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Herten VRLM, Hampe N, Takx RAP, Franssen KJ, Wang Y, Sucha D, Henriques JP, Leiner T, Planken RN, Isgum I. Automatic Coronary Artery Plaque Quantification and CAD-RADS Prediction Using Mesh Priors. IEEE Trans Med Imaging 2024; 43:1272-1283. [PMID: 37862273 DOI: 10.1109/tmi.2023.3326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Coronary artery disease (CAD) remains the leading cause of death worldwide. Patients with suspected CAD undergo coronary CT angiography (CCTA) to evaluate the risk of cardiovascular events and determine the treatment. Clinical analysis of coronary arteries in CCTA comprises the identification of atherosclerotic plaque, as well as the grading of any coronary artery stenosis typically obtained through the CAD-Reporting and Data System (CAD-RADS). This requires analysis of the coronary lumen and plaque. While voxel-wise segmentation is a commonly used approach in various segmentation tasks, it does not guarantee topologically plausible shapes. To address this, in this work, we propose to directly infer surface meshes for coronary artery lumen and plaque based on a centerline prior and use it in the downstream task of CAD-RADS scoring. The method is developed and evaluated using a total of 2407 CCTA scans. Our method achieved lesion-wise volume intraclass correlation coefficients of 0.98, 0.79, and 0.85 for calcified, non-calcified, and total plaque volume respectively. Patient-level CAD-RADS categorization was evaluated on a representative hold-out test set of 300 scans, for which the achieved linearly weighted kappa ( κ ) was 0.75. CAD-RADS categorization on the set of 658 scans from another hospital and scanner led to a κ of 0.71. The results demonstrate that direct inference of coronary artery meshes for lumen and plaque is feasible, and allows for the automated prediction of routinely performed CAD-RADS categorization.
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Lucci C, Rissanen I, Takx RAP, van der Kolk AG, Harteveld AA, Dankbaar JW, Geerlings MI, de Jong PA, Hendrikse J. Imaging of intracranial arterial disease: a comparison between MRI and unenhanced CT. Front Radiol 2024; 4:1338418. [PMID: 38426079 PMCID: PMC10902099 DOI: 10.3389/fradi.2024.1338418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Background and purpose Arterial calcifications on unenhanced CT scans and vessel wall lesions on MRI are often used interchangeably to portray intracranial arterial disease. However, the extent of pathology depicted with each technique is unclear. We investigated the presence and distribution of these two imaging findings in patients with a history of cerebrovascular disease. Materials and methods We analyzed CT and MRI data from 78 patients admitted for stroke or TIA at our institution. Vessel wall lesions were assessed on 7 T MRI sequences, while arterial calcifications were assessed on CT scans. The number of vessel wall lesions, severity of intracranial internal carotid artery (iICA) calcifications, and overall presence and distribution of the two imaging findings were visually assessed in the intracranial arteries. Results At least one vessel wall lesion or arterial calcification was assessed in 69 (88%) patients. Only the iICA and vertebral arteries (VA) showed a substantial number of both calcifications and vessel wall lesions. The other vessels showed almost exclusively vessel wall lesions. The number of vessel wall lesions was associated with the severity of iICA calcification (p = 0.013). Conclusions The number of vessel wall lesions increases with the severity of iICA calcifications. Nonetheless, the distribution of vessel wall lesions on MRI and arterial calcifications on CT shows remarkable differences. These findings support the need for a combined approach to examine intracranial arterial disease.
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Affiliation(s)
- Carlo Lucci
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Richard A. P. Takx
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Anja G. van der Kolk
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Anita A. Harteveld
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jan W. Dankbaar
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Mirjam I. Geerlings
- Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Celeng C, Takx RAP. Cancer-associated marantic endocarditis: a rare but relevant complication. Eur Heart J Cardiovasc Imaging 2023; 24:1627-1628. [PMID: 37421367 DOI: 10.1093/ehjci/jead162] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Affiliation(s)
- Csilla Celeng
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Richard A P Takx
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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Konijn LCD, Mali WPTM, van Overhagen H, Takx RAP, Veger HTC, de Jong PA. Systemic arterial calcium burden in patients with chronic limb-threatening ischemia. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00088-6. [PMID: 37150661 DOI: 10.1016/j.jcct.2023.03.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/12/2023] [Accepted: 03/11/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION 5-year mortality of chronic limb-threatening ischemia (CLTI) is 50-60% and coronary artery disease (CAD) is the main cause of death of CLTI patients, followed by stroke. The aim of this study is to quantify and qualify the calcium load in different arterial territories in patients with CLTI. METHODS Prospectively, 60 patients with CLTI were included and received a full-body CT scan. 6 patients were excluded. Different arterial territories (the peripheral lower extremity arteries, coronary arteries, extracranial and intracranial carotid arteries, thoracic and abdominal aorta) were analyzed. Analysis and interrelations of both quantitative and semi-quantitative CT measurements was performed. RESULTS Mean age was 72 years (range 47-95; SD 11.4). Almost all CLTI patients had calcified arterial beds (femoropopliteal 100%, crural 98.1%, coronary 100%, carotid bifurcation 96.2%, internal carotid artery 98.1%, thoracic aorta 96.2%, abdominal aorta 92.3%). Nearly all arterial territories had severe calcifications. 57% had a very high coronary Agatston score (>1000), and 35% extremely high (>2000). Calcifications in the lower extremity were significantly correlated to CAC score, carotid artery bifurcation calcification score, and to a lesser extent correlated to annular calcifications in the aorta. Very high and extremely high total CAC scores were strongly correlated with severe lower extremity arterial calcifications and severe carotid and intracranial internal carotid artery, thoracic and abdominal aorta calcifications in patients with CLTI patients. CONCLUSIONS In CLTI patients nearly all arterial territories are severely calcified, suggesting that systemic calcification plays an important role in the poor outcome of this disease.
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Affiliation(s)
- L C D Konijn
- Haga Hospital, Department of Diagnostic and Interventional Radiology, the Netherlands; University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, the Netherlands.
| | - W P T M Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, the Netherlands.
| | - H van Overhagen
- Haga Hospital, Department of Diagnostic and Interventional Radiology, the Netherlands.
| | - R A P Takx
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, the Netherlands.
| | - H T C Veger
- Haga Hospital, Department of Vascular Surgery, the Netherlands.
| | - P A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, the Netherlands.
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Kauw F, Velthuis BK, Takx RAP, Guglielmo M, Cramer MJ, van Ommen F, Bos A, Bennink E, Kappelle LJ, de Jong HWAM, Dankbaar JW. Detection of Cardioembolic Sources With Nongated Cardiac Computed Tomography Angiography in Acute Stroke: Results From the ENCLOSE Study. Stroke 2023; 54:821-830. [PMID: 36779342 PMCID: PMC9951793 DOI: 10.1161/strokeaha.122.041018] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Identifying cardioembolic sources in patients with acute ischemic stroke is important for the choice of secondary prevention strategies. We prospectively investigated the yield of admission (spectral) nongated cardiac computed tomography angiography (CTA) to detect cardioembolic sources in stroke. METHODS Participants of the ENCLOSE study (Improved Prediction of Recurrent Stroke and Detection of Small Volume Stroke) with transient ischemic attack or acute ischemic stroke with assessable nongated head-to-heart CTA at the University Medical Center Utrecht were included between June 2017 and March 2022. The presence of cardiac thrombus on cardiac CTA was based on a Likert scale and dichotomized into certainly or probably absent versus possibly, probably, or certainly present. The diagnostic certainty of cardiac thrombus was evaluated again on spectral computed tomography reconstructions. The likelihood of a cardioembolic source was determined post hoc by an expert panel in patients with cardiac thrombus on CTA. Parametric and nonparametric tests were used to compare the outcome groups. RESULTS Forty four (12%) of 370 included patients had a cardiac thrombus on admission CTA: 35 (9%) in the left atrial appendage and 14 (4%) in the left ventricle. Patients with cardiac thrombus had more severe strokes (median National Institutes of Health Stroke Scale score, 10 versus 4; P=0.006), had higher clot burden (median clot burden score, 9 versus 10; P=0.004), and underwent endovascular treatment more often (43% versus 20%; P<0.001) than patients without cardiac thrombus. Left atrial appendage thrombus was present in 28% and 6% of the patients with and without atrial fibrillation, respectively (P<0.001). The diagnostic certainty for left atrial appendage thrombus was higher for spectral iodine maps compared with the conventional CTA (P<0.001). The presence of cardiac thrombus on CTA increased the likelihood of a cardioembolic source according to the expert panel (P<0.001). CONCLUSIONS Extending the stroke CTA to cover the heart increases the chance of detecting cardiac thrombi and helps to identify cardioembolic sources in the acute stage of ischemic stroke with more certainty. Spectral iodine maps provide additional value for detecting left atrial appendage thrombus. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04019483.
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Affiliation(s)
- Frans Kauw
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Brain Center, Department of Neurology and Neurosurgery (F.K., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Richard A P Takx
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marco Guglielmo
- Department of Cardiology (M.G., M.J.C.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology (M.G., M.J.C.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Fasco van Ommen
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Anneloes Bos
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Edwin Bennink
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - L Jaap Kappelle
- Brain Center, Department of Neurology and Neurosurgery (F.K., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Sayour AA, Tokodi M, Celeng C, Takx RAP, Fábián A, Lakatos BK, Friebel R, Surkova E, Merkely B, Kovács A. Association of Right Ventricular Functional Parameters With Adverse Cardiopulmonary Outcomes: A Meta-analysis. J Am Soc Echocardiogr 2023:S0894-7317(23)00074-3. [PMID: 36773817 DOI: 10.1016/j.echo.2023.01.018] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
AIMS We aimed to confirm that three-dimensional echocardiography-derived right ventricular ejection fraction (RVEF) is better associated with adverse cardiopulmonary outcomes than the conventional echocardiographic parameters. METHODS We performed a meta-analysis of studies reporting the impact of unit change of RVEF, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) on clinical outcomes (all-cause mortality and/or adverse cardiopulmonary outcomes). Hazard ratios (HRs) were rescaled by the within-study SDs to represent standardized changes. Within each study, we calculated the ratio of HRs related to a 1 SD reduction in RVEF versus TAPSE, or FAC, or FWLS, to quantify the association of RVEF with adverse outcomes relative to the other metrics. These ratios of HRs were pooled using random-effects models. RESULTS Ten independent studies were identified as suitable, including data on 1,928 patients with various cardiopulmonary conditions. Overall, a 1 SD reduction in RVEF was robustly associated with adverse outcomes (HR = 2.64 [95% CI, 2.18-3.20], P < .001; heterogeneity: I2 = 65%, P = .002). In studies reporting HRs for RVEF and TAPSE, or RVEF and FAC, or RVEF and FWLS in the same cohort, head-to-head comparison revealed that RVEF showed significantly stronger association with adverse outcomes per SD reduction versus the other 3 parameters (vs TAPSE, HR = 1.54 [95% CI, 1.04-2.28], P = .031; vs FAC, HR = 1.45 [95% CI, 1.15-1.81], P = .001; vs FWLS, HR = 1.44 [95% CI, 1.07-1.95], P = .018). CONCLUSION Reduction in three-dimensional echocardiography-derived RVEF shows stronger association with adverse clinical outcomes than conventional right ventricular functional indices; therefore, it might further refine the risk stratification of patients with cardiopulmonary diseases.
