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Qureshi H, Kaul P, Dover DC, Blaha MJ, Bellows BK, Mancini GJ. Canadian Cost-Effectiveness of Coronary Artery Calcium Screening Based on the Multi-Ethnic Study of Atherosclerosis. JACC. ADVANCES 2024; 3:100886. [PMID: 38939688 PMCID: PMC11198549 DOI: 10.1016/j.jacadv.2024.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/10/2023] [Accepted: 12/20/2023] [Indexed: 06/29/2024]
Abstract
Background Cost-effectiveness of testing for coronary artery calcium (CAC) relative to other treatment strategies is not established in Canada. Objectives The purpose of this study was to evaluate the cost-effectiveness of using CAC score-guided statin treatment compared with universal statin therapy among intermediate-risk, primary prevention patients eligible for statins. Methods A state transition, microsimulation model used data from Canadian sources and the Multi-Ethnic Study of Atherosclerosis to simulate clinical and economic consequences of cardiovascular disease from a Canadian publicly funded health care system perspective. In the CAC score-guided treatment arm, statins were started when CAC ≥1. Outcome of interest was the incremental cost-effectiveness ratio at 5 and 10 years; an incremental cost-effectiveness ratio <$50,000 per quality-adjusted life year (QALY) gained was considered cost-effective. Sensitivity analyses examined uncertainty in model parameters. Results Compared with universal statin treatment at 5 and 10 years, CAC score-guided statin treatment was projected to increase mean costs by $326 (95% CI: $325-$326) and $172 (95% CI: $169-$175), increase mean QALYs by 0.01 (95% CI: 0.01-0.01) and 0.02 (95% CI: 0.02-0.02), and cost $54,492 (95% CI: $52,342-$56,816) and $8,118 (95% CI: $7,968-$8,279) per QALY gained, respectively. The model was most sensitive to statin cost, CAC testing cost, adherence to statin monitoring, and disutility associated with daily statin use. At 5 years, CAC score-guided statin treatment was cost-effective when CAC test costs ranged from $80 to $160 in different scenarios. Conclusions CAC score-guided statin initiation in comparison to universal statin treatment was borderline cost-neutral at 5 years and cost-effective at 10 years in statin-eligible Canadian patients at intermediate cardiovascular disease risk.
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Affiliation(s)
- Hena Qureshi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas C. Dover
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Blaha
- Department of Medicine, Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | | | - G.B. John Mancini
- Centre for Cardiovascular Innovation & Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
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Abdul-Rahman T, Bliss ZSB, Lizano-Jubert I, Muñoz MJS, Garg N, Pachchipulusu VK, Ashinze P, Miteu GD, Baig R, Omar DA, Badawy MM, Bukhari SMA, Wireko AA, Aborode AT, Atallah O, Mahmoud HA, Aldosoky W, Abohashem S. Beyond symptoms: Unlocking the potential of coronary calcium scoring in the prevention and treatment of coronary artery disease. Curr Probl Cardiol 2024; 49:102378. [PMID: 38185434 DOI: 10.1016/j.cpcardiol.2024.102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
Coronary Artery Disease (CAD) represents a persistent global health menace, particularly prevalent in Eastern European nations. Often asymptomatic until its advanced stages, CAD can precipitate life-threatening events like myocardial infarction or stroke. While conventional risk factors provide some insight into CAD risk, their predictive accuracy is suboptimal. Amidst this, Coronary Calcium Scoring (CCS), facilitated by non-invasive computed tomography (CT), emerges as a superior diagnostic modality. By quantifying calcium deposits in coronary arteries, CCS serves as a robust indicator of atherosclerotic burden, thus refining risk stratification and guiding therapeutic interventions. Despite certain limitations, CCS stands as an instrumental tool in CAD management and in thwarting adverse cardiovascular incidents. This review delves into the pivotal role of CCS in CAD diagnosis and treatment, elucidates the involvement of calcium in atherosclerotic plaque formation, and outlines the principles and indications of utilizing CCS for predicting major cardiovascular events.
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Affiliation(s)
| | | | | | | | - Neil Garg
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, United States
| | | | - Patrick Ashinze
- Department of Medical Services, Saint Francis Catholic Hospital, Okpara Inland, Delta, Nigeria
| | - Goshen David Miteu
- Department of Biomedical Science, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Rusab Baig
- Shadan Institute of Medical Sciences, Hyderabad, India
| | | | | | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | | | - Wesam Aldosoky
- Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Shady Abohashem
- Massachusetts General Hospital and Harvard Medical School, Boston, United States.
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Han D, Shanbhag A, Miller RJH, Kwok N, Waechter P, Builoff V, Newby DE, Dey D, Berman DS, Slomka P. Artificial intelligence-based automated left ventricular mass quantification from non-contrast cardiac CT scans: correlation with contrast CT and cardiac MRI. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.12.24301169. [PMID: 38260634 PMCID: PMC10802664 DOI: 10.1101/2024.01.12.24301169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Non-contrast CT scans are not used for evaluating left ventricle myocardial mass (LV mass), which is typically evaluated with contrast CT or cardiovascular magnetic resonance imaging (MRI). We assessed the feasibility of LV mass estimation from standard, ECG-gated, non-contrast CT using an artificial intelligence (AI) approach and compare it with coronary CT angiography (CTA) and cardiac MRI. Methods We enrolled consecutive patients who underwent coronary CTA, which included non-contrast CT calcium scanning and contrast CTA, and cardiac MRI. The median interval between coronary CTA and MRI was 22 days (IQR: 3-76). We utilized an nn-Unet AI model that automatically segmented non-contrast CT structures. AI measurement of LV mass was compared to contrast CTA and MRI. Results A total of 316 patients (Age: 57.1±16.7, 56% male) were included. The AI segmentation took on average 22 seconds per case. An excellent correlation was observed between AI and contrast CTA LV mass measures (r=0.84, p<0.001), with no significant differences (136.5±55.3 vs. 139.6±56.9 g, p=0.133). Bland-Altman analysis showed minimal bias of 2.9. When compared to MRI, measured LV mass was higher with AI (136.5±55.3 vs. 127.1±53.1 g, p<0.001). There was an excellent correlation between AI and MRI (r=0.85, p<0.001), with a small bias (-9.4). There were no statistical differences between the correlations of LV mass between contrast CTA and MRI, or AI and MRI. Conclusions The AI-based automated estimation of LV mass from non-contrast CT demonstrated excellent correlations and minimal biases when compared to contrast CTA and MRI.
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Affiliation(s)
- Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Robert JH Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Nicholas Kwok
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Parker Waechter
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Jeong J, Chao CJ, Arsanjani R, Ayoub C, Lester SJ, Pereyra M, Said EF, Roarke M, Tagle-Cornell C, Koepke LM, Tsai YL, Jung-Hsuan C, Chang CC, Farina JM, Trivedi H, Patel BN, Banerjee I. Opportunistic screening for coronary artery calcium deposition using chest radiographs - a multi-objective models with multi-modal data fusion. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.10.23299699. [PMID: 38260571 PMCID: PMC10802643 DOI: 10.1101/2024.01.10.23299699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background To create an opportunistic screening strategy by multitask deep learning methods to stratify prediction for coronary artery calcium (CAC) and associated cardiovascular risk with frontal chest x-rays (CXR) and minimal data from electronic health records (EHR). Methods In this retrospective study, 2,121 patients with available computed tomography (CT) scans and corresponding CXR images were collected internally (Mayo Enterprise) with calculated CAC scores binned into 3 categories (0, 1-99, and 100+) as ground truths for model training. Results from the internal training were tested on multiple external datasets (domestic (EUH) and foreign (VGHTPE)) with significant racial and ethnic differences and classification performance was compared. Findings Classification performance between 0, 1-99, and 100+ CAC scores performed moderately on both the internal test and external datasets, reaching average f1-score of 0.66 for Mayo, 0.62 for EUH and 0.61 for VGHTPE. For the clinically relevant binary task of 0 vs 400+ CAC classification, the performance of our model on the internal test and external datasets reached an average AUCROC of 0.84. Interpretation The fusion model trained on CXR performed better (0.84 average AUROC on internal and external dataset) than existing state-of-the-art models on predicting CAC scores only on internal (0.73 AUROC), with robust performance on external datasets. Thus, our proposed model may be used as a robust, first-pass opportunistic screening method for cardiovascular risk from regular chest radiographs. For community use, trained model and the inference code can be downloaded with an academic open-source license from https://github.com/jeong-jasonji/MTL_CAC_classification . Funding The study was partially supported by National Institute of Health 1R01HL155410-01A1 award.
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Hussain B, Mahmood A, Flynn MG, Alexander T. Coronary Artery Calcium Scoring in Asymptomatic Patients. HCA HEALTHCARE JOURNAL OF MEDICINE 2023; 4:341-352. [PMID: 37969852 PMCID: PMC10635695 DOI: 10.36518/2689-0216.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Coronary artery calcium (CAC) scoring is an important prognostic tool for personalized cardiovascular preventive care and has recently been incorporated into American College of Cardiology/American Heart Association guidelines. CAC provides direct visualization and quantification of CAC burden for risk stratification and primary prevention of cardiovascular events in an asymptomatic population. CAC scoring is recommended for individuals with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and selective populations with borderline ASCVD risk. In this review, we outline the interpretation of CAC scores for predicting the risk of cardiovascular events, and we highlight the guidelines for starting statin and potentially starting aspirin therapy. A CAC score of 0 is the strongest negative predictive factor for cardiovascular disease (CVD), and a 0 score can successfully de-risk a patient. On the contrary, higher CAC scores correlate with worse cardiovascular prognostic outcomes. The CAC scan is a widely available and reproducible means for an early look at the atherosclerotic burden, and it can help strategize early interventions. The CAC interpretation and the decision to start treatment need to be personalized based on individual risk factors. We believe the emerging literature supports our contention that the CAC score can be used more broadly to improve the prophylaxis and treatment of a wider range of apparently healthy patients.
