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Renapurkar RD, Bullen J, Rizk A, Abozeed M, Karim W, Bin Saeedan M, Tong MZ, Heresi GA. A Novel Dual Energy Computed Tomography Score Correlates With Postoperative Outcomes in Chronic Thromboembolic Pulmonary Hypertension. J Thorac Imaging 2024; 39:178-184. [PMID: 37423613 DOI: 10.1097/rti.0000000000000724] [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: 07/11/2023]
Abstract
PURPOSE To compare dual-energy computed tomography (DECT) based qualitative and quantitative parameters in chronic thromboembolic pulmonary hypertension with various postoperative primary and secondary endpoints. MATERIALS AND METHODS This was a retrospective analysis of 64 patients with chronic thromboembolic pulmonary hypertension who underwent DECT. First, a clot score was calculated by assigning the following score: pulmonary trunk-5, each main pulmonary artery-4, each lobar-3, each segmental-2, and subsegmental-1 per lobe; the sum total was then calculated. The perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. The combined score was calculated by adding clot and PD scores. For quantitative evaluation, we calculated perfused blood volume (PBV) (%) of each lung and the sum of both lungs. Primary endpoints included testing association between combined score and total PBV with change in mean pulmonary arterial pressure ([mPAP], change calculated as preop minus postop values). Secondary endpoints included explorative analysis of the correlation between combined score and PBV with change in preoperative and postoperative pulmonary vascular resistance, change in preoperative 6-minute walk distance (6MWD), and immediate postoperative complications such as reperfusion edema, ECMO placement, stroke, death and mechanical ventilation for more than 48 hours, all within 1 month of surgery. RESULTS Higher combined scores were associated with larger decreases in mPAP ( =0.27, P =0.036). On average, the decrease in mPAP (pre mPAP-post mPAP) increased by 2.2 mm Hg (95% CI: -0.6, 5.0) with each 10 unit increase in combined score. The correlation between total PBV and change in mPAP was small and not statistically significant. During an exploratory analysis, higher combined scores were associated with larger increases in 6MWD at 6 months postprocedure ( =0.55, P =0.002). CONCLUSION Calculation of DECT-based combined score offers potential in the evaluation of hemodynamic response to surgery. This response can also be objectively quantified.
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Affiliation(s)
| | | | - Alain Rizk
- Section of Thoracic Imaging, Imaging Institute
| | | | - Wadih Karim
- Section of Thoracic Imaging, Imaging Institute
| | | | | | - Gustavo A Heresi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH
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Agarwal A, Ravindran A, Donahue J, Eltoum IE, Abozeed M. Extranodal Rosai-Dorfman Disease: a rare presentation involving anterior chest wall in a middle-aged female. Skeletal Radiol 2024; 53:589-594. [PMID: 37603054 DOI: 10.1007/s00256-023-04427-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
Rosai-Dorfman Disease is a rare benign disorder involving overproduction of immune cells, causing swollen lymph nodes and, in rare cases, the sternum. The sternal involvement may cause chest pain and masses. Diagnosis is confirmed through clinical examination, biopsy, and imaging. Treatment options may include surgery, radiation, or steroids. In this case study, we present an unusual example of extranodal Rosai-Dorfman Disease involving the sternum, bilateral clavicles and first three ribs, and pectoral muscle with no associated lymphadenopathy or systemic symptoms in a 57-year-old female. The etiology, pathology, immunohistochemistry, imaging findings, and treatment options of this unique disease are discussed.
