Alto, CA, United States
| | - Jim O’Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,Siemens Medical Solutions USA, Inc., Malvern, PA, United States
| | - Michaela M. Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Ismael M. Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany,*Correspondence: Tilman Emrich,
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Varga-Szemes A, Halfmann M, Schoepf UJ, Jin N, Kilburg A, Dargis DM, Düber C, Ese A, Aquino G, Xiong F, Kreitner KF, Markl M, Emrich T. Highly Accelerated Compressed-Sensing 4D Flow for Intracardiac Flow Assessment. J Magn Reson Imaging 2022. [PMID: 36264176 DOI: 10.1002/jmri.28484] [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: 08/02/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Four-dimensional (4D) flow MRI allows for the quantification of complex flow patterns; however, its clinical use is limited by its inherently long acquisition time. Compressed sensing (CS) is an acceleration technique that provides substantial reduction in acquisition time. PURPOSE To compare intracardiac flow measurements between conventional and CS-based highly accelerated 4D flow acquisitions. STUDY TYPE Prospective. SUBJECTS Fifty healthy volunteers (28.0 ± 7.1 years, 24 males). FIELD STRENGTH/SEQUENCE Whole heart time-resolved 3D gradient echo with three-directional velocity encoding (4D flow) with conventional parallel imaging (factor 3) as well as CS (factor 7.7) acceleration at 3 T. ASSESSMENT 4D flow MRI data were postprocessed by applying a valve tracking algorithm. Acquisition times, flow volumes (mL/cycle) and diastolic function parameters (ratio of early to late diastolic left ventricular peak velocities [E/A] and ratio of early mitral inflow velocity to mitral annular early diastolic velocity [E/e']) were quantified by two readers. STATISTICAL TESTS Paired-samples t-test and Wilcoxon rank sum test to compare measurements. Pearson correlation coefficient (r), Bland-Altman-analysis (BA) and intraclass correlation coefficient (ICC) to evaluate agreement between techniques and readers. A P value < 0.05 was considered statistically significant. RESULTS A significant improvement in acquisition time was observed using CS vs. conventional accelerated acquisition (6.7 ± 1.3 vs. 12.0 ± 1.3 min). Net forward flow measurements for all valves showed good correlation (r > 0.81) and agreement (ICCs > 0.89) between conventional and CS acceleration, with 3.3%-8.3% underestimation by the CS technique. Evaluation of diastolic function showed 3.2%-17.6% error: E/A 2.2 [1.9-2.4] (conventional) vs. 2.3 [2.0-2.6] (CS), BA bias 0.08 [-0.81-0.96], ICC 0.82; and E/e' 4.6 [3.9-5.4] (conventional) vs. 3.8 [3.4-4.3] (CS), BA bias -0.90 [-2.31-0.50], ICC 0.89. DATA CONCLUSION Analysis of intracardiac flow patterns and evaluation of diastolic function using a highly accelerated 4D flow sequence prototype is feasible, but it shows underestimation of flow measurements by approximately 10%. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Ning Jin
- Siemens Medical Solutions USA Inc., Chicago, Illinois, USA
| | - Anton Kilburg
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Danielle M Dargis
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Amir Ese
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Gilberto Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Fei Xiong
- Siemens Medical Solutions USA Inc., Chicago, Illinois, USA
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
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Brandt V, Schoepf UJ, Aquino GJ, Bekeredjian R, Varga-Szemes A, Emrich T, Bayer RR, Schwarz F, Kroencke TJ, Tesche C, Decker JA. Impact of machine-learning-based coronary computed tomography angiography-derived fractional flow reserve on decision-making in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Radiol 2022; 32:6008-6016. [PMID: 35359166 DOI: 10.1007/s00330-022-08758-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate feasibility and diagnostic performance of coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) for detection of significant coronary artery disease (CAD) and decision-making in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to potentially avoid additional pre-TAVR invasive coronary angiography (ICA). METHODS Consecutive patients with severe AS (n = 95, 78.6 ± 8.8 years, 53% female) undergoing pre-procedural TAVR-CT followed by ICA with quantitative coronary angiography were retrospectively analyzed. CCTA datasets were evaluated using CAD Reporting and Data System (CAD-RADS) classification. CT-FFR measurements were computed using an on-site machine-learning algorithm. A combined algorithm was developed for decision-making to determine if ICA is needed based on pre-TAVR CCTA: [1] all patients with CAD-RADS ≥ 4 are referred for ICA; [2] patients with CAD-RADS 2 and 3 are evaluated utilizing