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Affiliation(s)
- Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Csilla Celeng
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Richard A P Takx
- Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint K Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rocco Friebel
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elena Surkova
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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Vos A, Houben IB, Celeng C, Takx RAP, Isgum I, Mali WPTM, Vink A, de Jong PA. Aortic calcification: A postmortem CT validation study in a middle-aged population. Eur J Radiol 2023; 159:110687. [PMID: 36610325 DOI: 10.1016/j.ejrad.2023.110687] [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: 08/26/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Computed tomography (CT)-detected aortic calcification is strongly associated with aortic stiffness and is an accurate predictor of cardiovascular and all-cause mortality and cognitive decline. Some previous pathologic studies have shown calcium accumulation in the medial layer of the vessel wall, while others have suggested localisation in the atherosclerotic intimal layer. OBJECTIVES The aim of this study was to histologically validate CT findings of aortic calcification for detectability and location in the aortic wall. METHODS We acquired postmortem CT images and collected 170 aortic tissue samples from five different locations in the thoracic and abdominal aorta of 40 individuals who underwent autopsy. Microscopic slides were stained with haematoxylin and eosin and elastic van Gieson stain. Calcified lesions were characterised and calcifications were manually annotated in the intima and media. The presence and morphology of calcifications were scored on CT images. RESULTS The mean age of the autopsied individuals was 63 years, and 28 % died of cardiovascular disease. Calcifications were present in 74/170 (44 %) samples. Calcification was more common in the abdominal aorta than in the thoracic aorta. In all samples with calcifications, 99 % were located in the intimal layer. Only 16/170 samples had a small amount of medial arterial calcification. The histological results showed an 85 % concordance for the presence or absence of CT calcifications. There was complete inter-method agreement for annularity of calcifications in 68 % of the samples (linear weighted kappa 0.68 (95 %CI 0.60-0.77). CONCLUSIONS Aortic calcifications visible on CT are located in the intimal layer of the abdominal aorta wall, at least in aortas that are not aneurysmatic or dissected. The presence and annularity of these calcifications can be reliably determined by CT.
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Affiliation(s)
- Annelotte Vos
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Ignas B Houben
- University Medical Center Utrecht and Utrecht University, Department of Vascular Surgery, The Netherlands; Frankel Cardiovascular Center, University of Michigan, Department of Cardiac Surgery, United States
| | - Csilla Celeng
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Richard A P Takx
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Ivana Isgum
- Amsterdam University Medical Centers, The Netherlands
| | - Willem P T M Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Aryan Vink
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Pim A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands.
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Vos A, Vink A, Kockelkoren R, Takx RAP, Celeng C, Mali WPTM, Isgum I, Bleys RLAW, de Jong PA. Radiography and Computed Tomography Detection of Intimal and Medial Calcifications in Leg Arteries in Comparison to Histology. J Pers Med 2022; 12:jpm12050711. [PMID: 35629134 PMCID: PMC9144714 DOI: 10.3390/jpm12050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Calcifications are common in the tunica intima and tunica media of leg arteries. There is growing interest in medial arterial calcifications, as they may be modifiable with treatment. We aimed to investigate radiography and computed tomography (CT) for the detection and characterization of both types of arterial calcification in leg arteries in relation to histology. In a postmortem study we therefore investigated 24 popliteal and 24 tibial arteries. The reference standard was presence of arterial calcification and the dominance of intimal or medial calcification on histology. Radiographs and CT scans were scored for presence of calcification and for dominant intimal or medial pattern based on prespecified criteria (annularity, thickness, continuity). Both radiography and CT detected 87% of histologically proven calcifications but missed mild calcifications in 13%. When only the arteries with detected calcifications were included, a moderate agreement was observed on intimal/medial location of calcifications between histology and radiography (correct in 19/24 arteries (79%); Kappa 0.58) or CT (correct in 33/46 arterial segments (72%); Kappa 0.48). With both modalities there was a slight tendency to classify intimal calcifications as being located in the media and to miss media calcification. Our study demonstrates the potential and limitations of both radiography and CT to detect and classify arterial calcifications in leg arteries.
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Affiliation(s)
- Annelotte Vos
- Department of Pathology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (A.V.); (A.V.)
- Department of Pathlogy, Meander Medical Center, 3800 BM Amersfoort, The Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (A.V.); (A.V.)
| | - Remko Kockelkoren
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Richard A. P. Takx
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Csilla Celeng
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Willem P. T. M. Mali
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Ivana Isgum
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Ronald L. A. W. Bleys
- Department of Anatomy, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands;
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
- Correspondence: ; Tel.: +31-88-7556689
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9
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Takx RAP, van Asperen R, Bartstra JW, Zwakenberg SR, Wolterink JM, Celeng C, de Jong PA, Beulens JW. Determinants of 18F-NaF uptake in femoral arteries in patients with type 2 diabetes mellitus. J Nucl Cardiol 2021; 28:2700-2705. [PMID: 32185685 PMCID: PMC8709815 DOI: 10.1007/s12350-020-02099-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The goal of this study was to investigate the potential determinants of 18F-NaF uptake in femoral arteries as a marker of arterial calcification in patients with type 2 diabetes and a history of arterial disease. METHODS AND RESULTS The study consisted of participants of a randomized controlled trial to investigate the effect of vitamin K2 (NCT02839044). In this prespecified analysis, subjects with type 2 diabetes and known arterial disease underwent full body 18F-NaF PET/CT. Target-to-background ratio (TBR) was calculated by dividing the mean SUVmax from both superficial femoral arteries by the SUVmean in the superior vena cava (SVC) and calcium mass was measured on CT. The association between 18F-NaF TBR and cardiovascular risk factors was investigated using uni- and multivariate linear regression corrected for age and sex. In total, 68 patients (mean age: 69 ± 8 years; male: 52) underwent 18F-NaF PET/CT. Higher CT calcium mass, total cholesterol, and HbA1c were associated with higher 18F-NaF TBR after adjusting. CONCLUSION This study shows that several modifiable cardiovascular risk factors (total cholesterol, triglycerides, HbA1c) are associated with femoral 18F-NaF tracer uptake in patients with type 2 diabetes.
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Affiliation(s)
- Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Ruth van Asperen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jonas W Bartstra
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Sabine R Zwakenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Csilla Celeng
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joline W Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
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Osborn EA, Ughi GJ, Verjans JW, Piao Z, Gerbaud E, Albaghdadi M, Khraishah H, Kassab MB, Takx RAP, Cui J, Mauskapf A, Shen C, Yeh RW, Klimas MT, Tawakol A, Tearney GJ, Jaffer FA. Intravascular Molecular-Structural Assessment of Arterial Inflammation in Preclinical Atherosclerosis Progression. JACC Cardiovasc Imaging 2021; 14:2265-2267. [PMID: 34419392 DOI: 10.1016/j.jcmg.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
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11
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Takx RAP, Celeng C. Cocaine use worsens coronary atherosclerosis in HIV infected. Eur Radiol 2021; 31:2754-2755. [PMID: 33683389 DOI: 10.1007/s00330-021-07806-z] [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: 12/18/2020] [Revised: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Richard A P Takx
- Department of Radiology, UMC Utrecht, Heidelberglaan 100, P.O. Box 85500, 3584, CX, Utrecht, The Netherlands.
| | - Csilla Celeng
- Department of Radiology, UMC Utrecht, Heidelberglaan 100, P.O. Box 85500, 3584, CX, Utrecht, The Netherlands
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12
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Noothout JMH, De Vos BD, Wolterink JM, Postma EM, Smeets PAM, Takx RAP, Leiner T, Viergever MA, Isgum I. Deep Learning-Based Regression and Classification for Automatic Landmark Localization in Medical Images. IEEE Trans Med Imaging 2020; 39:4011-4022. [PMID: 32746142 DOI: 10.1109/tmi.2020.3009002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this study, we propose a fast and accurate method to automatically localize anatomical landmarks in medical images. We employ a global-to-local localization approach using fully convolutional neural networks (FCNNs). First, a global FCNN localizes multiple landmarks through the analysis of image patches, performing regression and classification simultaneously. In regression, displacement vectors pointing from the center of image patches towards landmark locations are determined. In classification, presence of landmarks of interest in the patch is established. Global landmark locations are obtained by averaging the predicted displacement vectors, where the contribution of each displacement vector is weighted by the posterior classification probability of the patch that it is pointing from. Subsequently, for each landmark localized with global localization, local analysis is performed. Specialized FCNNs refine the global landmark locations by analyzing local sub-images in a similar manner, i.e. by performing regression and classification simultaneously and combining the results. Evaluation was performed through localization of 8 anatomical landmarks in CCTA scans, 2 landmarks in olfactory MR scans, and 19 landmarks in cephalometric X-rays. We demonstrate that the method performs similarly to a second observer and is able to localize landmarks in a diverse set of medical images, differing in image modality, image dimensionality, and anatomical coverage.