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Affiliation(s)
| | - Aishwarya Ravindran
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Clinical Pathology Department, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - James Donahue
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Thoracic Surgery Department, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Isam-Eldin Eltoum
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Clinical Pathology Department, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Mostafa Abozeed
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Radiology Department, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
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3
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Mettler SK, Nath HP, Grumley S, Orejas JL, Dolliver WR, Nardelli P, Yen AC, Kligerman SJ, Jacobs K, Manapragada PP, Abozeed M, Aziz MU, Zahid M, Ahmed AN, Terry NL, Elalami R, Estépar RSJ, Sonavane S, Billatos E, Wang W, Estépar RSJ, Richards JB, Cho MH, Diaz AA. Silent Airway Mucus Plugs in COPD and Clinical Implications. Chest 2023:S0012-3692(23)05825-7. [PMID: 38013161 DOI: 10.1016/j.chest.2023.11.033] [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: 07/15/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Airway mucus plugs are frequently identified on CT scans of patients with COPD with a smoking history without mucus-related symptoms (ie, cough, phlegm [silent mucus plugs]). RESEARCH QUESTION In patients with COPD, what are the risk and protective factors associated with silent airway mucus plugs? Are silent mucus plugs associated with functional, structural, and clinical measures of disease? STUDY DESIGN AND METHODS We identified mucus plugs on chest CT scans of participants with COPD from the COPDGene study. The mucus plug score was defined as the number of pulmonary segments with mucus plugs, ranging from 0 to 18, and categorized into three groups (0, 1-2, and ≥ 3). We determined risk and protective factors for silent mucus plugs and the associations of silent mucus plugs with measures of disease severity using multivariable linear and logistic regression models. RESULTS Of 4,363 participants with COPD, 1,739 had no cough or phlegm. Among the 1,739 participants, 627 (36%) had airway mucus plugs identified on CT scan. Risk factors of silent mucus plugs (compared with symptomatic mucus plugs) were older age (OR, 1.02), female sex (OR, 1.40), and Black race (OR, 1.93) (all P values < .01). Among those without cough or phlegm, silent mucus plugs (vs absence of mucus plugs) were associated with worse 6-min walk distance, worse resting arterial oxygen saturation, worse FEV1 % predicted, greater emphysema, thicker airway walls, and higher odds of severe exacerbation in the past year in adjusted models. INTERPRETATION Mucus plugs are common in patients with COPD without mucus-related symptoms. Silent mucus plugs are associated with worse functional, structural, and clinical measures of disease. CT scan-identified mucus plugs can complement the evaluation of patients with COPD.
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Affiliation(s)
- Sofia K Mettler
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Hrudaya P Nath
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Scott Grumley
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - José L Orejas
- Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Pietro Nardelli
- Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Andrew C Yen
- Department of Radiology, University of California San Diego, San Diego, CA
| | | | - Kathleen Jacobs
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Padma P Manapragada
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mostafa Abozeed
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Muhammad Usman Aziz
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mohd Zahid
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Asmaa N Ahmed
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Nina L Terry
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Rim Elalami
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Ehab Billatos
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, MA
| | - Raúl San José Estépar
- Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Jeremy B Richards
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alejandro A Diaz
- Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
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Rothenberg SA, Savage CH, Abou Elkassem A, Singh S, Abozeed M, Hamki O, Junck K, Tridandapani S, Li M, Li Y, Smith AD. Prospective Evaluation of AI Triage of Pulmonary Emboli on CT Pulmonary Angiograms. Radiology 2023; 309:e230702. [PMID: 37787676 DOI: 10.1148/radiol.230702] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Artificial intelligence (AI) algorithms have shown high accuracy for detection of pulmonary embolism (PE) on CT pulmonary angiography (CTPA) studies in academic studies. Purpose To determine whether use of an AI triage system to detect PE on CTPA studies improves radiologist performance or examination and report turnaround times in a clinical setting. Materials and Methods This prospective single-center study included adult participants who underwent CTPA for suspected PE in a clinical practice setting. Consecutive CTPA studies were evaluated in two phases, first by radiologists alone (n = 31) (May 2021 to June 2021) and then by radiologists aided by a commercially available AI triage system (n = 37) (September 2021 to December 2021). Sixty-two percent of radiologists (26 of 42 radiologists) interpreted studies in both phases. The reference standard was determined by an independent re-review of studies by thoracic radiologists and was used to calculate performance metrics. Diagnostic accuracy and turnaround times were compared using Pearson χ2 and Wilcoxon rank sum tests. Results Phases 1 and 2 included 503 studies (participant mean age, 54.0 years ± 17.8 [SD]; 275 female, 228 male) and 1023 studies (participant mean age, 55.1 years ± 17.5; 583 female, 440 male), respectively. In phases 1 and 2, 14.5% (73 of 503) and 15.9% (163 of 1023) of CTPA studies were positive for PE (P = .47). Mean wait time for positive PE studies decreased from 21.5 minutes without AI to 11.3 minutes with AI (P < .001). The accuracy and miss rate, respectively, for radiologist detection of any PE on CTPA studies was 97.6% and 12.3% without AI and 98.6% and 6.1% with AI, which was not significantly different (P = .15 and P = .11, respectively). Conclusion The use of an AI triage system to detect any PE on CTPA studies improved wait times but did not improve radiologist accuracy, miss rate, or examination and report turnaround times. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Murphy and Tee in this issue.