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Habibi S, Akbarnejad M, Rezaeian N, Salmanipour A, Mohammadzadeh A, Rezaei-Kalantari K, Chalian H, Asadian S. Computed Tomography-Based Coronary Artery Calcium Score Calculation at a Reduced Tube Voltage Utilizing Iterative Reconstruction and Threshold Modification Techniques: A Feasibility Study. Diagnostics (Basel) 2023; 13:3315. [PMID: 37958211 PMCID: PMC10648177 DOI: 10.3390/diagnostics13213315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The coronary artery calcium score (CACS) indicates cardiovascular health. A concern in this regard is the ionizing radiation from computed tomography (CT). Recent studies have tried to introduce low-dose CT techniques to assess CACS. We aimed to investigate the accuracy of iterative reconstruction (IR) and threshold modification while applying low tube voltage in coronary artery calcium imaging. METHODS The study population consisted of 107 patients. Each subject underwent an electrocardiogram-gated CT twice, once with a standard voltage of 120 kVp and then a reduced voltage of 80 kVp. The standard filtered back projection (FBP) reconstruction was applied in both voltages. Considering Hounsfield unit (HU) thresholds other than 130 (150, 170, and 190), CACS was calculated using the FBP-reconstructed 80 kVp images. Moreover, the 80 kVp images were reconstructed utilizing IR at different strength levels. CACS was measured in each set of images. The intraclass correlation coefficient (ICC) was used to compare the CACSs. RESULTS A 64% reduction in the effective dose was observed in the 80 kVp protocol compared to the 120 kVp protocol. Excellent agreement existed between CACS at high-level (strength level = 5) IR in low-kVp images and the standard CACS protocol in scores ≥ 11 (ICC > 0.9 and p < 0.05). Increasing the threshold density to 190 HU in FBP-reconstructed low-kVp images yielded excellent agreement with the standard protocol in scores ≥ 11 (ICC > 0.9 and p < 0.05) and good agreement in score zero (ICC = 0.84 and p = 0.02). CONCLUSIONS The modification of the density threshold and IR provides an accurate calculation of CACS in low-voltage CT with the potential to decrease patient radiation exposure.
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Affiliation(s)
- Shirin Habibi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Mohammad Akbarnejad
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran; (M.A.); (N.R.); (A.S.); (A.M.); (K.R.-K.)
| | - Nahid Rezaeian
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran; (M.A.); (N.R.); (A.S.); (A.M.); (K.R.-K.)
| | - Alireza Salmanipour
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran; (M.A.); (N.R.); (A.S.); (A.M.); (K.R.-K.)
| | - Ali Mohammadzadeh
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran; (M.A.); (N.R.); (A.S.); (A.M.); (K.R.-K.)
| | - Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran; (M.A.); (N.R.); (A.S.); (A.M.); (K.R.-K.)
| | - Hamid Chalian
- Department of Radiology, Cardiothoracic Imaging, University of Washington, Seattle, WA 98105, USA;
| | - Sanaz Asadian
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran; (M.A.); (N.R.); (A.S.); (A.M.); (K.R.-K.)
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Dalla Via J, Stewart N, Kennedy MA, Cehic DA, Purnell P, Toohey J, Morton J, Ramchand SK, Lewis JR, Zissiadis Y. Protocol: Can coronary artery calcium score identified on thoracic planning CT scans be used and actioned to identify cancer survivors at high risk of cardiac events: A feasibility study in cancer survivors undergoing radiotherapy in Australia. BMJ Open 2023; 13:e072376. [PMID: 37463809 PMCID: PMC10357636 DOI: 10.1136/bmjopen-2023-072376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION A coronary artery calcium (CAC) CT scan can identify calcified plaque and predict risk of future cardiac events. Cancer survivors undergoing thoracic radiotherapy routinely undergo a planning CT scan, which presents a unique opportunity to use already obtained medical imaging to identify those at the highest risk of cardiac events. While radiation therapy is an important modality for many cancer treatments, radiation dose to the heart in thoracic radiotherapy leads to cardiotoxicity and may accelerate pre-existing atherosclerosis. The primary aims of this study are to investigate the feasibility of using CAC scores calculated on thoracic radiotherapy planning CT scans to identify a subset of cancer survivors at an increased risk of future cardiac events, and to establish and evaluate a referral pathway for assessment and management in a cardio-oncology clinic. An optional substudy aims to investigate using abdominal aortic calcification (AAC) as a practical, low-radiation alternative to CAC to evaluate and monitor vascular health. METHODS AND ANALYSIS This is an observational, prospective study in a minimum of 100 cancer survivors commencing radiotherapy. Participants will have CAC scored from thoracic radiotherapy planning CT scans. Those identified as high risk (CAC score>0) will be referred to a cardio-oncology clinic. Feasibility, determined by adherence to the recommended pathway, and impact on quality of life and anxiety measured via questionnaire, will be assessed. Participants in Western Australia will be invited to participate in a 12-month observational pilot substudy, investigating lifestyle behaviours and the use of a dual-energy X-ray absorptiometry machine to measure musculoskeletal health and AAC. ETHICS AND DISSEMINATION Ethics approval has been obtained from St Vincent's Hospital, Sydney (Project number 2021/ETH11847), GenesisCare and Edith Cowan University (2022-03326-DALLAVIA). Study results will be reported in peer-reviewed academic journals, at scientific conferences, and at clinical forums, irrespective of the results observed. TRIAL REGISTRATION NUMBER ACTRN12621001343897.
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Affiliation(s)
- Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nina Stewart
- Radiation Oncology, GenesisCare, Perth, Western Australia, Australia
| | - Mary A Kennedy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Cehic
- Cardiology, Advara HeartCare, Adelaide, South Australia, Australia
| | - Peter Purnell
- Cardiology, Advara HeartCare, Perth, Western Australia, Australia
| | - Joanne Toohey
- Oncology, GenesisCare, Sydney, New South Wales, Australia
| | - Jamie Morton
- Cardiology, Advara HeartCare, Adelaide, South Australia, Australia
| | - Sabashini K Ramchand
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
- Department of Medicine, Endocrine Unit, Austin Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- ,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Yvonne Zissiadis
- Radiation Oncology, GenesisCare, Perth, Western Australia, Australia
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Kozakova M, Morizzo C, Jamagidze G, Della Latta D, Chiappino S, Chiappino D, Palombo C. Association between Low-Density Lipoprotein Cholesterol and Vascular Biomarkers in Primary Prevention. Biomedicines 2023; 11:1753. [PMID: 37371848 DOI: 10.3390/biomedicines11061753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Several noninvasive vascular biomarkers have been proposed to improve risk stratification for atherothrombotic events. To identify biomarkers suitable for detecting intermediate-risk individuals who might benefit from lipid-lowering treatment in primary prevention, the present study tested the association of plasma LDL-cholesterol with coronary artery calcification (CAC) Agatston score, high carotid and femoral intima-media thickness (IMT), low carotid distensibility and high carotid-femoral pulse-wave velocity in 260 asymptomatic individuals at intermediate cardiovascular risk and without diabetes and lipid-lowering treatment. High or low vascular biomarkers were considered when their value was above the 95th or below the 5th percentile, respectively, of the distribution in the healthy or in the study population. LDL-cholesterol was independently associated with the CAC score = 0 (OR 0.67; 95%CI 0.48-0.92, p = 0.01), CAC score > 100 (1.59; 1.08-2.39, p = 0.01) and high common femoral artery (CFA) IMT (1.89; 1.19-3.06, p < 0.01), but not with other biomarkers. Our data confirm that in individuals at intermediate risk, lipid-lowering treatment can be avoided in the presence of a CAC score = 0, while it should be used with a CAC score > 100. CFA IMT could represent a useful biomarker for decisions regarding lipid-lowering treatment. However, sex- and age-specific reference values should be established in a large healthy population.
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Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Esaote SpA, 16152 Genova, Italy
| | - Carmela Morizzo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giuli Jamagidze
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Daniele Della Latta
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
- Bioengineering and Deep Health Units, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Sara Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Dante Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
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Allio IR, Caobelli F, Popescu CE, Haaf P, Alberts I, Frey SM, Zellweger MJ. Low-dose coronary artery calcium scoring compared to the standard protocol. J Nucl Cardiol 2023; 30:1191-1198. [PMID: 36289163 PMCID: PMC10261226 DOI: 10.1007/s12350-022-03120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/19/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND We aimed to compare coronary artery calcium scoring (CACS) with computed tomography (CT) with 80 and 120 kVp in a large patient population and to establish whether there is a difference in risk classification between the two scores. METHODS Patients with suspected CAD undergoing MPS were included. All underwent standard CACS assessment with 120-kVp tube voltage and with 80 kVp. Two datasets (low-dose and standard) were generated and compared. Risk classes (0 to 25, 25 to 50, 50 to 75, 75 to 90, and > 90%) were recorded. RESULTS 1511 patients were included (793 males, age 69 ± 9.1 years). There was a very good correlation between scores calculated with 120 and 80 kVp (R = 0.94, R2 = 0.88, P < .001), with Bland-Altman limits of agreement of - 563.5 to 871.9 and a bias of - 154.2. The proportion of patients assigned to the < 25% percentile class (P = .03) and with CACS = 0 differed between the two protocols (n = 264 vs 437, P < .001). CONCLUSION In a large patient population, despite a good correlation between CACS calculated with standard and low-dose CT, there is a systematic underestimation of CACS with the low-dose protocol. This may have an impact especially on the prognostic value of the calcium score, and the established "power of zero" may no longer be warranted if CACS is assessed with low-dose CT.