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13
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Kauw F, de Jong PA, Takx RAP, de Jong HWAM, Kappelle LJ, Velthuis BK, Dankbaar JW. Effect of intravenous thrombolysis in stroke depends on pattern of intracranial internal carotid artery calcification. Atherosclerosis 2020; 316:8-14. [PMID: 33260009 DOI: 10.1016/j.atherosclerosis.2020.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/11/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The pattern of intracranial internal carotid artery calcification (ICAC) has been identified as an effect modifier of endovascular treatment in patients with acute ischemic stroke, but it is unclear whether it modifies the effect of intravenous thrombolysis. The purpose of this study was to evaluate the association between intravenous thrombolysis and 90-day clinical outcome, follow-up infarct volume, intracranial hemorrhage and recanalization across different patterns of ICAC. METHODS Patients with acute ischemic stroke were selected from the Dutch acute stroke study, a prospective multicenter observational cohort study. ICAC pattern was determined on admission thin-slice non-contrast CT and categorized as absent, intimal, medial or indistinguishable. The primary outcome was the ordinal 90-day modified Rankin Scale. Other outcomes included follow-up infarct volume, intracranial hemorrhage, recanalization and collateral status. Associations were quantified with regression analyses and stratified by ICAC pattern. RESULTS Of 982 patients, 609 (62%) received intravenous thrombolysis and 381 (39%) had a 90-day modified Rankin Scale of 3-6. Intravenous thrombolysis was associated with a lower 90-day modified Rankin Scale in the group without ICAC (adjusted OR 0.3; 95%-CI 0.1-0.9) and in the group with a medial ICAC pattern (adjusted OR 0.5; 95%-CI 0.3-0.8), but not in the groups with intimal (adjusted OR 0.9; 95%-CI 0.5-1.5) or indistinguishable patterns (adjusted OR 0.6; 95%-CI 0.2-1.8). The associations between intravenous thrombolysis and follow-up infarct volume and intracranial hemorrhage were not significant for any of the ICAC pattern groups. Intravenous thrombolysis was only associated with recanalization in the group with a medial ICAC pattern (adjusted OR 3.5; 95%-CI 1.2-11.0). Compared to an intimal ICAC pattern, a medial ICAC pattern was associated with good collateral status (adjusted OR 2.6; 95%-CI 1.1-6.0). CONCLUSIONS Intravenous thrombolysis was significantly associated with favorable clinical outcome and successful recanalization in the group with a medial ICAC pattern, but not in the group with an intimal ICAC pattern.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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14
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Kauw F, Greving JP, Takx RAP, de Jong HWAM, Schonewille WJ, Vos JA, Wermer MJH, van Walderveen MAA, Kappelle LJ, Velthuis BK, Dankbaar JW. Prediction of long-term recurrent ischemic stroke: the added value of non-contrast CT, CT perfusion, and CT angiography. Neuroradiology 2020; 63:483-490. [PMID: 32857214 PMCID: PMC7966192 DOI: 10.1007/s00234-020-02526-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to evaluate whether the addition of brain CT imaging data to a model incorporating clinical risk factors improves prediction of ischemic stroke recurrence over 5 years of follow-up. Methods A total of 638 patients with ischemic stroke from three centers were selected from the Dutch acute stroke study (DUST). CT-derived candidate predictors included findings on non-contrast CT, CT perfusion, and CT angiography. Five-year follow-up data were extracted from medical records. We developed a multivariable Cox regression model containing clinical predictors and an extended model including CT-derived predictors by applying backward elimination. We calculated net reclassification improvement and integrated discrimination improvement indices. Discrimination was evaluated with the optimism-corrected c-statistic and calibration with a calibration plot. Results During 5 years of follow-up, 56 patients (9%) had a recurrence. The c-statistic of the clinical model, which contained male sex, history of hyperlipidemia, and history of stroke or transient ischemic attack, was 0.61. Compared with the clinical model, the extended model, which contained previous cerebral infarcts on non-contrast CT and Alberta Stroke Program Early CT score greater than 7 on mean transit time maps derived from CT perfusion, had higher discriminative performance (c-statistic 0.65, P = 0.01). Inclusion of these CT variables led to a significant improvement in reclassification measures, by using the net reclassification improvement and integrated discrimination improvement indices. Conclusion Data from CT imaging significantly improved the discriminatory performance and reclassification in predicting ischemic stroke recurrence beyond a model incorporating clinical risk factors only. Electronic supplementary material The online version of this article (10.1007/s00234-020-02526-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - Jan A Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - L Jaap Kappelle
- Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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15
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Bruns S, Wolterink JM, Takx RAP, Hamersvelt RW, Suchá D, Viergever MA, Leiner T, Išgum I. Deep learning from dual‐energy information for whole‐heart segmentation in dual‐energy and single‐energy non‐contrast‐enhanced cardiac CT. Med Phys 2020; 47:5048-5060. [DOI: 10.1002/mp.14451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Steffen Bruns
- Department of Biomedical Engineering and Physics Amsterdam UMC – location AMCUniversity of Amsterdam Amsterdam1105 AZ Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMC Amsterdam1105 AZ Netherlands
| | - Jelmer M. Wolterink
- Department of Biomedical Engineering and Physics Amsterdam UMC – location AMCUniversity of Amsterdam Amsterdam1105 AZ Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMC Amsterdam1105 AZ Netherlands
| | - Richard A. P. Takx
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Robbert W. Hamersvelt
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Dominika Suchá
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Max A. Viergever
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Tim Leiner
- Department of Radiology University Medical Center Utrecht Utrecht3584 CX Netherlands
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics Amsterdam UMC – location AMCUniversity of Amsterdam Amsterdam1105 AZ Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht3584 CX Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMC Amsterdam1105 AZ Netherlands
- Department of Radiology and Nuclear Medicine Amsterdam UMC – location AMC Amsterdam1105 AZ Netherlands
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16
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Konijn LCD, van Overhagen H, Takx RAP, de Jong PA, Veger HTC, Mali WPTM. CT calcification patterns of peripheral arteries in patients without known peripheral arterial disease. Eur J Radiol 2020; 128:108973. [PMID: 32422552 DOI: 10.1016/j.ejrad.2020.108973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/15/2020] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE In the last few years histologic studies of peripheral arteries have shown that both intimal and medial calcifications are found in patients in an early, asymptomatic stage and that differentiation between medial and intimal calcifications is possible. The aim of this study was to assess the computed tomography (CT) calcification characteristics in peripheral arteries and to explore potential patterns in subjects without peripheral arterial disease (PAD). METHOD Retrospectively, 204 patients without known PAD were studied. The thin slice CT-imaging characteristics severity, annularity, thickness and continuity were scored in the following arteries: plantar and dorsal, crural, femoro-popliteal, iliac and the abdominal aorta. Interrelation was assessed using linear regression and significance was tested by Chi-Square tests. RESULTS In the crural arteries two calcification patterns with strong associations were found. Pattern 1: continuous-annular 93.5 % (29/31), continuous-thin and thin-annular both 73 % (27/37, p < 0.001) and pattern 2: thick-discontinuous 91.7 % (44/48), thick-dotted 68.8 % (33/48), patchy-dotted 59.3 % (16/27, p < 0.001). Similar associations were found in the femoro-popliteal artery, but not in the plantar, dorsal, iliac arteries and aorta. CONCLUSIONS In the crural and femoropopliteal arteries at least two morphological patterns can be distinguished on CT that, compared to a CT-histologically validated score, may represent an intimal and medial calcification pattern.
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Affiliation(s)
- Louise C D Konijn
- Haga Teaching Hospital, Department of Radiology, the Netherlands; University Medical Center Utrecht and Utrecht University, Department of Radiology, Utrecht, the Netherlands.
| | | | - Richard A P Takx
- University Medical Center Utrecht and Utrecht University, Department of Radiology, Utrecht, the Netherlands.
| | - Pim A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology, Utrecht, the Netherlands.
| | - Hugo T C Veger
- Haga Teaching Hospital, Department of Vascular Surgery, the Hague, the Netherlands.
| | - Willem P Th M Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology, Utrecht, the Netherlands.
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17
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van Rooij JLM, Takx RAP, Velthuis BK, Dankbaar JW, de Jong PA. Coiling of the Internal Carotid Artery is Associated with Hypertension in Patients Suspected of Stroke. Clin Neuroradiol 2020; 31:425-430. [PMID: 32189014 PMCID: PMC8211591 DOI: 10.1007/s00062-020-00892-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/14/2020] [Indexed: 11/28/2022]
Abstract
Purpose The etiology of coiling (i.e. severe elongation) of the extracranial part of the internal carotid artery (ICA) is poorly understood with the proposed etiology being congenital, atherosclerotic or hypertension. The objective was to investigate the association of coiling with hypertension, carotid artery atherosclerosis and other cardiovascular risk factors. Methods A case control study was performed in patients suspected of stroke, with (cases) or without (controls) coiling of the ICA determined on compute tomography angiography (CTA). Baseline characteristics included age, gender, hypertension, diabetes, smoking and hypercholesterolemia. Coiling of the ICA and atherosclerotic plaque at the carotid bifurcation were assessed on CTA. Logistic regression analyses were conducted. Results Coiling was identified in 108 patients with a median age of 71 years. Cases were compared with 256 controls with a median age of 69 years. Hypertension was present in 63% of the patients with coiling compared to 51% in the control group. Univariable analysis showed that hypertension was significantly associated with coiling, with an odds ratio of 1.65 (95% confidence interval (CI) 1.04–2.61, p = 0.034). Multivariable analysis corrected for age and sex resulted in an odds ratio of 1.71 (95% CI 1.05–2.80, p = 0.032), while correcting for atherosclerotic plaque at the bifurcation yielded an odds ratio of 1.63 (95% CI 1.00–2.66, p = 0.049). Age and atherosclerotic plaque were not significantly associated with coiling. Conclusion The main finding of this study was the significant association of hypertension with coiling of the ICA and the absence of an association with age, plaques and atherosclerotic risk factors other than hypertension.
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Affiliation(s)
- Josephus L M van Rooij
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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18
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Leiner T, Takx RAP. Predicting the Need for Revascularization in Stable Coronary Artery Disease: Protons or Photons? JACC Cardiovasc Imaging 2019; 13:1005-1007. [PMID: 31607672 DOI: 10.1016/j.jcmg.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tim Leiner
- Department of Radiology, University Medical Center of Utrecht, Utrecht, the Netherlands.
| | - Richard A P Takx
- Department of Radiology, University Medical Center of Utrecht, Utrecht, the Netherlands
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19
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Ishai A, Osborne MT, El Kholy K, Takx RAP, Ali A, Yuan N, Hsue P, Van Dyke TE, Tawakol A. Periodontal Disease Associates With Arterial Inflammation Via Potentiation of a Hematopoietic-Arterial Axis. JACC Cardiovasc Imaging 2019; 12:2271-2273. [PMID: 31326471 DOI: 10.1016/j.jcmg.2019.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
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20
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Wichmann JL, Takx RAP, Nunez JH, Vliegenthart R, Otani K, Litwin SE, Morris PB, De Cecco CN, Rosenberg RD, Bayer RR, Baumann S, Renker M, Vogl TJ, Wenger NK, Schoepf UJ. Relationship Between Pregnancy Complications and Subsequent Coronary Artery Disease Assessed by Coronary Computed Tomographic Angiography in Black Women. Circ Cardiovasc Imaging 2019; 12:e008754. [PMID: 31303028 DOI: 10.1161/circimaging.118.008754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Maternal pregnancy complications, particularly preeclampsia and gestational diabetes mellitus, are described to increase the risk for subsequent coronary artery disease (CAD). In addition, black women are at higher risk for CAD. The objective of this study was to compare the prevalence and extent of CAD as detected by coronary computed tomographic angiography (CCTA) in black women with and without a history of prior pregnancy complications. METHODS We retrospectively evaluated patient characteristics and CCTA findings in groups of black women with a prior history of preterm delivery (n=154), preeclampsia (n=137), or gestational diabetes mellitus (n=148), and a matched control group of black women who gave birth without such complications (n=445). Univariate and multivariate analyses were performed to assess risk factors of CAD. RESULTS All groups with prior pregnancy complications showed higher rates of any (≥20% luminal narrowing) and obstructive (≥50% luminal narrowing) CAD (preterm delivery: 29.2% and 9.1%; preeclampsia: 29.2% and 7.3%; and gestational diabetes mellitus: 47.3% and 15.5%) compared with control women (23.8% and 5.4%). After accounting for confounding factors at multivariate analysis, gestational diabetes mellitus remained a strong risk factor of any (odds ratio, 3.26; 95% CI, 2.03-5.22; P<0.001) and obstructive CAD (odds ratio, 3.00; 95% CI, 1.55-5.80; P<0.001) on CCTA. CONCLUSIONS Black women with a history of pregnancy complications, particularly gestational diabetes mellitus, have a higher prevalence of CAD on CCTA while only a history of gestational diabetes mellitus was independently associated with any and obstructive CAD on CCTA.