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Affiliation(s)
- Steven A Rothenberg
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Cody H Savage
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Asser Abou Elkassem
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Satinder Singh
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Mostafa Abozeed
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Omar Hamki
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Kevin Junck
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Srini Tridandapani
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Mei Li
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Yufeng Li
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
| | - Andrew D Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35233
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5
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Diaz AA, Orejas JL, Grumley S, Nath HP, Wang W, Dolliver WR, Yen A, Kligerman SJ, Jacobs K, Manapragada PP, Abozeed M, Aziz MU, Zahid M, Ahmed AN, Terry NL, San José Estépar R, Kim V, Make BJ, Han MK, Sonavane S, Washko GR, Cho M, San José Estépar R. Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease. JAMA 2023; 329:1832-1839. [PMID: 37210745 PMCID: PMC10201404 DOI: 10.1001/jama.2023.2065] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/07/2023] [Indexed: 05/23/2023]
Abstract
Importance Airway mucus plugs are common in patients with chronic obstructive pulmonary disease (COPD); however, the association of airway mucus plugging and mortality in patients with COPD is unknown. Objective To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality. Design, Setting, and Participants Observational retrospective analysis of prospectively collected data of patients with a diagnosis of COPD in the Genetic Epidemiology of COPD cohort. Participants were non-Hispanic Black or White individuals, aged 45 to 80 years, who smoked at least 10 pack-years. Participants were enrolled at 21 centers across the US between November 2007 and April 2011 and were followed up through August 31, 2022. Exposures Mucus plugs that completely occluded airways on chest CT scans, identified in medium- to large-sized airways (ie, approximately 2- to 10-mm lumen diameter) and categorized as affecting 0, 1 to 2, or 3 or more lung segments. Main Outcomes and Measures The primary outcome was all-cause mortality, assessed with proportional hazard regression analysis. Models were adjusted for age, sex, race and ethnicity, body mass index, pack-years smoked, current smoking status, forced expiratory volume in the first second of expiration, and CT measures of emphysema and airway disease. Results Among the 4483 participants with COPD, 4363 were included in the primary analysis (median age, 63 years [IQR, 57-70 years]; 44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. During a median 9.5-year follow-up, 1769 participants (40.6%) died. The mortality rates were 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) in participants who had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. The presence of mucus plugs in 1 to 2 vs 0 and 3 or more vs 0 lung segments was associated with an adjusted hazard ratio of death of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41), respectively. Conclusions and Relevance In participants with COPD, the presence of mucus plugs that obstructed medium- to large-sized airways was associated with higher all-cause mortality compared with patients without mucus plugging on chest CT scans.