CT-FFR and sent to ICA if CT-FFR ≤ 0.80; [3] patients with CAD-RADS < 2 or CAD-RADS 2-3 and normal CT-FFR are not referred for ICA. RESULTS Twelve patients (13%) had significant CAD (≥ 70% stenosis) on ICA and were treated with PCI. Twenty-eight patients (30%) showed CT-FFR ≤ 0.80 and 24 (86%) of those were reported to have a maximum stenosis ≥ 50% during ICA. Using the proposed algorithm, significant CAD could be identified with a sensitivity, specificity, and positive and negative predictive value of 100%, 78%, 40%, and 100%, respectively, potentially decreasing the number of necessary ICAs by 65 (68%). CONCLUSION Combination of CT-FFR and CAD-RADS is able to identify significant CAD pre-TAVR and bears potential to significantly reduce the number of needed ICAs. KEY POINTS • Coronary CT angiography-derived fractional flow reserve (CT-FFR) using machine learning together with the CAD Reporting and Data System (CAD-RADS) classification safely identifies significant coronary artery disease based on quantitative coronary angiography in patients prior to transcatheter aortic valve replacement. • The combination of CT-FFR and CAD-RADS enables decision-making and bears the potential to significantly reduce the number of needed invasive coronary angiographies.
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Affiliation(s)
- Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Halfmann MC, Benz S, Schoepf UJ, Hennermann JB, Kreitner KF, Lollert A, Dueber C, Altmann S, Varga-Szemes A, Kampmann C, Emrich T. Biventricular strain assessment indicates progressive impairment of myocardial contractility in phenotypically negative patients with Fabry's disease. Eur J Radiol 2022; 155:110471. [PMID: 35985091 DOI: 10.1016/j.ejrad.2022.110471] [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: 04/03/2022] [Revised: 07/01/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The accumulation of sphingolipids in Fabry's disease (FD) leads to left ventricular (LV) hypertrophy and shortened T1 in cardiac magnetic resonance (CMR). Early detection of myocardial involvement is essential for the timely initiation and efficacy of enzyme replacement therapy. However, there is a diagnostic gap between the onset of accumulation and detectable myocardial changes. This study aimed to evaluate the diagnostic value of biventricular strain assessment in early FD. METHODS Genetically proven FD patients (n = 58) and healthy volunteers (HV, n = 62) who had undergone 3 T CMR were retrospectively identified and stratified into 3 groups according to disease severity. Biventricular volumetry, global longitudinal strains (GLS), indexed biventricular masses (RVMi/LVMi), and T1 were evaluated. Group comparisons were performed by ANOVA and diagnostic accuracy was evaluated by ROC-analysis. RESULTS The study population included 19 group I, 20 group II and 19 group III patients. LV volumetry and T1 showed no significant difference between early FD patients and HV (all p > 0.760). However, RVMi was increased, while RV-GLS and LV-GLS were significantly impaired (p = 0.024 and < 0.001, respectively). Biventricular strains accurately discriminated early FD patients and HV with RV-GLS being non-inferior to LV-GLS (AUC for both 0.83, p > 0.05). Adding strains to the established approach using T1 and LVMi further increased diagnostic accuracy (AUC 0.99, p < 0.05). CONCLUSIONS Biventricular strains may help detect altered myocardial deformation patterns in phenotypically negative FD patients. These findings may lead to an earlier initiation of therapy, which in turn may slow hypertrophy and the associated long-term risks.
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Affiliation(s)
- Moritz C Halfmann
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, DZHK, Potsdamer St. 58, 10785 Berlin, Germany.
| | - Sebastian Benz
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA.
| | - Julia B Hennermann
- Center of Pediatric and Adolescent Medicine, Department of Metabolic Diseases, Villa Metabolica, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Karl-Friedrich Kreitner
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - André Lollert
- Department for Diagnostic and Interventional Radiology, Section of Pediatric Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Christoph Dueber
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Sebastian Altmann
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, DZHK, Potsdamer St. 58, 10785 Berlin, Germany.
| | - Akos Varga-Szemes
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Christoph Kampmann
- Center of Pediatric and Adolescent Medicine, Department of Paediatric Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany.
| | - Tilman Emrich
- Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, DZHK, Potsdamer St. 58, 10785 Berlin, Germany; Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA.