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Affiliation(s)
- Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Department of Di Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany (J.L.W., T.J.V.)
| | - Richard A P Takx
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Department of Radiology, University Medical Center Utrecht, the Netherlands (R.A.P.T.)
| | - Johanna H Nunez
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston
| | - Rozemarijn Vliegenthart
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands (R.V.)
| | - Katharina Otani
- Imaging & Therapy Systems Division, Healthcare Sector, Siemens Japan K.K., Tokyo, Japan (K.O.)
| | - Sheldon E Litwin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
| | - Pamela B Morris
- Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston
| | - Russell D Rosenberg
- Department of Medicine, Medical University of South Carolina, Charleston (R.D.R.)
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
| | - Stefan Baumann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (S.B.)
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany (M.R.)
| | - Thomas J Vogl
- Department of Di Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany (J.L.W., T.J.V.)
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.K.W.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
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Kohli P, Staziaki PV, Janjua SA, Addison DA, Hallett TR, Hennessy O, Takx RAP, Lu MT, Fintelmann FJ, Semigran M, Harris RS, Celli BR, Hoffmann U, Neilan TG. The effect of emphysema on readmission and survival among smokers with heart failure. PLoS One 2018; 13:e0201376. [PMID: 30059544 PMCID: PMC6066229 DOI: 10.1371/journal.pone.0201376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/13/2018] [Indexed: 12/22/2022] Open
Abstract
Heart Failure (HF) and chronic obstructive pulmonary disease (COPD) are morbid diseases that often coexist. In patients with coexisting disease, COPD is an independent risk factor for readmission and mortality. However, spirometry is often inaccurate in those with active heart failure. Therefore, we investigated the association between the presence of emphysema on computed tomography (CT) and readmission rates in smokers admitted with heart failure (HF). The cohort included a consecutive group of smokers discharged with HF from a tertiary center between January 1, 2014 and April 1, 2014 who also had a CT of the chest for dyspnea. The primary endpoint was any readmission for HF before April 1, 2016; secondary endpoints were 30-day readmission for HF, length of stay and all-cause mortality. Over the study period, there were 225 inpatient smokers with HF who had a concurrent chest CT (155 [69%] males, age 69±11 years, ejection fraction [EF] 46±18%, 107 [48%] LVEF of < 50%). Emphysema on CT was present in 103 (46%) and these were older, had a lower BMI, more pack-years, less diabetes and an increased afterload. During a follow-up of 2.1 years, there were 110 (49%) HF readmissions and 55 (24%) deaths. When separated by emphysema on CT, any readmission, 30-day readmission, length of stay and mortality were higher among HF patients with emphysema. In multivariable regression, emphysema by CT was associated with a two-fold higher (adjusted HR 2.11, 95% CI 1.41–3.15, p < 0.001) risk of readmission and a trend toward increased mortality (adjusted HR 1.70 95% CI 0.86–3.34, p = 0.12). In conclusion, emphysema by CT is a frequent finding in smokers hospitalized with HF and is associated with adverse outcomes in HF. This under recognized group of patients with both emphysema and heart failure may benefit from improved recognition and characterization of their co-morbid disease processes and optimization of therapies for their lung disease.
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Affiliation(s)
- Puja Kohli
- Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Pedro V. Staziaki
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Sumbal A. Janjua
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Daniel A. Addison
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Travis R. Hallett
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Orla Hennessy
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Richard A. P. Takx
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Michael T. Lu
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Florian J. Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Marc Semigran
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Robert S. Harris
- Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Bartolome R. Celli
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Tomas G. Neilan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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22
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Kauw F, Takx RAP, de Jong HWAM, Velthuis BK, Kappelle LJ, Dankbaar JW. Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2018; 45:279-287. [PMID: 29936515 DOI: 10.1159/000490422] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 01/31/2018] [Accepted: 05/24/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. METHODS A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms "ischemic stroke," "predictors/determinants," and "recurrence." Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I2) were calculated using inverse variance random effects models. RESULTS Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1-3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1-0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2-1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5-2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1-5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0-4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2-1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5-3.2). CONCLUSIONS In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Abstract
PURPOSE OF REVIEW With this review, we aim to summarize the role of positron emission tomography (PET) and near-infrared fluorescence imaging (NIRF) in the detection of atherosclerosis. RECENT FINDINGS 18F-FDG is an established measure of increased macrophage activity. However, due to its low specificity, new radiotracers have emerged for more specific detection of vascular inflammation and other high-risk plaque features such as microcalcification and neovascularization. Novel NIRF probes are engineered to sense endothelial damage as an early sign of plaque erosion as well as oxidized low-density lipoprotein (oxLDL) as a prime target for atherosclerosis. Integrated NIRF/OCT (optical coherence tomography) catheters enable to detect stent-associated microthrombi. Novel radiotracers can improve specificity of PET for imaging atherosclerosis. Advanced NIRF probes show promise for future application in human. Intravascular NIRF might play a prominent role in the detection of stent-induced vascular injury.
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Affiliation(s)
- Csilla Celeng
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Gaál József street 9, Budapest, 1122, Hungary
| | - Pim de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Hedgire S, Baliyan V, Zucker EJ, Bittner DO, Staziaki PV, Takx RAP, Scholtz JE, Meyersohn N, Hoffmann U, Ghoshhajra B. Perivascular Epicardial Fat Stranding at Coronary CT Angiography: A Marker of Acute Plaque Rupture and Spontaneous Coronary Artery Dissection. Radiology 2018; 287:808-815. [PMID: 29401041 DOI: 10.1148/radiol.2017171568] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose To evaluate the frequency and implications of perivascular fat stranding on coronary computed tomography (CT) angiograms obtained for suspected acute coronary syndrome (ACS). Materials and Methods This retrospective registry study was approved by the institutional review board. The authors reviewed the medical records and images of 1403 consecutive patients (796 men, 607 women; mean age, 52.8 years) who underwent coronary CT angiography at the emergency department from February 2012 to March 2016. Fat attenuation, length and number of circumferential quadrants of the affected segment, and attenuation values in the unaffected epicardial and subcutaneous fat were measured. "Cases" were defined as patients with perivascular fat stranding. Patients with significant stenosis but without fat stranding were considered control subjects. Baseline imaging characteristics, ACS frequency, and results of subsequent downstream testing were compared between cases and control subjects by using two-sample t, Mann-Whitney U, and Fisher tests. Results Perivascular fat stranding was seen in 11 subjects, nine with atherosclerotic lesions and two with spontaneous coronary artery dissections, with a mean fat stranding length of 19.2 mm and circumferential extent averaging 2.9 quadrants. The mean attenuation of perivascular fat stranding, normal epicardial fat, and normal subcutaneous fat was 17, -93.2, and -109.3 HU, respectively (P < .001). Significant differences (P < .05) between cases and control subjects included lower Agatston score, presence of wall motion abnormality, and initial elevation of serum troponin level. ACS frequency was 45.4% in cases and 3.8% in control subjects (P = .001). Conclusion Recognition of perivascular fat stranding may be a helpful additional predictor of culprit lesion and marker of risk for ACS in patients with significant stenosis or spontaneous coronary artery dissection. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Sandeep Hedgire
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Vinit Baliyan
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Evan J Zucker
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Daniel O Bittner
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Pedro V Staziaki
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Richard A P Takx
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Jan-Erik Scholtz
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Nandini Meyersohn
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Udo Hoffmann
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
| | - Brian Ghoshhajra
- From the Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (S.H., V.B., N.M., U.H., B.G.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.O.B., P.S., J.E.S.); Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany (D.O.B.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.)
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Bittner DO, Takx RAP, Staziaki PV, Janjua S, Neilan TG, Meyersohn NM, Lu MT, Prabhakar AM, Nagurney JT, Hoffmann U, Ghoshhajra BB. Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain. Int J Cardiol 2017; 249:473-478. [PMID: 29121752 PMCID: PMC5939567 DOI: 10.1016/j.ijcard.2017.06.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/16/2017] [Accepted: 06/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain. METHODS AND RESULTS We included 826 consecutive patients (mean age: 53±11years; 42% female) without known coronary artery disease (CAD) or initially elevated serum biomarkers, whom underwent non-contrast CT, to assess the CAC score, and CT angiography (CTA), to detect coronary stenosis. We analyzed the diagnostic performance of CAC and the Thrombolysis In Myocardial Infarction (TIMI) risk score for our primary outcomes (ACS and obstructive CAD). No CAC was found in 54% (n=444) of all patients, 63% (n=524) had a TIMI score of 0 and 40% (n=328) had both. The prevalence of obstructive CAD was 16% for ≥50% stenosis and 8.7% for ≥70% stenosis. The incidence of ACS was 7.9%, (MI=11, UAP=54). The NPV of CAC=0 was 99.5% for ACS. The NPV of a combination of TIMI score=0 and no CAC was 89% for any CAD (any plaque or stenosis) and 99.7% for ≥50% stenosis. A 100% NPV was found for ≥70% stenosis and ACS, correctly identifying 328 (40%) patients. CONCLUSIONS The exclusion of CAC, in combination with clinical risk assessment, has high clinical value in patients with acute chest pain, as it identifies patients at low risk for ACS and obstructive CAD more accurately as compared to clinical risk assessment alone.
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Affiliation(s)
- Daniel O Bittner
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Germany.
| | - Richard A P Takx
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pedro V Staziaki
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sumbal Janjua
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nandini M Meyersohn
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Lu
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand M Prabhakar
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian B Ghoshhajra
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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26
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Janjua SA, Staziaki PV, Szilveszter B, Takx RAP, Mayrhofer T, Hennessy O, Emami HA, Park J, Ivanov A, Hallett TR, Lu MT, Romero JM, Grinspoon SK, Hoffmann U, Zanni MV, Neilan TG. Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005777. [PMID: 29021257 DOI: 10.1161/circimaging.116.005777] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 08/21/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Data from broad populations have established associations between incidental carotid plaque and vascular events. Among people living with HIV (PLWHIV), the risk of vascular events is increased; however, whether incidental carotid plaque is increased and there is an association between incidental carotid plaque, plaque characteristics, and vascular events among PLWHIV is unclear. METHODS AND RESULTS Data from the multi-institutional Research Patient Data Registry were used. Presence and characteristics (high-risk plaque, including spotty calcification and low attenuation) of carotid plaque by computerized tomography among PLWHIV without known vascular disease were described. Data were compared with uninfected controls similar in age, sex, and cardiovascular risk factors, including diabetes mellitus, hyperlipidemia, and cigarette smoking to cases. Primary outcome was an atherosclerotic cardiovascular disease event, and secondary outcome was ischemic stroke. Cohort consisted of 209 PLWHIV (45±10 years, 72% male) and 168 controls. Using computerized tomography, PLWHIV without vascular disease had higher rates of any carotid plaque (34% versus 25%; P=0.04), noncalcified (18% versus 5%; P<0.001) and high-risk plaque (25% versus 16%; P=0.03). Over a follow-up of 3 years, 19 atherosclerotic cardiovascular disease events (9 strokes) occurred. Carotid plaque was independently associated with a 3-fold increase in atherosclerotic cardiovascular disease events among PLWHIV (hazard ratio, 2.91; confidence interval, 1.10-7.7, P=0.03) and a 4-fold increased risk of stroke (hazard ratio, 4.43; confidence interval, 1.17-16.70; P=0.02); high-risk plaque was associated with a 3-fold increased risk of atherosclerotic cardiovascular disease events and a 4-fold increased risk of stroke. CONCLUSIONS There is an increase in incidental carotid plaque, noncalcified plaque, and high-risk plaque among PLWHIV, and the presence and characteristics of carotid plaque are associated with subsequent vascular events.