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Affiliation(s)
- Alejandro A. Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - José L. Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Scott Grumley
- Department of Radiology, University of Alabama at Birmingham
| | - Hrudaya P. Nath
- Department of Radiology, University of Alabama at Birmingham
| | - Wei Wang
- Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Wojciech R. Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew Yen
- Department of Radiology, University of California, San Diego
| | - Seth J. Kligerman
- Department of Radiology, University of California, San Diego
- now with Department of Radiology, National Jewish Health, Denver, Colorado
| | - Kathleen Jacobs
- Department of Radiology, University of California, San Diego
| | | | - Mostafa Abozeed
- Department of Radiology, University of Alabama at Birmingham
| | | | - Mohd Zahid
- Department of Radiology, University of Alabama at Birmingham
| | - Asmaa N. Ahmed
- Department of Radiology, University of Alabama at Birmingham
| | - Nina L. Terry
- Department of Radiology, University of Alabama at Birmingham
| | - Ruben San José Estépar
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Victor Kim
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine at National Jewish Health, Denver, Colorado
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care at the University of Michigan, Ann Arbor
| | | | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michael Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
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Perchik JD, Wilson CM, Abozeed M, Manapragada PP, Ahmed AN, Singh SP. Adult Partial Anomalous Pulmonary Venous Return Repair and Superior Vena Cava Syndrome: A Delayed Complication of the Warden Procedure. Radiol Cardiothorac Imaging 2022; 4:e220077. [PMID: 36339061 PMCID: PMC9627227 DOI: 10.1148/ryct.220077] [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: 04/12/2022] [Revised: 07/13/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
The Warden procedure is one of the most common techniques for surgical correction of partial anomalous pulmonary venous return (PAPVR), involving transection and reanastomosis of the superior vena cava (SVC) to the right atrial appendage and baffling of the anomalous pulmonary veins through the atrial septal defect. While the procedure is typically well-tolerated in pediatric patients, adult patients requiring surgical correction of PAPVR are uncommon. The authors report a case of a 33-year-old woman who developed SVC syndrome as a delayed complication of the Warden procedure. Keywords: Cardiac, Congenital, Complications © RSNA, 2022.
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Ahmed AN, Abozeed M, Aziz MU, Singh SP. Role of computed tomography in adult congenital heart disease: A review. J Med Imaging Radiat Sci 2021; 52:S88-S109. [PMID: 34483084 DOI: 10.1016/j.jmir.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/17/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
Due to advances in cardiac surgery, perioperative care and transcatheter interventions, the majority of infants with congenital heart disease (CHD) now survive and reach adulthood. Transthoracic Echocardiography (TTE) is considered the primary imaging modality in evaluation of patients with CHD. However, in adults it can be limited due to several reasons. Although cardiac magnetic resonance (CMR) is extremely useful in evaluating cardiac morphology and function, it is not widely available, takes a long time to obtain images, and cannot be done in severely ill patients or patients that have claustrophobia. Due to high spatial and temporal resolution, isotropic imaging fast imaging and wide availability, multidetector computed tomography (MDCT) has emerged as an excellent alternative modality in the evaluation of adult congenital heart disease (ACHD). It can be performed on patients with hardware and those with claustrophobia, due to shorter image acquisition time. In this article, the commonly encountered congenital heart disorders in adults are reviewed, whether incidentally discovered on a computed tomography (CT), on a CT done to evaluate sequela of unknown CHD, or known treated CHD. To appropriately perform and evaluate CT imaging for postoperative correction or palliation congenital heart disease in adults, the imager should know the detailed cardiac anatomy, details of the operative technique used, and be familiar with the common short and long term post-operative complications.
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Affiliation(s)
- Asmaa Naguib Ahmed
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States.