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Affiliation(s)
- Ileana Rosely Allio
- Department of Cardiology, Clinic of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Federico Caobelli
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Philip Haaf
- Department of Cardiology, Clinic of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ian Alberts
- University Clinic of Nuclear Medicine, University of Bern, Bern, Switzerland
| | - Simon M Frey
- Department of Cardiology, Clinic of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, Clinic of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Griffith JP, Pinos D, Tesche C, Ricke J, Willemink MJ, Varga-Szemes A, Emrich T. Radiation Dose Reduction for Coronary Artery Calcium Scoring Using a Virtual Noniodine Algorithm on Photon-Counting Detector Computed-Tomography Phantom Data. Diagnostics (Basel) 2023; 13:diagnostics13091540. [PMID: 37174932 PMCID: PMC10177425 DOI: 10.3390/diagnostics13091540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Background: On the basis of the hypothesis that virtual noniodine (VNI)-based coronary artery calcium scoring (CACS) is feasible at reduced radiation doses, this study assesses the impact of radiation dose reduction on the accuracy of this VNI algorithm on a photon-counting detector (PCD)-CT. Methods: In a systematic in vitro setting, a phantom for CACS simulating three chest sizes was scanned on a clinical PCD-CT. The standard radiation dose was chosen at volumetric CT dose indices (CTDIVol) of 1.5, 3.3, 7.0 mGy for small, medium-sized, and large phantoms, and was gradually reduced by adjusting the tube current resulting in 100, 75, 50, and 25%, respectively. VNI images were reconstructed at 55 keV, quantum iterative reconstruction (QIR)1, and at 60 keV/QIR4, and evaluated regarding image quality (image noise (IN), contrast-to-noise ratio (CNR)), and CACS. All VNI results were compared to true noncontrast (TNC)-based CACS at 70 keV and standard radiation dose (reference). Results: INTNC was significantly higher than INVNI, and INVNI at 55 keV/QIR1 higher than at 60 keV/QIR4 (100% dose: 16.7 ± 1.9 vs. 12.8 ± 1.7 vs. 7.7 ± 0.9; p < 0.001 for every radiation dose). CNRTNC was higher than CNRVNI, but it was better to use 60 keV/QIR4 (p < 0.001). CACSVNI showed strong correlation and agreement at every radiation dose (p < 0.001, r > 0.9, intraclass correlation coefficient > 0.9). The coefficients of the variation in root-mean squared error were less than 10% and thus clinically nonrelevant for the CACSVNI of every radiation dose. Conclusion: This phantom study suggests that CACSVNI is feasible on PCD-CT, even at reduced radiation dose while maintaining image quality and CACS accuracy.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, 1083 Budapest, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Siemens Medical Solutions, 40 Liberty Boulevard, Malvern, PA 19355, USA
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes-Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, 55131 Mainz, Germany
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11
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Duerden L, O’Brien H, Doshi S, Charters P, King L, Hudson BJ, Rodrigues JCL. Impact of an ultra-low dose unenhanced planning scan on CT coronary angiography scan length and effective radiation dose. BJR Open 2023; 4:20210056. [PMID: 36105418 PMCID: PMC9459860 DOI: 10.1259/bjro.20210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/25/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Imaged scan length (z-axis coverage) is a simple parameter that can reduce CT dose without compromising image quality. In CT coronary angiography (CTCA), z-axis coverage may be planned using non-contrast calcium score scan (CaCS) to identify the relevant coronary anatomy. However, standardised Agatston CaCS is acquired at 120 kV which adds a relatively high contribution to total study dose and CaCS is no longer routinely recommended in UK guidelines. We evaluate an ultra-low dose unenhanced planning scan on CTCA scan length and effective radiation dose. Methods An ultra-low dose tin filter (Sn-filter) planning scan (100 kVp, maximum iterative reconstruction) was performed and used to plan the z-axis coverage on 48 consecutive CTCAs (62% men, 62 ± 13 years) compared with 47 CTCA planned using a localiser alone (46% men, 59 ± 12 years) between May and June 2019. Excess scanning beyond the ideal scan length was calculated for both groups. Estimations of radiation dose were also compared between the two groups. Results Addition of an ultra-low dose unenhanced planning scan to CTCA protocol was associated with reduction in overscanning with no impact on image quality. There was no significant difference in total study effective dose with the addition of the planning scan, which had an average dose-length product of 3 mGy.cm. (total study dose: Protocol A 2.1 mSv vs Protocol B 2.2 mSv, p = 0.92). Conclusion An ultra-low dose unenhanced planning scan facilitates optimal scan length for the diagnostic CTCA, reducing overscanning and preventing incomplete cardiac imaging with no significant dose penalty or impact on image quality. Advances in knowledge An ultra-low dose CTCA planning is feasible and effective at optimising scan length.
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Affiliation(s)
- Laura Duerden
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
| | - Helen O’Brien
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
| | - Susan Doshi
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, United Kingdom
| | - Pia Charters
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
| | - Laurence King
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
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12
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Wolff J, Matschinske J, Baumgart D, Pytlik A, Keck A, Natarajan A, von Schacky CE, Pauling JK, Baumbach J. Federated machine learning for a facilitated implementation of Artificial Intelligence in healthcare - a proof of concept study for the prediction of coronary artery calcification scores. J Integr Bioinform 2022; 19:jib-2022-0032. [PMID: 36054833 PMCID: PMC9800042 DOI: 10.1515/jib-2022-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 01/09/2023] Open
Abstract
The implementation of Artificial Intelligence (AI) still faces significant hurdles and one key factor is the access to data. One approach that could support that is federated machine learning (FL) since it allows for privacy preserving data access. For this proof of concept, a prediction model for coronary artery calcification scores (CACS) has been applied. The FL was trained based on the data in the different institutions, while the centralized machine learning model was trained on one allocation of data. Both algorithms predict patients with risk scores ≥5 based on age, biological sex, waist circumference, dyslipidemia and HbA1c. The centralized model yields a sensitivity of c. 66% and a specificity of c. 70%. The FL slightly outperforms that with a sensitivity of 67% while slightly underperforming it with a specificity of 69%. It could be demonstrated that CACS prediction is feasible via both, a centralized and an FL approach, and that both show very comparable accuracy. In order to increase accuracy, additional and a higher volume of patient data is required and for that FL is utterly necessary. The developed "CACulator" serves as proof of concept, is available as research tool and shall support future research to facilitate AI implementation.
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Affiliation(s)
- Justus Wolff
- Chair of Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Maximus-von-Imhof-Forum 3, 85354Freising, Germany
- Syte – Strategy Institute for Digital Health, Hohe Bleichen 8, 20354Hamburg, Germany
| | - Julian Matschinske
- Chair of Computational Systems Biology, University of Hamburg, Notkestreet 9-11, 22607Hamburg, Germany
| | - Dietrich Baumgart
- Preventicum Essen, Theodor-Althoff-Str. 47 45133Essen, Germany
- Preventicum Duesseldorf, Koenigsallee 11, 40212Duesseldorf, Germany
| | - Anne Pytlik
- Preventicum Essen, Theodor-Althoff-Str. 47 45133Essen, Germany
- Preventicum Duesseldorf, Koenigsallee 11, 40212Duesseldorf, Germany
| | - Andreas Keck
- Syte – Strategy Institute for Digital Health, Hohe Bleichen 8, 20354Hamburg, Germany
| | - Arunakiry Natarajan
- Independent Researcher, Digital Health, Informatics and Data Science, Lower Saxony, Germany
| | - Claudio E. von Schacky
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675Munich, Germany
| | - Josch K. Pauling
- Chair of Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Maximus-von-Imhof-Forum 3, 85354Freising, Germany
- LipiTUM, Chair of Experimental Bioinformatics, TUM School of Life Sciences, Technical University of Munich, Maximus-von-Imhof-Forum 3, 85354Freising, Germany
| | - Jan Baumbach
- Chair of Computational Systems Biology, University of Hamburg, Notkestreet 9-11, 22607Hamburg, Germany
- Computational BioMedicine Lab, Institute of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, 5230Odense, Denmark
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13
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Cao CF, Ma KL, Shan H, Liu TF, Zhao SQ, Wan Y, Jun-Zhang, Wang HQ. CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC Cancer 2022; 22:1238. [PMID: 36451138 PMCID: PMC9710150 DOI: 10.1186/s12885-022-10310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults. METHODS Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years. RESULTS 25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases. CONCLUSIONS Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR. PROSPERO TRIAL REGISTRATION NUMBER CRD42019133487.