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Affiliation(s)
- Sumbal A Janjua
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Pedro V Staziaki
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Balint Szilveszter
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Richard A P Takx
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Thomas Mayrhofer
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Orla Hennessy
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Hamed A Emami
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jakob Park
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Alexander Ivanov
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Travis R Hallett
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Michael T Lu
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Javier M Romero
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Steven K Grinspoon
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Udo Hoffmann
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Markella V Zanni
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Tomas G Neilan
- From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston.
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Takx RAP, Celeng C, Schoepf UJ. CT myocardial perfusion imaging: ready for prime time? Eur Radiol 2017; 28:1253-1256. [DOI: 10.1007/s00330-017-5057-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/08/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
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Ghoshhajra BB, Takx RAP, Staziaki PV, Vadvala H, Kim P, Neilan TG, Meyersohn NM, Bittner D, Janjua SA, Mayrhofer T, Greenwald JL, Truong QA, Abbara S, Brown DFM, Januzzi JL, Francis S, Nagurney JT, Hoffmann U. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome. Eur Radiol 2017; 27:2784-2793. [PMID: 27885414 PMCID: PMC5976244 DOI: 10.1007/s00330-016-4562-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 05/10/2016] [Revised: 08/03/2016] [Accepted: 08/11/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. METHODS Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. RESULTS One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. CONCLUSIONS Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. KEY POINTS • ED Coronary CTA using advanced systems is associated with low radiation exposure. • Negative coronary CTA is associated with low rates of MACE. • CTA in ED patients enables short median time to discharge home. • CTA strategy is characterized by few downstream tests including unnecessary ICA.
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Affiliation(s)
- Brian B Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
| | - Richard A P Takx
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pedro V Staziaki
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
| | - Harshna Vadvala
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
| | - Phillip Kim
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nandini M Meyersohn
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
| | - Daniel Bittner
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Medicine 2 - Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Sumbal A Janjua
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
| | - Thomas Mayrhofer
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Jeffrey L Greenwald
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Quyhn A Truong
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- Department of Radiology, Weill Cornell College of Medicine, New York, NY, USA
| | - Suhny Abbara
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- Department Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sanjeev Francis
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA
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Takx RAP, Henzler T, Schoepf UJ, Germann T, Schoenberg SO, Shirinova A, Bauer RW, Frellesen C, Zhang LJ, Nance JW, Fink C, Apfaltrer P. Predictive value of perfusion defects on dual energy CTA in the absence of thromboembolic clots. J Cardiovasc Comput Tomogr 2017; 11:183-187. [PMID: 28431860 DOI: 10.1016/j.jcct.2017.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine the predictive value of volumetrically measured lung perfusion defects (PDvol) and right ventricular dysfunction on dual-energy computed tomography angiography (DE-CTA) for predicting all cause mortality in patients suspected of pulmonary embolism (PE) but without evident thromboembolic clot on CTA. METHODS 448 patients underwent DE-CTA on a 64-channel DSCT system between January 2007 and December 2012 for suspected PE, of which 115 were without detectable thromboembolic clot on CTA. Diagnostic performance for identifying patients at risk of dying was evaluated using ROC analysis. All-cause mortality was assessed via the hospital electronic medical records and/or consultation of the patient or the patient's primary care physician via phone call interviews. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve (AUC) were determined for PDvol (volume of perfusion defects/total lung volume), transverse right ventricular to left ventricular diameter ratios (RV/LV) and for the combination of both tests. RESULTS Mortality was 38% within the investigated time period of 6 months. Patients who died had significantly higher PDvol (PDvol 28 ± 13% vs. 19 ± 12%, p < 0.001) and a non-significant difference in transverse RV/LV ratio (1.14 ± 0.37 vs. 1.06 ± 0.22, p = 0.159). The AUC was 0.71 for PDvol, 0.53 for RV/LV ratio, and 0.67 for the combination of PDvol and RV/LV ratio. PDvol remained a significant predictor after correcting for age. CONCLUSIONS In the absence of thromboembolic clots, PDvol at DE-CTA appears to be predictive for all cause mortality.
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Affiliation(s)
- Richard A P Takx
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Henzler
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
| | - Thomas Germann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Aysel Shirinova
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany; Clinic of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Radiology, General Hospital Celle, Celle, Germany
| | - Paul Apfaltrer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Takx RAP, Vliegenthart R, Schoepf UJ, Pilz LR, Schoenberg SO, Morris PB, Henzler T, Apfaltrer P. Coronary artery calcium in breast cancer survivors after radiation therapy. Int J Cardiovasc Imaging 2017; 33:1425-1431. [DOI: 10.1007/s10554-017-1119-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/18/2017] [Indexed: 11/25/2022]
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Meyersohn NM, Szilveszter B, Staziaki PV, Scholtz JE, Takx RAP, Hoffmann U, Ghoshhajra BB. Coronary CT angiography in the emergency department utilizing second and third generation dual source CT. J Cardiovasc Comput Tomogr 2017; 11:249-257. [PMID: 28506470 DOI: 10.1016/j.jcct.2017.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/17/2017] [Accepted: 03/19/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (coronary CTA) allows efficient triage of low to intermediate risk patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). Techniques for coronary CTA acquisition in the ED continue to evolve with the establishment of standardized scan protocols and the introduction of newer generations of CT hardware. OBJECTIVES To evaluate qualitative and quantitative image quality and radiation dose exposure of coronary CTA acquired on 2nd versus 3rd generation dual source CT (DSCT) scanners using a standardized institutional scan protocol designed for the ED. METHODS A retrospective observational case-control study was performed of 246 ED patients referred to coronary CTA with suspicion of ACS (56.5% male; mean age 53.3 ± 11.6 years) between October 2013 and August 2015.123 consecutive patients were scanned on 3rd generation DSCT, and a cohort of 123 patients matched by age, BMI and heart rate were identified who had undergone 2nd generation DSCT imaging utilizing the same standard clinical protocol. Qualitative and quantitative image quality parameters and radiation exposures were evaluated. RESULTS Qualitative image quality was significantly higher using 3rd generation DSCT as compared to 2nd generation (p < 0.001). Mean attenuation in the proximal coronary arteries was also significantly higher on 3rd generation DSCT than for 2nd generation (586 HU vs. 426 HU in the left main coronary artery (LM), p < 0.001). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values, however, were lower in 3rd generation DSCT than 2nd generation (SNR 11.2 [9.9-13.4] vs 13.5 [11.0-15.5] and CNR 12.4 [10.9-14.8] vs 15.2 [12.8-17.9] in the LM, p < 0.001). Median effective dose was also lower for 3rd generation DSCT than for 2nd generation (2.9 [2.3-5.0] mSv and 3.7 mSv [2.5-5.7], respectively) although this trend did not reach statistical significance (p = 0.065). CONCLUSION Qualitative image quality and mean CT attenuation values of the assessed coronary segments were significantly higher using 3rd generation DSCT. SNR and CNR were lower on 3rd generation DSCT, however this was accompanied by a trend toward lower radiation dose exposure when using the same standard institutional protocol.
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Affiliation(s)
- Nandini M Meyersohn
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Balint Szilveszter
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedro V Staziaki
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jan-Erik Scholtz
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard A P Takx
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Brian B Ghoshhajra
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Emami H, Takx RAP, Mayrhofer T, Janjua S, Park J, Pursnani A, Tawakol A, Lu MT, Ferencik M, Hoffmann U. Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin Therapy. JACC Cardiovasc Imaging 2017; 10:1031-1038. [PMID: 28330658 DOI: 10.1016/j.jcmg.2016.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to determine prognostic value of nonobstructive coronary artery disease (CAD) for atherosclerotic cardiovascular disease (ASCVD) events and to determine whether incorporation of this information into the pooled cohort equation reclassifies recommendations for statin therapy as defined by the 2013 guidelines for cholesterol management of the American College of Cardiology and American Heart Association (ACC/AHA). BACKGROUND Detection of nonobstructive CAD by coronary computed tomography angiography may improve risk stratification and permit individualized and more appropriate allocation of statin therapy. METHODS This study determined the pooled hazard ratio of nonobstructive CAD for ASCVD events from published studies and incorporated this information into the ACC/AHA pooled cohort equation. The study calculated revised sex- and ethnicity-based 10-year ASCVD risk and determined boundaries corresponding to the original 7.5% risk for ASCVD events. It also assessed reclassification for statin eligibility by incorporating the results from meta-analysis to individual patients from a separate cohort. RESULTS This study included 2 studies (2,295 subjects; 66% male; prevalence of nonobstructive CAD, 47%; median follow-up, 49 months; 67 ASCVD events). The hazard ratio of nonobstructive CAD for ASCVD events was 3.2 (95% confidence interval: 1.5 to 6.7). Incorporation of this information into the pooled cohort equation resulted in reclassification toward statin eligibility in individuals with nonobstructive CAD, with an original ASCVD score of 3.0% and 5.9% or higher in African-American women and men and a score of 4.4% and 4.6% or higher in Caucasian women and men, respectively. The absence of nonobstructive CAD resulted in reclassification toward statin ineligibility if the original ASCVD score was as 10.0% and 17.9% or lower in African-American women and men and 13.7% and 14.3% or lower in Caucasian women and men, respectively. Reclassification is observed in 14% of patients. CONCLUSIONS Detection of nonobstructive CAD by coronary computed tomography angiography improves risk stratification and permits individualized and more appropriate allocation of statin therapy across sex and ethnicity groups.
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Affiliation(s)
- Hamed Emami
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Yale-New Haven Hospital, Yale Medical School, New Haven, Connecticut
| | - Richard A P Takx
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas Mayrhofer
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Sumbal Janjua
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jakob Park
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amit Pursnani
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ahmed Tawakol
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael T Lu
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Maros Ferencik
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Wolterink JM, Leiner T, de Vos BD, Coatrieux JL, Kelm BM, Kondo S, Salgado RA, Shahzad R, Shu H, Snoeren M, Takx RAP, van Vliet LJ, van Walsum T, Willems TP, Yang G, Zheng Y, Viergever MA, Išgum I. An evaluation of automatic coronary artery calcium scoring methods with cardiac CT using the orCaScore framework. Med Phys 2017; 43:2361. [PMID: 27147348 DOI: 10.1118/1.4945696] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular disease (CVD) events. In clinical practice, CAC is manually identified and automatically quantified in cardiac CT using commercially available software. This is a tedious and time-consuming process in large-scale studies. Therefore, a number of automatic methods that require no interaction and semiautomatic methods that require very limited interaction for the identification of CAC in cardiac CT have been proposed. Thus far, a comparison of their performance has been lacking. The objective of this study was to perform an independent evaluation of (semi)automatic methods for CAC scoring in cardiac CT using a publicly available standardized framework. METHODS Cardiac CT exams of 72 patients distributed over four CVD risk categories were provided for (semi)automatic CAC scoring. Each exam consisted of a noncontrast-enhanced calcium scoring CT (CSCT) and a corresponding coronary CT angiography (CCTA) scan. The exams were acquired in four different hospitals using state-of-the-art equipment from four major CT scanner vendors. The data were divided into 32 training exams and 40 test exams. A reference standard for CAC in CSCT was defined by consensus of two experts following a clinical protocol. The framework organizers evaluated the performance of (semi)automatic methods on test CSCT scans, per lesion, artery, and patient. RESULTS Five (semi)automatic methods were evaluated. Four methods used both CSCT and CCTA to identify CAC, and one method used only CSCT. The evaluated methods correctly detected between 52% and 94% of CAC lesions with positive predictive values between 65% and 96%. Lesions in distal coronary arteries were most commonly missed and aortic calcifications close to the coronary ostia were the most common false positive errors. The majority (between 88% and 98%) of correctly identified CAC lesions were assigned to the correct artery. Linearly weighted Cohen's kappa for patient CVD risk categorization by the evaluated methods ranged from 0.80 to 1.00. CONCLUSIONS A publicly available standardized framework for the evaluation of (semi)automatic methods for CAC identification in cardiac CT is described. An evaluation of five (semi)automatic methods within this framework shows that automatic per patient CVD risk categorization is feasible. CAC lesions at ambiguous locations such as the coronary ostia remain challenging, but their detection had limited impact on CVD risk determination.