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Emrich T, Aquino G, Schoepf JU, O'Doherty J, Halfmann M, Brandt V, Varga-Szemes A. Calcium-Scoring aus Koronar CT-Angiographien: In-vitro- und In-vivo-Validierung eines neuartigen virtuellen jodfreien Rekonstruktionsalgorithmus an einem Photon Counting Detektor-CT. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- T Emrich
- Universitätsmedizin Mainz, Klinik u. Poliklinik für Diagn. u. Interv. Radiol., Mainz
| | - G Aquino
- Medical University of South Carolina, Radiology, Charleston
| | - J U Schoepf
- Medical University of South Carolina, Radiology, Charleston
| | | | - M Halfmann
- Universitätsmedizin Mainz, Radiologie, Mainz
| | - V Brandt
- Medical University of South Carolina, Radiology, Charleston
| | - A Varga-Szemes
- Medical University of South Carolina, Radiology, Charleston
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Aquino GJ, Decker JA, Schoepf UJ, Carson L, Paladugu N, Yacoub B, Brandt V, Emrich AL, Schwarz F, Burt JR, Bayer R, Varga-Szemes A, Emrich T. Feasibility of Coronary CT Angiography-derived Left Ventricular Long-Axis Shortening as an Early Marker of Ventricular Dysfunction in Transcatheter Aortic Valve Replacement. Radiol Cardiothorac Imaging 2022; 4:e210205. [PMID: 35833168 DOI: 10.1148/ryct.210205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/13/2021] [Revised: 04/18/2022] [Accepted: 05/19/2022] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the value of using left ventricular (LV) long-axis shortening (LAS) derived from coronary CT angiography (CCTA) to predict mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods Patients with severe AS who underwent CCTA for preprocedural TAVR planning between September 2014 and December 2019 were included in this retrospective study. CCTA covered the whole cardiac cycle in 10% increments. Image series reconstructed at end systole and end diastole were used to measure LV-LAS. All-cause mortality within 24 months of follow-up after TAVR was recorded. Cox regression analysis was performed, and hazard ratios (HRs) are presented with 95% CIs. The C index was used to evaluate model performance, and the likelihood ratio χ2 test was performed to compare nested models. Results The study included 175 patients (median age, 79 years [IQR, 73-85 years]; 92 men). The mortality rate was 22% (38 of 175). When adjusting for predictive clinical confounders, it was found that LV-LAS could be used independently to predict mortality (adjusted HR, 2.83 [95% CI: 1.13, 7.07]; P = .03). In another model using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), LV-LAS remained significant (adjusted HR, 3.38 [95 CI: 1.48, 7.72]; P = .004), and its use improved the predictive value of the STS-PROM, increasing the STS-PROM C index from 0.64 to 0.71 (χ2 = 29.9 vs 19.7, P = .001). In a subanalysis of patients with a normal LV ejection fraction (LVEF), the significance of LV-LAS persisted (adjusted HR, 3.98 [95 CI: 1.56, 10.17]; P = .004). Conclusion LV-LAS can be used independently to predict mortality in patients undergoing TAVR, including those with a normal LVEF.Keywords: CT Angiography, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Outcomes Analysis, Cardiomyopathies, Left Ventricle, Aortic Valve Supplemental material is available for this article. © RSNA, 2022See also the commentary by Everett and Leipsic in this issue.