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Affiliation(s)
- Chun-Feng Cao
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Kun-Long Ma
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Hua Shan
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Tang-Fen Liu
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Si-Qiao Zhao
- grid.412262.10000 0004 1761 5538Department of Orthopedics, No.1 Hospital of Xi’an City, Northwestern University, Xi’an, 710002 Shaanxi Province People’s Republic of China
| | - Yi Wan
- grid.233520.50000 0004 1761 4404Department of Health Services, Fourth Military Medical University, Xi’an, 710032 No.169 West Changle Road, Shaanxi Province People’s Republic of China
| | - Jun-Zhang
- grid.489934.bBaoji Central Hospital, 8 Jiangtan Road, Baoji, 721008 Shaanxi Province People’s Republic of China ,grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi Province People’s Republic of China
| | - Hai-Qiang Wang
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
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14
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Kallur AS, Bhogal S, Garcia-Garcia HM. Coronary Artery Calcium Scoring in the Young: A Continuum Risk? JACC Cardiovasc Imaging 2022; 15:2016-2017. [PMID: 36357147 DOI: 10.1016/j.jcmg.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/09/2022]
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15
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Gallo RJ, Brown DL. Addition of Coronary Artery Calcium Scores to Primary Prevention Risk Estimation Models-Primum Non Nocere. JAMA Intern Med 2022; 182:590-591. [PMID: 35467702 DOI: 10.1001/jamainternmed.2022.1258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert J Gallo
- Department of Medicine, Stanford School of Medicine, Stanford, California
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16
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Madaj P, Li D, Nakanishi R, Andreini D, Pontone G, Conte E, O'Rourke R, Hamilton-Craig C, Nimmagadda M, Kim N, Fatima B, Dailing C, Shaikh K, Shekar C, Lee JH, Budoff MJ. Radiation Doses in Patients Undergoing Computed Tomographic Coronary Artery Calcium Evaluation With a 64-Slice Scanner Versus a 256-Slice Scanner. Tex Heart Inst J 2022; 49:478371. [PMID: 35244722 DOI: 10.14503/thij-18-6793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Computed tomographic coronary artery calcium scanning enables cardiovascular risk stratification; however, exposing patients to high radiation levels is an ongoing concern. New-generation computed tomographic systems use lower radiation doses than older systems do. To quantify comparative doses of radiation exposure, we prospectively acquired images from 220 patients with use of a 64-slice GE LightSpeed VCT scanner (control group, n=110) and a 256-slice GE Revolution scanner (study group, n=110). The groups were matched for age, sex, and body mass index; statistical analysis included t tests and linear regression. The mean dose-length product was 21% lower in the study group than in the control group (60.2 ± 27 vs 75.9 ± 22.6 mGy·cm; P <0.001) and also in each body mass index subgroup. Similarly, the mean effective radiation dose was 21% lower in the study group (0.84 ± 0.38 vs 1.06 ± 0.32 mSv) and lower in each weight subgroup. After adjustment for sex, women in the study group had a lower dose-length product (50.4 ± 23.4 vs 64.7 ± 27.6 mGy·cm) than men did and received a lower effective dose (0.7 ± 0.32 vs 0.9 ± 0.38 mSv) (P=0.009). As body mass index and waist circumference increased, so did doses for both scanners. Our study group was exposed to radiation doses lower than the previously determined standard of 1 mSv, even after adjustment for body mass index and waist circumference. In 256-slice scanning for coronary artery calcium, radiation doses are now similar to those in lung cancer screening and mammography.
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Affiliation(s)
- Paul Madaj
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Dong Li
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Rine Nakanishi
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California.,Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Edoardo Conte
- Department of Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Rachael O'Rourke
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Cardiology, University of Queensland, Brisbane, Australia
| | | | - Manojna Nimmagadda
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Nicholas Kim
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Badiha Fatima
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Christopher Dailing
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Kashif Shaikh
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Chandana Shekar
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ju Hwan Lee
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Matthew J Budoff
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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17
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Hacıoğlu Y, Kılıçkaya P, Rakıcı İT, Karataş S, Pişkinpaşa ME, Karabağ T. Correlation of Coronary Calcium Scores with Growth Differentiation Factor-15 Levels in Patients with Coronary Artery Disease. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.58740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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18
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Ali MM, Gul S, Naqvi M, Hakam L, Inayat A, Saleem S, Polavarpu M, Syed MA. Utility of Coronary Artery Calcium Scores in Predicting Risk of Subclinical Cardiovascular Atherosclerotic Disease: An Analysis of Limitations to its Adoption With Policy Recommendations. Cureus 2021; 13:e14647. [PMID: 34046279 PMCID: PMC8141302 DOI: 10.7759/cureus.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This survey-based analysis aims to highlight key limitations to a wider adoption of coronary artery calcium (CAC) scoring as a means of screening asymptomatic individuals for atherosclerotic cardiovascular disease. The need for a screening tool that adds objective anatomical information to historically established risk scores in the aforementioned population has been met by this imaging modality. Despite that, there has been a hesitance towards frequent usage of these scans. Within the pre-set sampling frame of the University of Toledo, a convenience sampling technique was used to reach out to 60 health care providers. The resultant responses were analyzed and discussed. In addition to identifying patients who need to be worked up further, CAC scans can also help re-stratify patients within-risk groups and inform decision-making regarding the use of lipid-lowering therapies. The public health impact of a greater but appropriate utilization of this diagnostic tool will be impactful. This analysis seeks to better understand real-life obstacles to a wider adoption of these scans and attempts to lay out policy recommendations to address these issues.
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Affiliation(s)
| | - Sajjad Gul
- Internal Medicine, Order of St. Francis - St. Francis Medical Center, Peoria, USA
| | - Muzna Naqvi
- Internal Medicine, Banner Health, Phoenix, USA
| | - Laila Hakam
- Internal Medicine, Banner Health, Phoenix, USA
| | - Asad Inayat
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Sameer Saleem
- Internal Medicine, Presence Health St Joseph Hospital, Chicago, USA
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19
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Parcha V, Malla G, Kalra R, Li P, Pandey A, Nasir K, Arora G, Arora P. Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis. Hypertension 2021; 77:1106-1118. [PMID: 33641360 PMCID: PMC7946744 DOI: 10.1161/hypertensionaha.120.16689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease to inform hypertension treatment in adults with elevated BP or low-risk stage I hypertension. The use of coronary artery calcium (CAC) score to guide hypertension therapy has not been adequately evaluated. Participants free of cardiovascular disease were pooled from Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study. The risk for incident cardiovascular events (heart failure, stroke, coronary heart disease), by CAC status (CAC-0 or CAC>0) and BP treatment group was assessed using multivariable-adjusted Cox regression. The 10-year number needed to treat to prevent a single cardiovascular event was also estimated. This study included 6461 participants (median age 53 years; 53.3% women; 32.3% Black participants). Over a median follow-up of 8.5 years, 347 incident cardiovascular events occurred. Compared with those with normal BP, the risk of incident cardiovascular event was higher among those with elevated BP/low-risk stage I hypertension and CAC>0 (hazard ratio, 2.4 [95% CI, 1.7–3.4]) and high-risk stage I/stage II hypertension (BP, 140–160/80–100 mm Hg) with CAC>0 (hazard ratio, 2.9 [95% CI, 2.1–4.0]). A similar pattern was evident across racial subgroups and for individual study outcomes. Among those with CAC-0, the 10-year number needed to treat was 160 for elevated BP/low-risk stage I hypertension and 44 for high-risk stage I or stage II hypertension (BP, 140–160/80–100 mm Hg). Among those with CAC>0, the 10-year number needed to treat was 36 and 22, respectively. Utilization of the CAC score may guide the initiation of hypertension therapy and preventive approaches to personalize cardiovascular risk reduction among individuals where the current guidelines do not recommend treatment.
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Affiliation(s)
- Vibhu Parcha
- From the Division of Cardiovascular Disease (V.P., P.A.), University of Alabama at Birmingham
| | - Gargya Malla
- Department of Epidemiology (G.M.), University of Alabama at Birmingham
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis (R.K.)
| | - Peng Li
- School of Nursing (P.L.), University of Alabama at Birmingham
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX (A.P.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (K.N.).,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX (K.N.)
| | | | - Pankaj Arora
- From the Division of Cardiovascular Disease (V.P., P.A.), University of Alabama at Birmingham.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, AL (P.A.)
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20
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Salam S, Gallagher O, Gossiel F, Paggiosi M, Eastell R, Khwaja A. Vascular calcification relationship to vascular biomarkers and bone metabolism in advanced chronic kidney disease. Bone 2021; 143:115699. [PMID: 33091638 DOI: 10.1016/j.bone.2020.115699] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vascular calcification (VC) and renal osteodystrophy are important complications of advanced chronic kidney disease (CKD). High resolution peripheral quantitative computed tomography (HRpQCT) is able to assess bone microstructure in renal osteodystrophy and lower leg arterial calcification (LLAC) is usually seen as an incidental finding. LLAC can be a useful quantitative assessment of VC in CKD but the relationship between LLAC and vascular biomarkers and bone is unknown. We aimed to assess the relationship between LLAC and biomarkers, bone turnover and microstructure. METHODS In this cross-sectional study, fasting blood samples were taken from 69 CKD stages 4-5D patients and 68 healthy controls. HRpQCT of distal tibia and radius were performed. 43 CKD patients had trans-iliac bone biopsy after tetracycline labelling. RESULTS LLAC was more severe in CKD than controls (median [IQR] 1.043 [0.05-16.52] vs 0 [0-0.55] mgHA, p < 0.001). CKD patients with diabetes (28%) had significantly higher LLAC compared to non-diabetic CKD (median [IQR] 24.07 [3.42-61.30] vs 0.23 [0-3.78] mgHA, p < 0.001). LLAC mass in CKD correlated with serum phosphate (rho = 0.29, p < 0.05), calcium x phosphate product (rho = 0.31, p < 0.05), intact parathyroid hormone (rho = 0.38, p < 0.01), intact fibroblast growth factor-23 (iFGF23) (rho = 0.40, p = 0.001), total alkaline phosphatase (rho = 0.41, p < 0.001), bone alkaline phosphatase (rho = 0.29, p < 0.05), osteocalcin (rho = 0.32, p < 0.05), osteoprotegerin (rho = 0.40, p = 0.001) and dephosphorylated-uncarboxylated matrix Gla protein (rho = 0.31, p < 0.05). LLAC in CKD also correlated with worse distal tibia cortical bone mineral density, thickness and porosity. No association was found between LLAC and bone turnover, mineralization or volume on biopsy in CKD. In multivariate analysis, only age, diabetes, iPTH and iFGF23 were independently associated with LLAC in CKD. CONCLUSIONS High levels of PTH and FGF23, along with older age and the presence of diabetes may all play independent roles in the development of LLAC in advanced CKD.