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Affiliation(s)
- Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Bob D de Vos
- Image Sciences Institute, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Jean-Louis Coatrieux
- INSERM, U1099, Rennes F-35000, France; LTSI, Université de Rennes 1, Rennes F-35000, France; and Centre de Recherche en Information Biomédicale Sino-Français (LIA CRIBs), Nanjing 210096, China
| | - B Michael Kelm
- Imaging and Computer Vision, Corporate Technology, Siemens AG, Erlangen 91051, Germany
| | | | - Rodrigo A Salgado
- Department of Radiology, University Hospital Antwerpen, Edegem 2650, Belgium
| | - Rahil Shahzad
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands; Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, Rotterdam 3000 CA, The Netherlands; and Quantitative Imaging Group, Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft 2600 GA, The Netherlands
| | - Huazhong Shu
- Centre de Recherche en Information Biomédicale Sino-Français (LIA CRIBs), Nanjing 210096, China and Lab of Image Science and Technology, School of Computer Science and Technology, Nanjing 210096, China
| | - Miranda Snoeren
- Department of Radiology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Lucas J van Vliet
- Quantitative Imaging Group, Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft 2600 GA, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, Rotterdam 3000 CA, The Netherlands
| | - Tineke P Willems
- Department of Radiology, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| | - Guanyu Yang
- Lab of Image Science and Technology, School of Computer Science and Technology, Nanjing 210096, China and Centre de Recherche en Information Biomédicale Sino-Français (LIA CRIBs), Nanjing 210096, China
| | - Yefeng Zheng
- Imaging and Computer Vision, Corporate Technology, Siemens Corporation, Princeton, New Jersey 08540-6632
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
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Takx RAP, Krissak R, Fink C, Bachmann V, Henzler T, Meyer M, Nance JW, Schoenberg SO, Apfaltrer P. Low-tube-voltage selection for triple-rule-out CTA: relation to patient size. Eur Radiol 2016; 27:2292-2297. [PMID: 27686566 PMCID: PMC5408040 DOI: 10.1007/s00330-016-4607-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 06/05/2016] [Revised: 08/18/2016] [Accepted: 09/07/2016] [Indexed: 11/08/2022]
Abstract
Objectives To investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA). Methods We retrospectively included 73 patients (age 64 ± 14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients’ chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA. Results There was no significant difference in BMI (26.0 ± 4.6 vs. 28.0 ± 6.7 kg/m2), PC (103 ± 7 vs. 104 ± 10 cm2) and TSA (92 ± 15 vs. 91 ± 19 cm2) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p < 0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7 ± 4.1 vs. 20.7 ± 10.7 mSv; p < 0.001). Conclusions 100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction. Key Points • 100 kV protocols result in a significantly lower radiation dose. • Mean vascular attenuation is significantly higher using 100 kV. • SNR and CNR are not significantly different between 100 kV and 120 kV. • 100 kV CTA is feasible regardless of patient size while maintaining image quality.
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Affiliation(s)
- Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands.
| | - Radko Krissak
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Hufeland Klinikum GmbH, Bad Langensalza, Germany
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany.,Department of Radiology, General Hospital Celle, Celle, Germany
| | - Valentin Bachmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Paul Apfaltrer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Figueroa AL, Takx RAP, MacNabb MH, Abdelbaky A, Lavender ZR, Kaplan RS, Truong QA, Lo J, Ghoshhajra BB, Grinspoon SK, Hoffmann U, Tawakol A. Relationship Between Measures of Adiposity, Arterial Inflammation, and Subsequent Cardiovascular Events. Circ Cardiovasc Imaging 2016; 9:e004043. [PMID: 27072302 DOI: 10.1161/circimaging.115.004043] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to evaluate how different measures of adiposity are related to both arterial inflammation and the risk of subsequent cardiovascular events. METHODS AND RESULTS We included individuals who underwent (18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging for oncological evaluation. Subcutaneous adipose tissue (SAT) volume, visceral adipose tissue (VAT) volume, and VAT/SAT ratio were determined. Additionally, body mass index, metabolic syndrome, and aortic (18)F-fluorodeoxyglucose uptake (a measure of arterial inflammation) were determined. Subsequent development of cardiovascular disease (CVD) events was adjudicated. The analysis included 415 patients with a median age of 55 (P25-P75: 45-65) and a median body mass index of 26.4 (P25-P75: 23.4-30.9) kg/m(2). VAT and SAT volume were significantly higher in obese individuals. VAT volume (r=0.290; P<0.001) and VAT/SAT ratio (r=0.208; P<0.001) were positively correlated with arterial inflammation. Thirty-two subjects experienced a CVD event during a median follow-up of 4 years. Cox proportional hazard models showed that VAT volume and VAT/SAT ratio were associated with CVD events (hazard ratio [95% confidence interval]: 1.15 [1.06-1.25]; P<0.001; 3.60 [1.88-6.92]; P<0.001, respectively). Body mass index, metabolic syndrome, and SAT were not predictive of CVD events. CONCLUSIONS Measures of visceral fat are positively related to arterial inflammation and are independent predictors of subsequent CVD events. Individuals with higher measures of visceral fat as well as elevated arterial inflammation are at highest risk for subsequent CVD events. The findings suggest that arterial inflammation may explain some of the CVD risk associated with adiposity.
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Affiliation(s)
- Amparo L Figueroa
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Richard A P Takx
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Megan H MacNabb
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Amr Abdelbaky
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Zachary R Lavender
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Rebecca S Kaplan
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Quynh A Truong
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Janet Lo
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Brian B Ghoshhajra
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Steven K Grinspoon
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Udo Hoffmann
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.)
| | - Ahmed Tawakol
- From the Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology (A.L.F., R.A.P.T., M.H.M., A.A., Z.R.L., R.S.K., B.B.G., U.H., A.T.), Program in Nutritional Metabolism (J.L., S.K.G.), and Division of Cardiology, Department of Medicine (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.P.T.); and Department of Radiology, Weill Cornell College of Medicine, New York, NY (Q.A.T.).
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Celeng C, Maurovich-Horvat P, Ghoshhajra BB, Merkely B, Leiner T, Takx RAP. Prognostic Value of Coronary Computed Tomography Angiography in Patients With Diabetes: A Meta-analysis. Diabetes Care 2016; 39:1274-80. [PMID: 27330128 DOI: 10.2337/dc16-0281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/13/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The usefulness of coronary computed tomography angiography (CTA) for the evaluation of coronary artery disease (CAD) in patients with diabetes is ambiguous. We therefore performed a meta-analysis of studies reporting event rates and hazard ratios (HR) to determine the prognostic value of CTA in this patient population. RESEARCH DESIGN AND METHODS We searched PubMed and Embase up to November 2015. Study subjects' characteristics, events (all-cause mortality or cardiac death, nonfatal myocardial infarction, unstable angina pectoris, stroke, revascularization), and events excluding revascularization were collected. We calculated the prevalence of obstructive and nonobstructive CAD on CTA, annualized event rates, and pooled unadjusted and adjusted HR using a generic inverse random model. RESULTS Eight studies were eligible for inclusion into this meta-analysis, with 6,225 participants (56% male; weighted age, 61 years) with a follow-up period ranging from 20 to 66 months. The prevalence of obstructive CAD, nonobstructive CAD, and no CAD was 38%, 36%, and 25%, respectively. The annualized event rate was 17.1% for obstructive CAD, 4.5% for nonobstructive CAD, and 0.1% for no CAD. Obstructive and nonobstructive CAD were associated with an increased HR of 5.4 and 4.2, respectively. A higher HR for obstructive CAD was observed in studies including revascularization compared with those that did not (7.3 vs. 3.7, P = 0.124). CONCLUSIONS CTA in patients with diabetes allows for safely ruling out future events, and the detection of CAD could allow for the identification of high-risk patients in whom aggressive risk factor modification, medical surveillance, or elective revascularization could potentially improve survival.
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Affiliation(s)
- Csilla Celeng
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Brian B Ghoshhajra
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Richard A P Takx
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
Advances in atherosclerosis imaging technology and research have provided a range of diagnostic tools to characterize high-risk plaque in vivo; however, these important vascular imaging methods additionally promise great scientific and translational applications beyond this quest. When combined with conventional anatomic- and hemodynamic-based assessments of disease severity, cross-sectional multimodal imaging incorporating molecular probes and other novel noninvasive techniques can add detailed interrogation of plaque composition, activity, and overall disease burden. In the catheterization laboratory, intravascular imaging provides unparalleled access to the world beneath the plaque surface, allowing tissue characterization and measurement of cap thickness with micrometer spatial resolution. Atherosclerosis imaging captures key data that reveal snapshots into underlying biology, which can test our understanding of fundamental research questions and shape our approach toward patient management. Imaging can also be used to quantify response to therapeutic interventions and ultimately help predict cardiovascular risk. Although there are undeniable barriers to clinical translation, many of these hold-ups might soon be surpassed by rapidly evolving innovations to improve image acquisition, coregistration, motion correction, and reduce radiation exposure. This article provides a comprehensive review of current and experimental atherosclerosis imaging methods and their uses in research and potential for translation to the clinic.
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Affiliation(s)
- Jason M Tarkin
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Marc R Dweck
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Nicholas R Evans
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Richard A P Takx
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Adam J Brown
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Ahmed Tawakol
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - James H F Rudd
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.).