| | - Mostafa Abozeed
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States
| | - Muhammad Usman Aziz
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States
| | - Satinder P Singh
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States
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8
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Abozeed M, Conic S, Bullen J, Rizk A, Saeedan MB, Karim W, Heresi GA, Renapurkar RD. Dual energy CT based scoring in chronic thromboembolic pulmonary hypertension and correlation with clinical and hemodynamic parameters: a retrospective cross-sectional study. Cardiovasc Diagn Ther 2021; 12:305-313. [DOI: 10.21037/cdt-21-686] [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] [Received: 10/27/2021] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
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9
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Ghosh S, Abozeed M, Bin Saeedan M, Raman SV. Chest radiography of contemporary trans-catheter cardiovascular devices: a pictorial essay. Cardiovasc Diagn Ther 2020; 10:1874-1894. [PMID: 33381431 DOI: 10.21037/cdt-20-617] [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] [Indexed: 11/06/2022]
Abstract
There is a plethora of cardiovascular devices used for therapy and monitoring, and newer devices are being introduced constantly. As a result of advancement of medical technology and rapid development of such technology to address unmet needs across cardiovascular care, multiple conditions which were previously treated surgically or with medications now benefit from trans-catheter device-based evaluation and management. Moreover, innovation to existing technology has transformed the structural design of many traditional cardiovascular devices, making them safer and enabling easier deployment within the chest (catheter-based versus surgical). A post-procedure chest radiography (CXR) is often the first routine imaging test ordered in these patients. A CXR is a relatively inexpensive and noninvasive imaging tool, which can be obtained at the patient's bedside if needed. Commonly implanted cardiovascular devices can be quite easily checked for appropriate positioning on routine CXRs. Potential complications associated with mal-positioning of such devices may be life-threatening. Such complications often manifest early on CXRs and may not be readily apparent on clinical examination. Prompt recognition of such abnormal radiographic appearances is critical for timely diagnosis and effective management. Clinicians need to be familiar with new devices in order to assess proper placement and identify complications related to mal-positioning. This pictorial essay aims to describe the radiologic appearances of contemporary cardiovascular devices, review indications for their usage and potential complications, and discuss magnetic resonance imaging (MRI) compatibility.
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Affiliation(s)
- Subha Ghosh
- Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mostafa Abozeed
- Cardiopulmonary Imaging Division, University of Alabama at Birmingham, Birmingham, AL, USA.,Radiology Department, Al-Azhar University, Cairo, Egypt
| | - Mnahi Bin Saeedan
- Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Subha V Raman
- Indiana University Health and IU Krannert Institute of Cardiology, Indianapolis, IN, USA
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Abozeed M, Bolen MA. Screening CT angiography in patients with suspected fibromuscular dysplasia: improved patient care with single-session skull vertex to pelvis coverage. Cardiovasc Diagn Ther 2020; 10:201-207. [PMID: 32420100 DOI: 10.21037/cdt.2020.02.06] [Citation(s) in RCA: 2] [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] [Indexed: 11/06/2022]
Abstract
Background Imaging plays a key role in the workup of patients with clinically suspected fibromuscular dysplasia (FMD), and research has highlighted the potential of computed tomography angiography (CTA) in screening for thoracic, abdominal, and pelvic arterial abnormalities in these patients. We sought to evaluate imaging findings from patients with suspected or diagnosed FMD who underwent screening CTA at our institution with a novel single-acquisition protocol that offers increased anatomic coverage, with images obtained from the skull vertex to the pelvis. Methods Images from 80 consecutive patients scanned with the novel single-session CTA protocol covering the skull vertex to the pelvis were compared with images from 20 additional consecutive patients who underwent CTA for the head and neck separate from CTA of the chest, abdomen, and pelvis. Results Compared with CTA performed in separate sessions, the single-session CTA protocol decreased the radiation dose by 38% (P<0.001) and decreased the contrast dose by 39% (P<0.001), with satisfactory image quality noted in all instances. Additionally, higher mean contrast attenuation was noted in the aortic arch with use of the novel protocol (409±76 HU) versus with use of the dual-acquisition protocol (260±38 HU; P<0.001). Conclusions These results suggest that use of a novel single-session CTA protocol extending from the skull vertex to the pelvis provides effective screening imaging in patients with suspected or diagnosed FMD as compared with multisession, standard-pitch CTA.
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Affiliation(s)
- Mostafa Abozeed
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.,Radiology Department, Al-Azhar University, Cairo, Egypt
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11
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Abozeed M, Kocyigit D, Kwon D, Flamm SD, Wilkoff B, Jellis CL. PREDICTORS OF ARTIFACT WITH PACEMAKERS AND IMPLANTABLE CARDIOVERTER DEFIBRILLATORS ON CARDIAC MAGNETIC RESONANCE IMAGING: OPTIMIZATION OF PATIENT SELECTION FOR DIAGNOSTIC IMAGE QUALITY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32309-3] [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: 11/27/2022]
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