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Affiliation(s)
- Syazrah Salam
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom; Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, United Kingdom.
| | - Orla Gallagher
- Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, United Kingdom
| | - Fatma Gossiel
- Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, United Kingdom
| | - Margaret Paggiosi
- Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, United Kingdom
| | - Richard Eastell
- Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, United Kingdom
| | - Arif Khwaja
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
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21
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Comparison of Calcium Scoring Between 64-Multidetector Computed Tomography and 320-Multidetector Computed Tomography Using a Cardiac Phantom: Achieving Consistent Image Quality With Dose Optimization. J Comput Assist Tomogr 2021; 45:73-77. [PMID: 31929375 DOI: 10.1097/rct.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The purpose of this study was to evaluate the relationship between radiation dose and noise level on various coronary calcium scoring protocols between 64-multidetector computed tomography (MDCT) and 320-MDCT. The cardiac QRM phantoms (1 small size and 1 medium size) were used in this study. Lower-dose imaging protocols were proposed for optimization with the parameters of 120 kVp and 10 mAs for small-size phantom (0.336 mSv) in 64-MDCT imaging and small-size phantom (0.2 mSv) in 320-MDCT case, and 120 kVp and 80 mAs for medium-size phantom (2.73 mSv) in 64-MDCT imaging and medium-size phantom (1.58 mSv) in 320-MDCT case. Our results suggest that people can apply lower-dose protocols in the clinical use for early diagnosis of coronary disease without sacrificing diagnostic accuracy.
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22
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Young CR, Reynolds DA, Gambill N, Brooks DI, Villines TC. Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography. Tomography 2020; 6:356-361. [PMID: 33364425 PMCID: PMC7744187 DOI: 10.18383/j.tom.2020.00041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Extensive coronary artery calcium (CAC) diminishes the accuracy of coronary computed tomography angiography (CCTA). Many imagers adjust CCTA acquisition parameters depending on a preCCTA Agatston CAC score to optimize diagnostic accuracy. Typical preCCTA CAC imaging adds considerably to radiation exposure, partially attributable to imaging beyond the area known for highest CAC, the proximal coronary arteries. We aimed to determine whether a z-axis reduced scan length (RSL) would identify the majority of CAC and provide adequate information to computed tomography angiography providers relative to a standard full-scan length (FSL) preCCTA noncontrast CT. We retrospectively examined 200 subjects. The mean CAC scores detected in RSL and FSL were 77.4 (95% CI 50.6 to 104.3) and 93.9 (95% CI 57.3 to 130.5), respectively. RSL detected 81% of the FSL CAC. Among false negatives, with no CAC detected in RSL, FSL CAC severity was minimal (mean score 2.8). There was high concordance, averaging 88%, between CCTA imaging parameter adjustment decisions made by 2 experienced imagers based on either RSL or FSL. CAC detected and decision concordance decreased with increasing CAC burden. CAC detected was lower, and false negatives were more common in the right coronary artery owing to its anatomic course, placing larger segments outside RSL. Axial scan length and effective dose decreased 59% from FSL (∼14.5 cm/∼1.1 mSv) to RSL (∼5.9 cm/∼0.45 mSv). This retrospective study suggests that RSL identifies most CAC, results in similar CCTA acquisition parameter modifications, and reduces radiation exposure. Our colleagues corroborated these results in a recently published prospective study.
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Affiliation(s)
- Colin R. Young
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Radiology, Yale New Haven Hospital, New Haven, CT
| | - David A. Reynolds
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Brooke Army Medical Center, Fort Sam Houston, TX; and
| | - Neil Gambill
- Walter Reed National Military Medical Center, Bethesda, MD
| | | | - Todd C. Villines
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- University of Virginia Health Center, Charlottesville, VA
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23
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O'Malley PG, Arnold MJ, Kelley C, Spacek L, Buelt A, Natarajan S, Donahue MP, Vagichev E, Ballard-Hernandez J, Logan A, Thomas L, Ritter J, Neubauer BE, Downs JR. Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2020; 173:822-829. [PMID: 32956597 DOI: 10.7326/m20-4648] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION In June 2020, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) released a joint update of their clinical practice guideline for managing dyslipidemia to reduce cardiovascular disease risk in adults. This synopsis describes the major recommendations. METHODS On 6 August to 9 August 2019, the VA/DoD Evidence-Based Practice Work Group (EBPWG) convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature (English-language publications from 1 December 2013 to 16 May 2019), and developed 27 recommendations and a simple 1-page algorithm. The recommendations were graded by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. RECOMMENDATIONS This synopsis summarizes key features of the guideline in 7 crucial areas: targeting of statin dose (not low-density lipoprotein cholesterol goals), additional tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition.
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Affiliation(s)
- Patrick G O'Malley
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - Michael J Arnold
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - Cathy Kelley
- U.S. Department of Veterans Affairs Pharmacy Benefits Management Services, Scottsdale, Arizona (C.K.)
| | - Lance Spacek
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
| | - Andrew Buelt
- Bay Pines VA Healthcare System, Bay Pines, Florida (A.B.)
| | - Sundar Natarajan
- New York University School of Medicine and VA New York Harbor Healthcare System, New York, New York (S.N.)
| | - Mark P Donahue
- Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina (M.P.D.)
| | - Elena Vagichev
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
| | | | - Amanda Logan
- Cincinnati VA Medical Center, Cincinnati, Ohio (A.L.)
| | - Lauren Thomas
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
| | - Joan Ritter
- Walter Reed Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland (J.R.)
| | - Brian E Neubauer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - John R Downs
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
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24
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Waltz J, Kocher M, Kahn J, Dirr M, Burt JR. The Future of Concurrent Automated Coronary Artery Calcium Scoring on Screening Low-Dose Computed Tomography. Cureus 2020; 12:e8574. [PMID: 32670710 PMCID: PMC7358941 DOI: 10.7759/cureus.8574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
Low-dose computed tomography (LDCT) has been extensively validated for lung cancer screening in selected patient populations. Additionally, the use of gated cardiac CT to assess coronary artery calcium (CAC) burden has been validated to determine a patient's risk for major cardiovascular adverse events. This is typically performed by calculating an Agatston score based on density and overall burden of calcified plaque within the coronary arteries. Patients that qualify for LDCT for lung cancer screening commonly share major risk factors for coronary artery disease and would frequently benefit from an additional gated cardiac CT for the assessment of CAC. Given the widespread use of LDCT for lung cancer screening, we evaluated current literature regarding the use of non-gated chest CT, specifically LDCT, for the detection and grading of coronary artery calcifications. Additionally, given the evolving and increasing use of artificial intelligence (AI) in the interpretation of radiologic studies, current literature for the use of AI in CAC assessment was reviewed. We reviewed primary scientific literature dating up to April 2020 using Pubmed and Google Scholar, with the search terms low dose CT, lung cancer screening, coronary artery calcium, EKG/cardiac gated CT, deep learning, machine learning, and AI. These publications were then independently evaluated by each member of our team. Overall, there was a consensus within these papers that LDCT for lung cancer screening plays a role in the evaluation of CAC. Most studies note the inherent problems with the evaluation of the density of coronary calcifications on LDCT to give an accurate numeric calcium or Agatston score. The current method of evaluating CAC on LDCT involves using a qualitative categorical system (none, mild, moderate, or severe). When performed by cardiac imaging experts, this method broadly correlates with traditional CAC score groups (0, 1 to 100, 101 to 400, and > 400). Furthermore, given the high sensitivity of a properly protocolled LDCT for coronary calcium, a negative study for CAC precludes the need for a dedicated gated CT assessment. However, qualitative methods are not as accurate or reproducible when performed by general radiologists. The implementation of AI in the LDCT screening process has the potential to give a quantifiable and reproducible numeric value to the calcium score, based on whole heart volume scoring of calcium. This more closely aligns with the Agatston score and serves as a better guide for treatment and risk assessment using current guidelines. We conclude that CAC should be assessed on all LDCT performed for lung cancer screening and that a qualitative categorical scoring system should be provided in the impression for each patient. Early studies involving AI for the assessment of CAC are promising, but more extensive studies are needed before a final recommendation for its use can be given. The implementation of an accurate, automated AI CAC assessment tool would improve radiologist compliance and ease of overall workflow. Ultimately, the potential end result would be improved turnaround time, better patient outcomes, and reduced healthcare costs by maximizing preventative care in this high-risk population.