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Affiliation(s)
- Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Landin Carson
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Namrata Paladugu
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Anna Lena Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Florian Schwarz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Jeremy R Burt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Richard Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
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Rudzinski PN, Leipsic JA, Schoepf UJ, Dudek D, Schwarz F, Andreas M, Zlahoda-Huzior A, Thilo C, Renker M, Burt JR, Emrich T, Varga-Szemes A, Amoroso NS, Steinberg DH, Pukacki P, Demkow M, Kepka C, Bayer RR. CT in Transcatheter-delivered Treatment of Valvular Heart Disease. Radiology 2022; 304:4-17. [PMID: 35638923 DOI: 10.1148/radiol.210567] [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
Minimally invasive strategies to treat valvular heart disease have emerged over the past 2 decades. The use of transcatheter aortic valve replacement in the treatment of severe aortic stenosis, for example, has recently expanded from high- to low-risk patients and became an alternative treatment for those with prohibitive surgical risk. With the increase in transcatheter strategies, multimodality imaging, including echocardiography, CT, fluoroscopy, and cardiac MRI, are used. Strategies for preprocedural imaging strategies vary depending on the targeted valve. Herein, an overview of preprocedural imaging strategies and their postprocessing approaches is provided, with a focus on CT. Transcatheter aortic valve replacement is reviewed, as well as less established minimally invasive treatments of the mitral and tricuspid valves. In addition, device-specific details and the goals of CT imaging are discussed. Future imaging developments, such as peri-procedural fusion imaging, machine learning for image processing, and mixed reality applications, are presented.
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Affiliation(s)
- Piotr Nikodem Rudzinski
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Jonathon A Leipsic
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Dariusz Dudek
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Florian Schwarz
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Martin Andreas
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Adriana Zlahoda-Huzior
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Christian Thilo
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Matthias Renker
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Jeremy R Burt
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Tilman Emrich
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Nicholas S Amoroso
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Daniel H Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Piotr Pukacki
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Marcin Demkow
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Cezary Kepka
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
| | - Richard R Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (P.N.R., U.J.S., J.R.B., T.E., A.V.S.), and Department of Cardiology (N.S.A., D.H.S., R.R.B.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland (P.N.R., M.D., C.K.); Department of Radiology for Providence Health Care, Vancouver Coastal Health, Vancouver, Canada (J.A.L.); Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.); Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy (D.D.); Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (F.S.); Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (M.A.); Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland (A.Z.H.); Department of Cardiology, Medizinische Klinik I, RoMed Klinikum Rosenheim, Rosenheim, Germany (C.T.); Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R.); and Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland (P.P.)
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Fischer AM, Decker JA, Schoepf J, Varga-Szemes A, Flohr T, Schmidt B, Gutjahr R, Sahbaee P, Giovagnoli DA, Emrich T, Martinez JD, Lari KB, Bayer RR, Martin SS. Optimization of contrast material administration for coronary CT angiography using a software-based test-bolus evaluation algorithm. Br J Radiol 2022; 95:20201456. [PMID: 35084228 PMCID: PMC10993975 DOI: 10.1259/bjr.20201456] [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: 12/18/2020] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the benefit of a prototype circulation time-based test bolus evaluation algorithm for the individualized optimal timing of contrast media (CM) delivery in patients undergoing coronary CT angiography (CCTA). METHODS Thirty-two patients (62 ± 16 years) underwent CCTA using a prototype bolus evaluation tool to determine the optimal time-delay for CM administration. Contrast attenuation, signal-to-noise ratio (SNR), objective, and subjective image quality were evaluated by two independent radiologists. Results were compared to a control cohort (matched for age, sex, body mass index, and tube voltage) of patients who underwent CCTA using the generic test bolus peak attenuation +4 s protocol as scan delay. RESULTS In the study group, the mean time delay to CCTA acquisition was significantly longer (26.0 ± 2.9 s) compared to the control group (23.1 ± 3.5 s; p < 0.01). In the study group, SNR improvement was seen in the right coronary artery (17.5 vs 13; p = 0.028), the left main (15.3 vs 12.3; p = 0.027), and the left anterior descending artery (18.5 vs 14.1; p = 0.048). Subjective image quality was rated higher in the study group (4.75 ± 0.7 vs 3.64 ± 0.5; p < 0.001). CONCLUSIONS The prototype test bolus evaluation algorithm provided a reliable patient-specific scan delay for CCTA that ensured homogenous vascular attenuation, improvement in objective and subjective image quality, and avoidance of beam hardening artifacts. ADVANCES IN KNOWLEDGE The prototype contrast bolus evaluation and optimization tool estimated circulation time-based time-delay improves the overall quality of CCTA.