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Celeng C, Takx RAP, Ferencik M, Maurovich-Horvat P. Non-invasive and invasive imaging of vulnerable coronary plaque. Trends Cardiovasc Med 2016; 26:538-47. [PMID: 27079893 DOI: 10.1016/j.tcm.2016.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/28/2016] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
Vulnerable plaque is characterized by a large necrotic core and an overlying thin fibrous cap. Non-invasive imaging modalities such as computed tomography angiography (CTA) and magnetic resonance imaging (MRI) allow for the assessment of morphological plaque characteristics, while positron emission tomography (PET) enables the detection of metabolic activity within the atherosclerotic lesions. Invasive imaging modalities such as intravascular ultrasound (IVUS), optical-coherence tomography (OCT), and intravascular MRI (IV-MRI) display plaques at a high spatial resolution. Near-infrared spectroscopy (NIRS) allows for the detection of chemical components of atherosclerotic plaques. In this review, we describe state-of-the-art non-invasive and invasive imaging modalities and stress the combination of their advantages to identify vulnerable plaque features.
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Affiliation(s)
- Csilla Celeng
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Richard A P Takx
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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den Harder AM, Willemink MJ, de Jong PA, Schilham AMR, Rajiah P, Takx RAP, Leiner T. New horizons in cardiac CT. Clin Radiol 2016; 71:758-67. [PMID: 26932775 DOI: 10.1016/j.crad.2016.01.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/23/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022]
Abstract
Until recently, cardiovascular computed tomography angiography (CCTA) was associated with considerable radiation doses. The introduction of tube current modulation and automatic tube potential selection as well as high-pitch prospective ECG-triggering and iterative reconstruction offer the ability to decrease dose with approximately one order of magnitude, often to sub-millisievert dose levels. In parallel, advancements in computational technology have enabled the measurement of fractional flow reserve (FFR) from CCTA data (FFRCT). This technique shows potential to replace invasively measured FFR to select patients in need of coronary intervention. Furthermore, developments in scanner hardware have led to the introduction of dual-energy and photon-counting CT, which offer the possibility of material decomposition imaging. Dual-energy CT reduces beam hardening, which enables CCTA in patients with a high calcium burden and more robust myocardial CT perfusion imaging. Future-generation CT systems will be capable of counting individual X-ray photons. Photon-counting CT is promising and may result in a substantial further radiation dose reduction, vastly increased spatial resolution, and the introduction of a whole new class of contrast agents.
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Affiliation(s)
- A M den Harder
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands.
| | - M J Willemink
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - P A de Jong
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - A M R Schilham
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - P Rajiah
- Cardiothoracic Imaging Division, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - R A P Takx
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
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Gernaat SAM, de Vos BD, Isgum I, Rijnberg N, Bijlsma RM, Takx RAP, Pignol JP, Leiner T, Grobbee DE, van der Graaf Y, van den Bongard DHJG, Verkooijen HM. Abstract P3-12-22: Reproducibility of automated coronary artery calcification scoring on radiotherapy treatment planning computed tomography scans of breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-22] [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: 11/16/2022]
Abstract
Abstract
Introduction: Presence of coronary artery calcifications (CAC) is a major independent risk factor for cardiovascular (CV) disease. CAC can be visualized on CT scans. Most breast cancer patients planned for radiotherapy (RT) receive planning CT scans. These scans may provide a reliable estimate of a patients' CV risk. This study evaluated the feasibility and reproducibility of an automated algorithm for CAC scoring on RT planning CT scans of breast cancer patients.
Methods: This study was conducted within the Utrecht cohort for Multiple BReast cancer intErvention studies and Long-term evaLuAtion (UMBRELLA), and includes 562 breast cancer patients undergoing RT at University Medical Center Utrecht. Planning CT scans were performed using a 16-slice scanner (16 x 0.75 mm collimation, 3 mm thickness, 120 kVp, with or without breath hold (BH), without ECG synchronization). CAC were automatically scored using an algorithm developed with chest CT scans that considers lesions >130 Hounsfield units as CAC. CAC were identified using a supervised pattern recognition based on texture, size, and spatial features. To test validity of automated CAC scoring, manually scoring by an expert was performed in all scans with CAC (n = 80) and a random sample of scans without CAC (n = 83). Interscan reproducibility of automated CAC scoring was assessed in patients having two scans (n = 295). All scans with CAC score ≥ 1000 were manually checked and corrected if appropriate. Agatston calcification scores were analyzed continuously and categorically (0, 1-10, 11-100, 101-400, >400). Agreement and reliability for categories were determined with proportional agreement (%) and linearly weighted kappa. Reliability of Agatston scores were assessed with Intraclass correlation coefficients (ICC).
Results: Of 562 patients, 129 (23%) patients had CAC scores > 0 with a mean of 93 (standard deviation: 166). Four patients had CAC scores ≥ 1000, which were erroneous and corrected. Of the 163 CT scans scored manually and automatically, 58 (36%) were performed with BH. Proportion of agreement was 79% (95% Confidence Interval (CI): 0.72-0.85) for all 163 scans: 88% (0.76-0.95) for 58 scans with BH and 74% (0.65-0.82) for 105 scans without. Proportion of agreement beyond chance was 0.80 (95% CI: 0.74-0.87) for all scans: 0.86 (0.77-0.96) with BH and 0.77 (0.684-0.853) without. Agatston score ICC was 0.86 (95% CI: 0.82-0.90) for all scans: 0.95 (0.91-0.97) with BH and 0.67 (0.55-0.76) without. For the interscan reproducibility (n = 295), the majority of patients (81%) had one scan with BH and one scan without. Proportion of agreement was 84% (95% CI: 0.79-0.88) and reliability was 0.61 (95% CI: 0.50-0.72). Agatston score ICC was 0.75 (95% CI: 0.69-0.80).
Conclusion: Automated CAC scoring on RT planning CT scans of breast cancer patients is feasible. Agreement with manually scored scans is high and higher in CT scans performed with BH. Interscan reproducibility is fair. Automated CAC scores ≥ 1000 should to be manually checked and corrected if necessary. Automated CAC scoring on RT planning CT scans of breast cancer patients is available for all patients undergoing RT, and can provide information on CV risk at no additional cost.
Citation Format: Gernaat SAM, de Vos BD, Isgum I, Rijnberg N, Bijlsma RM, Takx RAP, Pignol JP, Leiner T, Grobbee DE, van der Graaf Y, van den Bongard DHJG, Verkooijen HM. Reproducibility of automated coronary artery calcification scoring on radiotherapy treatment planning computed tomography scans of breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-22.
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Affiliation(s)
- SAM Gernaat
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - BD de Vos
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - I Isgum
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - N Rijnberg
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - RM Bijlsma
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - RAP Takx
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - JP Pignol
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - T Leiner
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - DE Grobbee
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - Y van der Graaf
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - DHJG van den Bongard
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
| | - HM Verkooijen
- University Medical Center Utrecht, Utrecht, Netherlands; Erasmus Medical Center - Cancer Insitute, Rotterdam, Netherlands
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Pompe E, de Jong PA, de Jong WU, Takx RAP, Eikendal ALM, Willemink MJ, Oudkerk M, Budde RPJ, Lammers JWJ, Mohamed Hoesein FAA. Inter-observer and inter-examination variability of manual vertebral bone attenuation measurements on computed tomography. Eur Radiol 2016; 26:3046-53. [PMID: 26801161 PMCID: PMC4972882 DOI: 10.1007/s00330-015-4145-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 05/04/2015] [Revised: 08/25/2015] [Accepted: 11/30/2015] [Indexed: 01/22/2023]
Abstract
Objective To determine inter-observer and inter-examination variability of manual attenuation measurements of the vertebrae in low-dose unenhanced chest computed tomography (CT). Methods Three hundred and sixty-seven lung cancer screening trial participants who underwent baseline and repeat unenhanced low-dose CT after 3 months because of an indeterminate lung nodule were included. The CT attenuation value of the first lumbar vertebrae (L1) was measured in all CTs by one observer to obtain inter-examination reliability. Six observers performed measurements in 100 randomly selected CTs to determine agreement with limits of agreement and Bland-Altman plots and reliability with intraclass correlation coefficients (ICCs). Reclassification analyses were performed using a threshold of 110 HU to define osteoporosis. Results Inter-examination reliability was excellent with an ICC of 0.92 (p < 0.001). Inter-examination limits of agreement ranged from -26 to 28 HU with a mean difference of 1 ± 14 HU. Inter-observer reliability ICCs ranged from 0.70 to 0.91. Inter-examination variability led to 11.2 % reclassification of participants and inter-observer variability led to 22.1 % reclassification. Conclusions Vertebral attenuation values can be manually quantified with good to excellent inter-examination and inter-observer reliability on unenhanced low-dose chest CT. This information is valuable for early detection of osteoporosis on low-dose chest CT. Key Points • Vertebral attenuation values can be manually quantified on low-dose unenhanced CT reliably. • Vertebral attenuation measurements may be helpful in detecting subclinical low bone density. • This could become of importance in the detection of osteoporosis. Electronic supplementary material The online version of this article (doi:10.1007/s00330-015-4145-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther Pompe
- Department of Pulmonology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, E.03.511, The Netherlands.
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Werner U de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk L M Eikendal
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin J Willemink
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthijs Oudkerk
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan-Willem J Lammers
- Department of Pulmonology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, E.03.511, The Netherlands
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Takx RAP, Ishai A, Truong QA, MacNabb MH, Scherrer-Crosbie M, Tawakol A. Supraclavicular Brown Adipose Tissue 18F-FDG Uptake and Cardiovascular Disease. J Nucl Med 2016; 57:1221-5. [PMID: 26795284 DOI: 10.2967/jnumed.115.166025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 08/26/2015] [Accepted: 12/07/2015] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Preclinical data suggest a negative correlation between brown adipose tissue (BAT) and the degree of coronary atherosclerosis. We sought to evaluate the relationship between (18)F-FDG uptake in supraclavicular BAT in relation to arterial inflammation and subsequent cardiovascular disease (CVD) events in humans. METHODS Individuals who underwent (18)F-FDG PET/CT for clinical indications but who did not have either cancer or known atherosclerotic disease at the time of imaging were included. A radiologist masked to clinical data measured (18)F-FDG uptake within BAT (in the supraclavicular region) as well as in subcutaneous adipose tissues. Tissue density was evaluated using CT (Hounsfield units). Arterial inflammation was assessed by measuring arterial (18)F-FDG uptake and calculating target-to-background ratio. CVD events were independently adjudicated by masked cardiologists. Thereafter, the relationship between BAT activity and CVD events was evaluated. RESULTS A total of 443 patients (age, 55 y [44-66 y]; 44% men; body mass index [BMI], 26 [range, 23-31]) were included, and 30 patients experienced a cardiovascular event during a median follow-up of 4 y. BAT activity negatively correlated with arterial inflammation (r = -0.178, P < 0.01), a relationship that persisted after correcting for age and BMI (r = -0.147, P < 0.01). When either high sensitivity or high accuracy thresholds (from receiver-operating curve analyses) were used to define elevated BAT, high BAT was associated with a reduced risk of CVD events (P = 0.048), even after correcting for age (P = 0.037). CONCLUSION Our results suggest that increased supraclavicular BAT activity is inversely associated with arterial inflammation, independently of age and BMI. Additionally, increased BAT may be associated with fewer cardiovascular events.