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Affiliation(s)
- Jeffrey Waltz
- Diagnostic Radiology, Medical University of South Carolina, Charleston, USA
| | - Madison Kocher
- Radiology, Medical University of South Carolina, Charleston, USA
| | - Jacob Kahn
- Radiology, Medical University of South Carolina, Charleston, USA
| | - McKenzie Dirr
- Radiology, Medical University of South Carolina, Charleston, USA
| | - Jeremy R Burt
- Radiology, Medical University of South Carolina, Charleston, USA
- Cardiothoracic Imaging, Medical University of South Carolina, Charleston, USA
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25
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Vingiani V, Abadia AF, Schoepf UJ, Fischer AM, Varga-Szemes A, Sahbaee P, Allmendinger T, Giovagnoli DA, Hudson HT, Marano R, Tinnefeld FC, Martin SS. Individualized coronary calcium scoring at any tube voltage using a kV-independent reconstruction algorithm. Eur Radiol 2020; 30:5834-5840. [PMID: 32468107 DOI: 10.1007/s00330-020-06951-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE We prospectively investigate the feasibility of a patient specific automated tube voltage selection (ATVS)-based coronary artery calcium scoring (CACS) protocol, using a kV-independent reconstruction algorithm, to achieve significant dose reductions while maintaining the overall cardiac risk classification. METHODS Forty-three patients (mean age, 61.8 ± 9.0 years; 40% male) underwent a clinically indicated CACS scan at 120kVp, as well as an additional CACS acquisition using an individualized tube voltage between 70 and 130kVp based on the ATVS selection (CARE-kV). Datasets of the additional CACS scans were reconstructed using a kV-independent algorithm that allows for calcium scoring without changing the weighting threshold of 130HU, regardless of the tube voltage chosen for image acquisition. Agatston scores and radiation dose derived from the different ATVS-based CACS studies were compared to the standard acquisition at 120kVp. RESULTS Thirteen patients displayed a score of 0 and were correctly identified with the ATVS protocol. Agatston scores derived from the standard 120kVp (median, 33.4; IQR, 0-289.7) and the patient-tailored kV-independent protocol (median, 47.5; IQR, 0-287.5) showed no significant differences (p = 0.094). The intra-class correlation for Agatston scores derived from the two different protocols was excellent (ICC = 0.99). The mean dose-length-product was 29.8 ± 11.9 mGy × cm using the ATVS protocol and 31.7 ± 11.4 mGy × cm using the standard 120kVp protocol (p < 0.001). Additionally, 95% of patients were classified into the same risk category (0, 1-10, 11-100, 101-400, or > 400) using the patient-tailored protocol. CONCLUSIONS ATVS-based CACS, using a kV-independent algorithm, allows for high accuracy compared to the standard 120kVp scanning, while significantly reducing radiation dose parameters. KEY POINTS • ATVS allows for CT scanning with reduced radiation dose values. • KV-independent CACS is feasible at any tube voltage between 70 and 130 kVp. • ATVS applied to kV-independent CACS can significantly reduce the radiation dose.
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Affiliation(s)
- Vincenzo Vingiani
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andres F Abadia
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Andreas M Fischer
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Pooyan Sahbaee
- Computed Tomography - Research & Development, Siemens Healthcare GmbH, Forchheim, Germany.,Siemens Medical Solutions USA, Malvern, PA, USA
| | - Thomas Allmendinger
- Computed Tomography - Research & Development, Siemens Healthcare GmbH, Forchheim, Germany
| | - Dante A Giovagnoli
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - H Todd Hudson
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Riccardo Marano
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fiona C Tinnefeld
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Simon S Martin
- Department of Radiology and Radiological Sciences, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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26
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Hou KY, Tsujioka K, Yang CC. Optimization of HU threshold for coronary artery calcium scans reconstructed at 0.5-mm slice thickness using iterative reconstruction. J Appl Clin Med Phys 2020; 21:111-120. [PMID: 31889419 PMCID: PMC7021007 DOI: 10.1002/acm2.12806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/30/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This work investigated the simultaneous influence of tube voltage, tube current, body size, and HU threshold on calcium scoring reconstructed at 0.5-mm slice thickness using iterative reconstruction (IR) through multivariate analysis. Regression results were used to optimize the HU threshold to calibrate the resulting Agatston scores to be consistent with those obtained from the conventional protocol. METHODS A thorax phantom set simulating three different body sizes was used in this study. A total of 14 coronary artery calcium (CAC) protocols were studied, including 1 conventional protocol reconstructed at 3-mm slice thickness, 1 FBP protocol, and 12 statistical IR protocols (3 kVp values*4 SD values) reconstructed at 0.5-mm slice thickness. Three HU thresholds were applied for calcium identification, including 130, 150, and 170 HU. A multiple linear regression method was used to analyze the impact of kVp, SD, body size, and HU threshold on the Agatston scores of three calcification densities for IR-reconstructed CAC scans acquired with 0.5-mm slice thickness. RESULTS Each regression relationship has R2 larger than 0.80, indicating a good fit to the data. Based on the regression models, the HU thresholds as a function of SD estimated to ensure the quantification accuracy of calcium scores for 120-, 100-, and 80-kVp CAC scans reconstructed at 0.5-mm slice thickness using IR for three different body sizes were proposed. Our results indicate that the HU threshold should be adjusted according to the imaging condition, whereas a 130-HU threshold is appropriate for 120-kVp CAC scans acquired with SD = 55 for body size of 24.5 cm. CONCLUSION The optimized HU thresholds were proposed for CAC scans reconstructed at 0.5-mm slice thickness using IR. Our study results may provide a potential strategy to improve the reliability of calcium scoring by reducing partial volume effect while keeping radiation dose as low as reasonably achievable.
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Affiliation(s)
- Kuei-Yuan Hou
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan
| | - Katsumi Tsujioka
- Faculty of Radiological Technology, Fujita Health University, Aichi, Japan
| | - Ching-Ching Yang
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
PURPOSE OF REVIEW In this review, we describe the mechanism behind coronary artery calcification formation and detection, as well as its implication in cardiovascular disease (CVD) risk stratification, intervention, and prognosis in asymptomatic individuals. RECENT FINDINGS Multiple cohort and population studies have shown that coronary artery calcium scoring is effective and reproducible in predicting the risk for cardiovascular disease. The updated 2018 ACC/AHA guideline has incorporated consideration of coronary artery calcification testing into cardiovascular disease risk stratification and therapy guidance. Coronary artery calcification's evidence-based role in detection, risk stratification, and ultimately its unique influence on therapeutic intervention and prognosis of cardiovascular disease in asymptomatic population is increasingly being recognized..
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Jaminon A, Reesink K, Kroon A, Schurgers L. The Role of Vascular Smooth Muscle Cells in Arterial Remodeling: Focus on Calcification-Related Processes. Int J Mol Sci 2019; 20:E5694. [PMID: 31739395 PMCID: PMC6888164 DOI: 10.3390/ijms20225694] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 12/22/2022] Open
Abstract
Arterial remodeling refers to the structural and functional changes of the vessel wall that occur in response to disease, injury, or aging. Vascular smooth muscle cells (VSMC) play a pivotal role in regulating the remodeling processes of the vessel wall. Phenotypic switching of VSMC involves oxidative stress-induced extracellular vesicle release, driving calcification processes. The VSMC phenotype is relevant to plaque initiation, development and stability, whereas, in the media, the VSMC phenotype is important in maintaining tissue elasticity, wall stress homeostasis and vessel stiffness. Clinically, assessment of arterial remodeling is a challenge; particularly distinguishing intimal and medial involvement, and their contributions to vessel wall remodeling. The limitations pertain to imaging resolution and sensitivity, so methodological development is focused on improving those. Moreover, the integration of data across the microscopic (i.e., cell-tissue) and macroscopic (i.e., vessel-system) scale for correct interpretation is innately challenging, because of the multiple biophysical and biochemical factors involved. In the present review, we describe the arterial remodeling processes that govern arterial stiffening, atherosclerosis and calcification, with a particular focus on VSMC phenotypic switching. Additionally, we review clinically applicable methodologies to assess arterial remodeling and the latest developments in these, seeking to unravel the ubiquitous corroborator of vascular pathology that calcification appears to be.
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Affiliation(s)
- Armand Jaminon
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Koen Reesink
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Abraham Kroon
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands;
| | - Leon Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
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29
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Smith ER, Hewitson TD, Holt SG. Diagnostic Tests for Vascular Calcification. Adv Chronic Kidney Dis 2019; 26:445-463. [PMID: 31831123 DOI: 10.1053/j.ackd.2019.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 02/06/2023]
Abstract
Vascular calcification (VC) is the heterogeneous endpoint of multiple vascular insults, which varies by arterial bed, the layer of the arterial wall affected, and is propagated by diverse cellular and biochemical mechanisms. A variety of in vivo and ex vivo techniques have been applied to the analysis of VC in preclinical studies, but clinical examination has principally relied on a number of noninvasive and invasive imaging modalities for detection and quantitation. Most imaging methods suffer from suboptimal spatial resolution, leading to the inability to distinguish medial from intimal VC and insufficient sensitivity to detect microcalcifications that are indicative of active mineral deposition and of vulnerable plaques which may be prone to rupture. Serum biomarkers lack specificity for VC and cannot discriminate pathology. Overall, uncertainties surrounding the sensitivity and specificity of different VC testing modalities, the absence of a clear cause-effect relationship, and lack of any evidence-based diagnostic or therapeutic protocols in relation to VC testing in chronic kidney disease has yielded weak or ungraded recommendations for their use in clinical practice. While VC is recognized as a key manifestation of chronic kidney disease-mineral and bone disorder and those with an increasing burden of VC are considered to be at higher cardiovascular risk, routine screening is not currently recommended.