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Affiliation(s)
- Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- University Department of Geriatric Medicine FELIX PLATTER and
University of Basel, Basel,
Switzerland
| | - Josua A. Decker
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg,
Augsburg, Germany
| | - Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | | | | | | | | | - Dante A Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Medical Center, Mainz,
Germany
- German Center for Cardiovascular Research (DZHK), Partner Site
Rhine Main, Mainz,
Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Kia B Lari
- University of South Carolina School of Medicine
Greenville, Greenville, South
Carolina, USA
| | - Robert R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, South
Carolina, USA
| | - Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Frankfurt,
Frankfurt, Germany
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Chamberlin JH, Aquino G, Schoepf UJ, Nance S, Godoy F, Carson L, Giovagnoli VM, Gill CE, McGill LJ, O'Doherty J, Emrich T, Burt JR, Baruah D, Varga-Szemes A, Kabakus IM. An Interpretable Chest CT Deep Learning Algorithm for Quantification of COVID-19 Lung Disease and Prediction of Inpatient Morbidity and Mortality. Acad Radiol 2022; 29:1178-1188. [PMID: 35610114 PMCID: PMC8977389 DOI: 10.1016/j.acra.2022.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 12/23/2022]
Abstract
Rationale and Objectives The burden of coronavirus disease 2019 (COVID-19) airspace opacities is time consuming and challenging to quantify on computed tomography. The purpose of this study was to evaluate the ability of a deep convolutional neural network (dCNN) to predict inpatient outcomes associated with COVID-19 pneumonia. Materials and Methods A previously trained dCNN was tested on an external validation cohort of 241 patients who presented to the emergency department and received a chest computed tomography scan, 93 with COVID-19 and 168 without. Airspace opacity scoring systems were defined by the extent of airspace opacity in each lobe, totaled across the entire lungs. Expert and dCNN scores were concurrently evaluated for interobserver agreement, while both dCNN identified airspace opacity scoring and raw opacity values were used in the prediction of COVID-19 diagnosis and inpatient outcomes. Results Interobserver agreement for airspace opacity scoring was 0.892 (95% CI 0.834-0.930). Probability of each outcome behaved as a logistic function of the opacity scoring (25% intensive care unit admission at score of 13/25, 25% intubation at 17/25, and 25% mortality at 20/25). Length of hospitalization, intensive care unit stay, and intubation were associated with larger airspace opacity score (p = 0.032, 0.039, 0.036, respectively). Conclusion The tested dCNN was highly predictive of inpatient outcomes, performs at a near expert level, and provides added value for clinicians in terms of prognostication and disease severity.
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Halfmann MC, Benz S, Schoepf UJ, Düber C, Kloeckner R, Eichstaedt J, Wenzel P, Kreitner KF, Varga-Szemes A, Emrich T. Myocardial Mass Corrected CMR Feature Tracking-Based Strain Ratios are Different in Pathologies With Increased Myocardial Mass. Acad Radiol 2022; 29 Suppl 4:S40-S48. [PMID: 32712258 DOI: 10.1016/j.acra.2020.06.026] [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] [Received: 04/25/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES Acute myocarditis (AM) and hypertensive heart disease (HHD) have different pathophysiological backgrounds, thus potentially showing distinct patterns of altered myocardial deformation. Therefore, CMR left ventricular (LV) feature tracking (FT)- based strain parameters were indexed to myocardial mass index (LVMi) in order to evaluate potential additional value in the differentiation among AM, HHD, and healthy volunteers (HV) compared to non-indexed conventional strain. MATERIALS AND METHODS Patients with AM (n = 43) and HHD (n = 28) underwent CMR at 3T. 61 HV served as controls. Cine imaging-based FT-strain analysis was performed and natural strain (nStrain) values were evaluated for gender and age specific differences in HV. Strain parameters were indexed to LVMi yielding ratio Strain (rStrain). These were evaluated for their discriminatory accuracy compared to nStrain values. RESULTS There were significant differences in nStrain between genders (p < 0.05), but not between age groups in HV. Circumferential strains differentiated best between HV and AM, reaching an area under the curve (AUC) of 0.86 (female) and 0.81 (male), yielding 93 (72) % sensitivity and 55 (75) % specificity. In discriminating between HV and HHD as well as AM and HHD, longitudinal strains outperformed all other parameters with AUCs of 1.00 (female)/ 0.92 (male) and 0.90 (female)/ 0.74 (male), respectively. Sensitivity and specificity levels of 100 %/ 100 % (female) and 91 %/ 72 % (male) for HV versus AM as well as 82 %/ 71 % (female) and 91%/ 57 % (male) for AM versus HHD could be demonstrated. The usage of rStrains significantly increased the AUC for circumferential and radial strains in male patients. CONCLUSION rStrain provided additional value in the differentiation of diseases with increased LVM. As rStrain is derived from standard native cine imaging, such parameters can be time efficiently and reliably calculated, giving them the potential to be a powerful addition to the currently developing multiparametric native diagnostic approaches.