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Affiliation(s)
- Richard A P Takx
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amorina Ishai
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Quynh A Truong
- Department of Radiology, Weill Cornell College of Medicine, New York, New York; and
| | - Meghan H MacNabb
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marielle Scherrer-Crosbie
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ahmed Tawakol
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Takx RAP, MacNabb MH, Emami H, Abdelbaky A, Singh P, Lavender ZR, di Carli M, Taqueti V, Foster C, Mann J, Comley RA, Weber CIK, Tawakol A. Increased arterial inflammation in individuals with stage 3 chronic kidney disease. Eur J Nucl Med Mol Imaging 2015; 43:333-339. [PMID: 26464074 DOI: 10.1007/s00259-015-3203-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/17/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using 18F-FDG PET/CT in patients with CKD and in matched controls. METHODS This restrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed. RESULTS Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). CONCLUSION Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of cardiovascular events.
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Affiliation(s)
- Richard A P Takx
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Megan H MacNabb
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hamed Emami
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Amr Abdelbaky
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Parmanand Singh
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Zachary R Lavender
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo di Carli
- Division of Radiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Viviany Taqueti
- Division of Radiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Courtney Foster
- Division of Radiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Ahmed Tawakol
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
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Wolterink JM, Leiner T, Takx RAP, Viergever MA, Isgum I. Automatic Coronary Calcium Scoring in Non-Contrast-Enhanced ECG-Triggered Cardiac CT With Ambiguity Detection. IEEE Trans Med Imaging 2015; 34:1867-78. [PMID: 25794387 DOI: 10.1109/tmi.2015.2412651] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. We present a system that automatically quantifies total patient and per coronary artery CAC in non-contrast-enhanced, ECG-triggered cardiac CT. The system identifies candidate calcifications that cannot be automatically labeled with high certainty and optionally presents these to an expert for review. Candidates were extracted by intensity-based thresholding and described by location features derived from estimated coronary artery positions, as well as size, shape and intensity features. Next, a two-class classifier distinguished between coronary calcifications and negatives or a multiclass classifier labeled CAC per coronary artery. Candidates that could not be labeled with high certainty were identified by entropy-based ambiguity detection and presented to an expert for review and possible relabeling. The system was evaluated with 530 test images. Using the two-class classifier, the intra-class correlation coefficient (ICC) between reference and automatically determined total patient CAC volume was 0.95. Using the multiclass classifier, the ICC between reference and automatically determined per artery CAC volume was 0.98 (LAD), 0.69 (LCX), and 0.95 (RCA). In 49% of CTs, no ambiguous candidates were identified, while review of the remaining CTs increased the ICC for total patient CAC volume to 1.00, and per artery CAC volume to 1.00 (LAD), 0.95 (LCX), and 0.99 (RCA). In conclusion, CAC can be automatically identified in non-contrast-enhanced ECG-triggered cardiac CT. Ambiguity detection with expert review may enable the application of automatic CAC scoring in the clinic with a performance comparable to that of a human expert.
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Takx RAP, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, Hoffmann U, Leiner T. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002666. [PMID: 25596143 DOI: 10.1161/circimaging.114.002666] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hemodynamically significant coronary artery disease is an important indication for revascularization. Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating hemodynamically significant coronary artery disease. The aim was to determine the diagnostic accuracy of myocardial perfusion imaging by single-photon emission computed tomography, echocardiography, MRI, positron emission tomography, and computed tomography compared with invasive coronary angiography with fractional flow reserve for the diagnosis of hemodynamically significant coronary artery disease. METHODS AND RESULTS The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. PubMed, EMBASE, and Web of Science were searched until May 2014. Thirty-seven studies, reporting on 4721 vessels and 2048 patients, were included. Meta-analysis yielded pooled sensitivity, pooled specificity, pooled likelihood ratios (LR), pooled diagnostic odds ratio, and summary area under the receiver operating characteristic curve. The negative LR (NLR) was chosen as the primary outcome. At the vessel level, MRI (pooled NLR, 0.16; 95% confidence interval [CI], 0.13-0.21) was performed similar to computed tomography (pooled NLR, 0.22; 95% CI, 0.12-0.39) and positron emission tomography (pooled NLR, 0.15; 95% CI, 0.05-0.44), and better than single-photon emission computed tomography (pooled NLR, 0.47; 95% CI, 0.37-0.59). At the patient level, MRI (pooled NLR, 0.14; 95% CI, 0.10-0.18) performed similar to computed tomography (pooled NLR, 0.12; 95% CI, 0.04-0.33) and positron emission tomography (pooled NLR, 0.14; 95% CI, 0.02-0.87), and better than single-photon emission computed tomography (pooled NLR, 0.39; 95% CI, 0.27-0.55) and echocardiography (pooled NLR, 0.42; 95% CI, 0.30-0.59). CONCLUSIONS Stress myocardial perfusion imaging with MRI, computed tomography, or positron emission tomography can accurately rule out hemodynamically significant coronary artery disease and can act as a gatekeeper for invasive revascularization. Single-photon emission computed tomography and echocardiography are less suited for this purpose.
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Affiliation(s)
- Richard A P Takx
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.).
| | - Björn A Blomberg
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
| | - Hamza El Aidi
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
| | - Jesse Habets
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
| | - Pim A de Jong
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
| | - Eike Nagel
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
| | - Udo Hoffmann
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
| | - Tim Leiner
- From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.)
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Willemink MJ, Vliegenthart R, Takx RAP, Leiner T, Budde RPJ, Bleys RLAW, Das M, Wildberger JE, Prokop M, Buls N, de Mey J, Schilham AMR, de Jong PA. Coronary Artery Calcification Scoring with State-of-the-Art CT Scanners from Different Vendors Has Substantial Effect on Risk Classification. Radiology 2014; 273:695-702. [DOI: 10.1148/radiol.14140066] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Takx RAP, Išgum I, Willemink MJ, van der Graaf Y, de Koning HJ, Vliegenthart R, Oudkerk M, Leiner T, de Jong PA. Quantification of coronary artery calcium in nongated CT to predict cardiovascular events in male lung cancer screening participants: results of the NELSON study. J Cardiovasc Comput Tomogr 2014; 9:50-7. [PMID: 25533223 DOI: 10.1016/j.jcct.2014.11.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/28/2014] [Accepted: 11/08/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the incremental prognostic value of the number and maximum volume of coronary artery calcifications over modified Agatston score strata, age, pack-years, and smoking status for predicting cardiovascular events. METHODS A total of 3559 male current and former smokers received a CT examination for lung cancer screening. Smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected. Images were acquired without electrocardiography gating on 16-slice CT scanners. The association between the presence of both fatal and nonfatal cardiovascular events and the predictors was quantified using Cox proportional hazard analysis. RESULTS Median follow-up period was 2.9 years. Incident cardiovascular events occurred in 186 participants. Adjusted hazard ratios for modified Agatston score strata of 1 to 10, 11 to 100, 101 to 400, and >400 were 3.39 (95% confidence interval [CI], 1.20-9.59), 6.52 (95% CI, 2.73-15.60), 6.58 (95% CI, 2.75-15.78), and 12.58 (95% CI, 5.42-29.16), respectively. Moreover, comparing the models with and without modified Agatston score strata to the model with age, pack-years, and smoking status yielded a significantly better net reclassification improvement (NRI; 27.3%; P < .0001). Adding the number of calcifications to the model with age, pack-years, smoking status, and modified Agatston score strata resulted in a slightly better NRI (1.68%; P = .0490) with a hazard ratio of 1.13 (95% CI, 1.05-1.21) per 10 calcifications. The incremental prognostic information contained in the volume of the largest calcification was not statistically significant (NRI, 0.14%; P = .3458). CONCLUSION Cardiovascular event rate increased with higher numbers of calcified lesions. The number but not maximum volume of calcifications has independent, although minimal, prognostic value over age, pack-years, smoking status, and modified Agatston score strata in our population.
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Affiliation(s)
- Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin J Willemink
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rozemarijn Vliegenthart
- Center for Medical Imaging-North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging-North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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de Jong PA, Hellings WE, Takx RAP, Išgum I, van Herwaarden JA, Mali WPTM. Computed tomography of aortic wall calcifications in aortic dissection patients. PLoS One 2014; 9:e102036. [PMID: 25003993 PMCID: PMC4087005 DOI: 10.1371/journal.pone.0102036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/15/2014] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications in a consecutive series of patients with aortic dissection who underwent contrast-enhanced CT. Methods The study population compromised of 69 consecutive subjects aged 60 years and older with a contrast-enhanced CT scan demonstrating an aortic dissection. All CT scans were evaluated for the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications by two experienced observers. Between observer reliability was evaluated by using Cohen’s Kappa. Differences between groups were tested using unpaired T test and Chi-square test. Results Presumed media calcifications were observed in 22 (32%) patients of 60 years and older and were found more frequently in chronic aortic dissection (N = 12/23, 52%) than in acute aortic dissection (N = 10/46, 22%). Conclusion As the intima has been torn away by the aortic dissection it is highly likely that CT scans can visualize the calcifications in the tunica media of the aorta.
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Affiliation(s)
- Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Willem E. Hellings
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard A. P. Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivana Išgum
- Images Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Willem P. Th. M. Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Blomberg BA, Thomassen A, Takx RAP, Hildebrandt MG, Simonsen JA, Buch-Olsen KM, Diederichsen ACP, Mickley H, Alavi A, Høilund-Carlsen PF. Delayed ¹⁸F-fluorodeoxyglucose PET/CT imaging improves quantitation of atherosclerotic plaque inflammation: results from the CAMONA study. J Nucl Cardiol 2014; 21:588-97. [PMID: 24633502 DOI: 10.1007/s12350-014-9884-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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: 12/10/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to determine if delayed (18)F-fluorodeoxyglucose ((18)FDG) PET/CT imaging improves quantitation of atherosclerotic plaque inflammation. Blood-pool activity can disturb the arterial (18)FDG signal. With time, blood-pool activity declines. Therefore, delayed imaging can potentially improve quantitation of vascular inflammation. METHODS AND RESULTS 40 subjects were prospectively assessed by dual-time-point PET/CT imaging at approximately 90 and 180 minutes after (18)FDG administration. For both time-points, global uptake of (18)FDG was determined in the carotid arteries and thoracic aorta by calculating the blood-pool corrected maximum standardized uptake value (cSUVMAX). A target-to-background ratio (TBR) was calculated to determine the contrast resolution at 90 and 180 minutes. Furthermore, we assessed whether the acquisition time-point affected the relation between cSUVMAX and the estimated 10-year risk for fatal cardiovascular disease (SCORE %). A significant increase in carotid cSUVMAX (23%, P < .0001), carotid TBR (20%, P < .0001), aortic cSUVMAX (14%, P < .0001), and aortic TBR (20%, P < .0001) was observed with time. At 90 minutes, cSUVMAX did not relate to SCORE %, whereas at 180 minutes significant positive relations were observed between SCORE % and carotid (τ = 0.25, P = .045) and aortic (τ = 0.33, P = .008) cSUVMAX. CONCLUSIONS Delayed (18)FDG PET/CT imaging at 180 minutes improves quantitation of atherosclerotic plaque inflammation over imaging at 90 minutes. Therefore, the optimal acquisition time-point to assess atherosclerotic plaque inflammation lies beyond the advocated time-point of 90 minutes after (18)FDG administration.
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Affiliation(s)
- Björn A Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark,
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