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30
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Maxwell S, Fox R, McRobbie D, Bulsara M, Doust J, O’Leary P, Slavotinek J, Stubbs J, Moorin R. How have advances in CT dosimetry software impacted estimates of CT radiation dose and cancer incidence? A comparison of CT dosimetry software: Implications for past and future research. PLoS One 2019; 14:e0217816. [PMID: 31412037 PMCID: PMC6693687 DOI: 10.1371/journal.pone.0217816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/21/2019] [Indexed: 12/01/2022] Open
Abstract
Objective Organ radiation dose from a CT scan, calculated by CT dosimetry software, can be combined with cancer risk data to estimate cancer incidence resulting from CT exposure. We aim to determine to what extent the use of improved anatomical representation of the adult human body “phantom” in CT dosimetry software impacts estimates of radiation dose and cancer incidence, to inform comparison of past and future research. Methods We collected 20 adult cases for each of three CT protocols (abdomen/pelvis, chest and head) from each of five public hospitals (random sample) (January-April inclusive 2010) and three private clinics (self-report). Organ equivalent and effective dose were calculated using both ImPACT (mathematical phantom) and NCICT (voxelised phantom) software. Bland-Altman plots demonstrate agreement and Passing-Bablok regression reports systematic, proportional or random differences between results. We modelled the estimated lifetime attributable risk of cancer from a single exposure for each protocol, using age-sex specific risk-coefficients from the Biologic Effects of Ionizing Radiation VII report. Results For the majority of organs used in epidemiological studies of cancer incidence, the NCICT software (voxelised) provided higher dose estimates. Across the lifespan NCICT resulted in cancer estimates 2.9%-6.6% and 14.8%-16.3% higher in males and females (abdomen/pelvis) and 7.6%-19.7% and 12.9%-26.5% higher in males and females respectively (chest protocol). For the head protocol overall cancer estimates were lower for NCICT, but with greatest disparity, >30% at times. Conclusion When the results of previous studies estimating CT dose and cancer incidence are compared to more recent, or future, studies the dosimetry software must be considered. Any change in radiation dose or cancer risk may be attributable to the software and phantom used, rather than—or in addition to—changes in scanning practice. Studies using dosimetry software to estimate radiation dose should describe software comprehensively to facilitate comparison with past and future research.
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Affiliation(s)
- Susannah Maxwell
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Richard Fox
- School of Physics, University of Western Australia, Perth, Western Australia, Australia
| | - Donald McRobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - Max Bulsara
- Institute for Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Centre for Health Services Research, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Jenny Doust
- Centre for Research in Evidence-Based Practice Faculty of Health Sciences and Medicine Bond University, Gold Coast, Queensland, Australia
| | - Peter O’Leary
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - John Stubbs
- CanSpeak Australia, Spring Hill, Queensland, Australia
| | - Rachael Moorin
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Computed Tomography in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gräni C, Vontobel J, Benz DC, Bacanovic S, Giannopoulos AA, Messerli M, Grossmann M, Gebhard C, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Ultra-low-dose coronary artery calcium scoring using novel scoring thresholds for low tube voltage protocols-a pilot study. Eur Heart J Cardiovasc Imaging 2019; 19:1362-1371. [PMID: 29432592 DOI: 10.1093/ehjci/jey019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 11/13/2022] Open
Abstract
Aims To determine if tube-adapted thresholds for coronary artery calcium (CAC) scoring by computed tomography at 80 kilovolt-peak (kVp) tube voltage and 70-kVp yield comparable results to the standard 120-kVp protocol. Methods and results We prospectively included 103 patients who underwent standard scanning with 120-kVp tube voltage and additional scans with 80 kVp and 70 kVp. Mean body mass index (BMI) was 27.9 ± 5.1 kg/m2. For the lowered tube voltages, we applied novel kVp-adapted thresholds for calculation of CAC scores and compared them with standard 120-kVp scans using intraclass correlation and Bland-Altman (BA) analysis. Furthermore, risk-class (CAC score 0/1-10/11-100/101-400/>400) changes were assessed. Median CAC score from 120-kVp scans was 212 (interquartile range 25-901). Thirteen (12.6%) patients had zero CAC. Using the novel kVp-adapted thresholds, CAC scores derived from 80-kVp scans showed excellent correlation (r = 0.994, P < 0.001) with standard 120-kVp scans with BA limits of agreement of -235 (-39.5%) to 172 (28.9%). Similarly, for 70-kVp scans, correlation was excellent (r = 0.972, P < 0.001) but with broader limits of agreement of -476 (-85.0%) to 270 (48.2%). Only 2 (2.8%) reclassifications were observed for the 80-kVp scans in patients with a BMI <30 kg/m2 (n = 71), and 2 (6.1%) for the 70-kVp scans in patients with a BMI <25 kg/m2 (n = 33). Mean effective radiation dose was 0.60 ± 0.07 millisieverts (mSv), 0.19 ± 0.02 mSv, and 0.12 ± 0.01 mSv for the 120-kVp, 80-kVp, and 70-kVp scans, respectively. Conclusion The present study suggests that CAC scoring with reduced peak tube voltage is accurate if kVp-adapted thresholds for calculation of CAC scores are applied while offering a substantial further radiation dose reduction.
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Affiliation(s)
- Christoph Gräni
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Jan Vontobel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Sara Bacanovic
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Michael Messerli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Marvin Grossmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Cathérine Gebhard
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
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Layoun ME, Yang EH, Herrmann J, Iliescu CA, Lopez-Mattei JC, Marmagkiolis K, Budoff MJ, Ferencik M. Applications of Cardiac Computed Tomography in the Cardio-Oncology Population. Curr Treat Options Oncol 2019; 20:47. [PMID: 31056717 PMCID: PMC8772342 DOI: 10.1007/s11864-019-0645-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT The increased risk for cardiovascular events in aging cancer survivors and those undergoing certain chemotherapeutic treatments has raised concern for more rigorous screening and surveillance methods above that of the general population. At this time, there are limited guidelines for how to best manage this vulnerable cohort. Questions regarding timing of screening, choice of imaging modality and risk reduction strategies-especially in those patients with known atherosclerotic disease-remain to be elucidated. Over a decade of case series, retrospective studies and clinical trials have shed light on the evolving role of cardiac computed tomography (CT) in this population, of which there is a relative paucity of data regarding its potential utility in the specific cardio-oncology population. Focusing on ability of cardiac CT to evaluate multiple cardiac and vascular structures, provide diagnostic and prognostic information, as well as assist interventional and surgical colleagues in surgical/percutaneous valve replacement and revascularization strategies is the premise for this review.
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Affiliation(s)
- Michael E Layoun
- Knight Cardiovascular Institute, Division of Cardiology, Department of Medicine, Oregon Health & Science University, 3180 Sam Jackson Park Rd., Mail Code UHN62, Portland, OR, 97239, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Cezar A Iliescu
- Department of Cardiology, Division of Internal Medicine, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Juan C Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kostas Marmagkiolis
- Premier Heart and Vascular Group, Florida Hospital Pepin Heart Institute, Tampa, FL, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Division of Cardiology, Department of Medicine, Oregon Health & Science University, 3180 Sam Jackson Park Rd., Mail Code UHN62, Portland, OR, 97239, USA.
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Symons R, Sandfort V, Mallek M, Ulzheimer S, Pourmorteza A. Coronary artery calcium scoring with photon-counting CT: first in vivo human experience. Int J Cardiovasc Imaging 2019; 35:733-739. [PMID: 30635819 DOI: 10.1007/s10554-018-1499-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/07/2018] [Indexed: 12/17/2022]
Abstract
To evaluate the performance of photon-counting detector (PCD) computed tomography (CT) for coronary artery calcium (CAC) score imaging at standard and reduced radiation doses compared to conventional energy-integrating detector (EID) CT. A dedicated cardiac CT phantom, ten ex vivo human hearts, and ten asymptomatic volunteers underwent matched EID and PCD CT scans at different dose settings without ECG gating. CAC score, contrast, and contrast-to-noise ratio (CNR) were calculated in the cardiac CT phantom. CAC score accuracy and reproducibility was assessed in the ex vivo hearts. Standard radiation dose (120 kVp, reference mAs = 80) in vivo CAC scans were compared against dose-reduced CAC scans (75% dose reduction; reference mAs = 20) for image quality and CAC score reproducibility. Interstudy agreement was assessed by using intraclass correlation (ICC), linear regression, and Bland-Altman analysis with 95% confidence interval limits of agreement (LOA). Calcium-soft tissue contrast and CNR were significantly higher for the PCD CAC scans in the cardiac CT phantom (all P < 0.01). Ex vivo hearts: CAC score reproducibility was significantly higher for the PCD scans at the lowest dose setting (50 mAs) (P = 0.002); score accuracy was similar for both detector systems at all dose settings. In vivo scans: the agreement between standard dose and low dose CAC score was significantly better for the PCD than for the EID with narrower LOA in Bland-Altman analysis, linear regression slopes closer to 1 (0.96 vs. 0.84), and higher ICC values (0.98 vs. 0.93, respectively). Phantom and in vivo human studies showed PCD may significantly improve CAC score image quality and/or reduce CAC score radiation dose while maintaining diagnostic image quality.
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Affiliation(s)
- Rolf Symons
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA.,Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Veit Sandfort
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Marissa Mallek
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Amir Pourmorteza
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA. .,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Radiology and Imaging Sciences, Winship Cancer Institute of Emory University, 1701 Uppergate Drive, Suite 5018A, Atlanta, GA, 30322, USA.