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Affiliation(s)
- Moritz C Halfmann
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
| | - Sebastian Benz
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425
| | - Christoph Düber
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Roman Kloeckner
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Jakob Eichstaedt
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425
| | - Tilman Emrich
- Department for Interventional and Diagnostic Radiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany; Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425; German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany.
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Decker JA, Brill LM, Orlowski U, Varga-Szemes A, Emrich T, Schoepf UJ, Schwarz F, Kröncke TJ, Scheurig-Münkler C. Spontaneous Iliopsoas Muscle Hemorrhage-Predictors of Associated Mortality. Acad Radiol 2022; 29:536-542. [PMID: 34176729 DOI: 10.1016/j.acra.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Spontaneous iliopsoas muscle hemorrhage (SIPH) is a rare clinical condition associated with high mortality. In this work we aimed to retrospectively investigate the predictors of mortality in a single-institution cohort of consecutive SIPH patients. MATERIALS AND METHODS Consecutive patients (n = 61, 30 men, 76 years [range 51-93]) with computed tomography (CT) confirmed diagnosis of SIPH were retrospectively included between January 2010 and April 2020. CT studies were assessed for signs of active bleeding, extramuscular retroperitoneal hematoma, visible sedimentation, and hematoma volume. Medication history, laboratory parameters, comorbidities, and disease management were also recorded. All parameters were subsequently examined with regard to their impact on outcome and survival. Univariate and multivariate Cox regressions were performed to identify variables associated with time to death. RESULTS The overall mortality was 22.9%. A total of 77% of patients received anticoagulant therapy prior to the onset of SIPH. Active bleeding in contrast enhanced CT (CECT) was the only independent variable associated with shorter survival (p = 0.01, hazard ratio 7.05 [1.45-34.20]). Hematoma volume or extramuscular retroperitoneal hematoma had no significant influence on short-term mortality. CONCLUSION Only active bleeding but not hematoma volume or extra-muscular bleeding is an independent risk factor for short-term mortality in patients with SIPH.
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Qi L, Ni X, Schoepf UJ, Varga-Szemes A, McGill L, Wang W, Zhang L, Luo S, Wen J, Zhang LJ. Time-dependent cardiac structural and functional changes after kidney transplantation: a multi-parametric cardiac magnetic resonance study. Eur Radiol 2022; 32:5265-5275. [PMID: 35275257 DOI: 10.1007/s00330-022-08621-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/14/2021] [Revised: 12/11/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To map time-dependent cardiac structural and functional change patterns after renal transplantation (KT) using cardiac magnetic resonance (CMR). METHODS Fifty-three patients with pre-KT and post-KT CMR exams were retrospectively analyzed. Patients were divided into three groups according to the time of post-KT CMR: group 1 (3 months post-KT, n = 16), group 2 (6 months post-KT, n = 21), and group 3 (over 9 months post-KT, n = 16). Twenty-one age- and sex-matched healthy controls (HC) were recruited for the study. CMR-derived left ventricular (LV) volumes, LV mass index (LVMi), LV ejection fraction (LVEF), global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and native T1 value were compared. The association between the changes of CMR parameters was assessed. RESULTS LVMi post-KT decreased in groups 2 (p < 0.001) and 3 (p = 0.004) but both groups had higher LVMi values compared to HC (both p < 0.001). GLS post-KT was decreased in group 1 (p = 0.021), but slightly increased in group 2 (p = 0.728) and group 3 (p = 0.100) without significant difference. GLS post-KT in group 3 was not different from HC (p = 0.104). LVEF, GRS, and GCS post-KT in groups 2 and 3 significantly increased and showed no significant difference from HC. The post-KT native T1 value in all three groups significantly decreased; however, no group showed any significant difference from HC. The change of LVEF was associated with the change of GCS, GRS, and GLS. CONCLUSIONS Although GRS, GCS, GLS, and native T1 values reversed to normal level, LVMi remained impaired in median 14 months after KT. KEY POINTS • Kidney transplantation has favorable effects on cardiac structure and function. • In a median 14 months of follow-up after KT, left ventricle strain and native T1 value reversed to normal level while LV mass index (LVMi) did not. Left ventricular hypertrophy may help to explain why KT recipients are still at increased cardiovascular risk. • The reason for the decrease of native T1 value after KT may be more than myocardial fibrosis and needs to be further studied.
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Affiliation(s)
- Li Qi
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Xuefeng Ni
- Department of Nephrology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Liam McGill
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Wei Wang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Lingyan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jiqiu Wen
- Department of Nephrology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China.
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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Yacoub B, Kabakus IM, Schoepf UJ, Giovagnoli VM, Fischer AM, Wichmann JL, Martinez JD, Sharma P, Rapaka S, Sahbaee P, Hoelzer P, Burt JR, Varga-Szemes A, Emrich T. Performance of an Artificial Intelligence-Based Platform Against Clinical Radiology Reports for the Evaluation of Noncontrast Chest CT. Acad Radiol 2022; 29 Suppl 2:S108-S117. [PMID: 33714665 DOI: 10.1016/j.acra.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/18/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES Research on implementation of artificial intelligence (AI) in radiology workflows and its impact on reports remains scarce. In this study, we aim to assess if an AI platform would perform better than clinical radiology reports in evaluating noncontrast chest computed tomography (CT) scans. MATERIALS AND METHODS Consecutive patients who had undergone noncontrast chest CT were retrospectively identified. The radiology reports were reviewed in a binary fashion for reporting of pulmonary lesions, pulmonary emphysema, aortic dilatation, coronary artery calcifications (CAC), and vertebral compression fractures (VCF). CT scans were then processed using an AI platform. The reports' findings and the AI results were subsequently compared to a consensus read by two board-certificated radiologists as reference. RESULTS A total of 100 patients (mean age: 64.2 ± 14.8 years; 57% males) were included in this study. Aortic segmentation and calcium quantification failed to be processed by AI in 2 and 3 cases, respectively. AI showed superior diagnostic performance in identifying aortic dilatation (AI: sensitivity: 96.3%, specificity: 81.4%, AUC: 0.89) vs (Reports: sensitivity: 25.9%, specificity: 100%, AUC: 0.63), p <0.001; and CAC (AI: sensitivity: 89.8%, specificity: 100, AUC: 0.95) vs (Reports: sensitivity: 75.4%, specificity: 94.9%, AUC: 0.85), p = 0.005. Reports had better performance than AI in identifying pulmonary lesions (Reports: sensitivity: 97.6%, specificity: 100%, AUC: 0.99) vs (AI: sensitivity: 92.8%, specificity: 82.4%, AUC: 0.88), p = 0.024; and VCF (Reports: sensitivity:100%, specificity: 100%, AUC: 1.0) vs (AI: sensitivity: 100%, specificity: 63.7%, AUC: 0.82), p <0.001. A comparable diagnostic performance was noted in identifying pulmonary emphysema on AI (sensitivity: 80.6%, specificity: 66.7%. AUC: 0.74) and reports (sensitivity: 74.2%, specificity: 97.1%, AUC: 0.86), p = 0.064. CONCLUSION Our results demonstrate that incorporating AI support platforms into radiology workflows can provide significant added value to clinical radiology reporting.
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Affiliation(s)
- Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Ismail M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
| | - Vincent M Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; University Hospital Basel, University of Basel, Department of Radiology, Basel, Switzerland
| | - Julian L Wichmann
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany; Siemens Healthineers, Erlangen, Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | - Jeremy R Burt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; University Medical Center Mainz, Department of Diagnostic and Interventional Radiology, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, Mainz, Germany
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