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36
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Dumeer S, Einstein AJ. Coronary calcium scoring of CT attenuation correction scans: Automatic, manual, or visual? J Nucl Cardiol 2018; 25:2144-2147. [PMID: 28741065 DOI: 10.1007/s12350-017-0995-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Shifali Dumeer
- Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew J Einstein
- Department of Medicine, Cardiology Division, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, 622 West 168th Street PH 10-203A, New York, NY, 10032, USA.
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Einstein AJ. Optimizing coronary artery calcium scanning to meet the challenges of population screening. J Cardiovasc Comput Tomogr 2018; 13:303-304. [PMID: 30337275 DOI: 10.1016/j.jcct.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Andrew J Einstein
- Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, United States.
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Suh JW, Yun BL. Breast Arterial Calcification: A Potential Surrogate Marker for Cardiovascular Disease. J Cardiovasc Imaging 2018; 26:125-134. [PMID: 30310879 PMCID: PMC6160812 DOI: 10.4250/jcvi.2018.26.e20] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
Breast arterial calcifications (BAC), frequently observed on screening mammography, have been considered as an incidental finding without increased risk for breast cancer. They are medial calcifications and therefore, are indicative of arteriosclerosis. Previous studies indicated that the risk factors of BAC partly overlap with those of cardiovascular disease (CVD), and the presence of BAC is associated with prevalent and incident CVD. This suggests that medial arterial calcification might contribute to CVD through a pathway distinct from the intimal atherosclerotic process. A recent study showed that the presence and severity of BAC are associated with the presence of coronary artery calcification or plaques on coronary computed tomography angiography in asymptomatic women aged more than 40 years. In addition, BAC provided an independent and incremental predictive value over conventional risk factors. Given that population-based mammography screening is currently recommended in asymptomatic women, the evaluation of BAC may be helpful in identifying high-risk women without additional cost or radiation exposure.
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Affiliation(s)
- Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seongnam, Korea
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Fan R, Shi X, Qian Y, Wang Y, Fan L, Chen R, Xiao Y, Liu S. Optimized categorization algorithm of coronary artery calcification score on non-gated chest low-dose CT screening using iterative model reconstruction technique. Clin Imaging 2018; 52:287-291. [PMID: 30193187 DOI: 10.1016/j.clinimag.2018.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the optimized categorization algorithm of coronary artery calcification score (CACS) for more accurate risk assessment on non-gated chest low-dose CT (LDCT) screening using iterative model reconstruction (IMR) technique. METHODS We enrolled 102 patients who required coronary artery CTA examination and had coronary artery calcification (CAC) in this study. The CACS on non-gated LDCT and ECG-gated CT images were both measured by Agatston analysis software on Philips workstation. RESULTS According to the original algorithm (1-100, 100-400 and >400), the CACS measured by non-gated LDCT scan showed a good agreement with ECG-gated CT scan (weighted kappa value of 0.602, P < 0.05). Two ROC curves were drawn to evaluate the accuracy of CACS categorization. The cutoff values were 87.44 and 255.26 respectively. Based on the best diagnostic cutoff value, the CACS measured by the non-gated LDCT scan showed an excellent agreement with ECG-gated CT scan (weighted kappa value of 0.781, P < 0.05). CONCLUSIONS The CACS on non-gated LDCT may have been underestimated. We therefore developed an optimized categorization algorithm of non-gated CACS in this study.
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Affiliation(s)
- Rongrong Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaolei Shi
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Qian
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Yun Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rutan Chen
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Xiao
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Patel AA, Fine J, Naghavi M, Budoff MJ. Radiation exposure and coronary artery calcium scans in the society for heart attack prevention and eradication cohort. Int J Cardiovasc Imaging 2018; 35:179-183. [PMID: 30084106 DOI: 10.1007/s10554-018-1431-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 01/30/2023]
Abstract
Coronary artery calcium (CAC) scoring is used in asymptomatic patients to improve their clinically predicted risk for future cardiovascular events. Current CT protocols seek to reduce radiation exposure without diminishing image quality. Reported radiation exposure remains widely variable (0.8-5 mSv) depending on the type of protocol. In this study, we report the radiation exposure of CAC scoring from the Society for Heart Attack Prevention and Eradication (SHAPE) early detection program cohort sites, which spanned multiple centers using 64-MDCT (multi-detector computed tomography) scanners. We reviewed radiation exposure in milliSieverts (mSv) for 82,214 participants from the SHAPE early detection program cohort who underwent CAC scoring. This occurred over a 2.5-year period (2012-2014) divided among 33 sites in 7 countries with four different types 64-MDCT scanners. The effective radiation dose was reported as mSv. Mean radiation dosing amongst all 82,214 participants was 1.03 mSv, a median dose of 0.94 mSv. The mean radiation dose ranged from 0.76 to 1.31 mSv across the 33 sites involved with the SHAPE program cohort. Subgroup analysis by age, gender or body mass index (BMI) less than 30 kg/m2 showed no variability. Radiation dose in patients with BMI > 30 kg/m2 were significantly greater than other subgroups (µ = 1.96 mSv, p < 0.001). The use of 64-MDCT scanners and protocols provide the effective radiation dose for CAC scoring, which is approximately 1 mSv. This is consistently lower than previously reported for CAC scanning, regardless of scanner type, age or gender. In contrast, a greater BMI influenced mean radiation doses.
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Affiliation(s)
- Amish A Patel
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.,Riverside School of Medicine Department of Cardiovascular Medicine, University of California, Riverside, CA, USA
| | - Jeffrey Fine
- Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA
| | - Morteza Naghavi
- Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA. .,Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA.
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Tang YC, Liu YC, Hsu MY, Tsai HY, Chen CM. Adaptive Iterative Dose Reduction 3D Integrated with Automatic Tube Current Modulation for CT Coronary Artery Calcium Quantification: Comparison to Traditional Filtered Back Projection in an Anthropomorphic Phantom and Patients. Acad Radiol 2018; 25:1010-1017. [PMID: 29395796 DOI: 10.1016/j.acra.2017.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/20/2017] [Accepted: 12/23/2017] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES We aimed to evaluate integrated adaptive iterative dose reduction 3D (AIDR 3D) algorithm in automatic tube current modulation (ATCM) for the quantification of coronary artery calcium score (CACS) and cardiac risk stratification. MATERIALS AND METHODS A thoracic phantom with calcium inserts of known densities was scanned with filtered back projection (FBP) and AIDR 3D algorithms in small- and medium-sized phantoms. Twenty-four patients underwent two consecutive scans of CACS with FBP and AIDR 3D algorithms. The absolute Agatston score, Agatston score risk, volume score, and Agatston score percentile-based risk were compared, and concordance coefficients and agreement plots were made. RESULTS Agatston and volume scores were significantly different between the phantom sizes (P < .01). There were no significant differences in the Agatston scores between FBP and AIDR 3D for the medium phantoms (P = .25). In the patients, there were no significant differences in Agatston and volume scores between FBP and AIDR 3D (P = .06 and P = .09, respectively). The correlation coefficients of Agatston and volume scores with AIDR 3D were excellent compared to those of FBP. There were no significant differences in Agatston score risk and Agatston score percentile-based risk between FBP and AIDR 3D (P = .74 and P = 1, respectively). There was mean dose reduction of 57.8% ± 18.6% for AIDR 3D. CONCLUSION The absolute Agatston score differed between FBP and AIDR 3D reconstructions. However, the cardiac risk categorizations of the two methods were comparable. An integrated AIDR 3D algorithm with automatic tube current modulation enables radiation dose savings at a consistent noise level without sacrificing CACS.
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De Santis D, Eid M, De Cecco CN, Jacobs BE, Albrecht MH, Varga-Szemes A, Tesche C, Caruso D, Laghi A, Schoepf UJ. Dual-Energy Computed Tomography in Cardiothoracic Vascular Imaging. Radiol Clin North Am 2018; 56:521-534. [PMID: 29936945 DOI: 10.1016/j.rcl.2018.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dual energy computed tomography is becoming increasingly widespread in clinical practice. It can expand on the traditional density-based data achievable with single energy computed tomography by adding novel applications to help reach a more accurate diagnosis. The implementation of this technology in cardiothoracic vascular imaging allows for improved image contrast, metal artifact reduction, generation of virtual unenhanced images, virtual calcium subtraction techniques, cardiac and pulmonary perfusion evaluation, and plaque characterization. The improved diagnostic performance afforded by dual energy computed tomography is not associated with an increased radiation dose. This review provides an overview of dual energy computed tomography cardiothoracic vascular applications.
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Affiliation(s)
- Domenico De Santis
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Marwen Eid
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Moritz H Albrecht
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Lazarettstraße 36, Munich 80636, Germany
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
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Kerut EK, Hall ME, Turner MC, McMullan MR. Coronary risk assessment using traditional risk factors with CT coronary artery calcium scoring in clinical practice. Echocardiography 2018; 35:1216-1222. [DOI: 10.1111/echo.14091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Edmund Kenneth Kerut
- Division of Cardiovascular Disease; Department of Medicine; University of Mississippi School of Medicine; Jackson MS USA
- Heart Clinic of Louisiana; Marrero LA USA
| | - Michael E. Hall
- Division of Cardiovascular Disease; Department of Medicine; University of Mississippi School of Medicine; Jackson MS USA
| | - Michael C. Turner
- Cardiovascular Specialists of Southwest Louisiana; Lake Charles LA USA
| | - Michael R. McMullan
- Division of Cardiovascular Disease; Department of Medicine; University of Mississippi School of Medicine; Jackson MS USA
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Hong JC, Blankstein R, Shaw LJ, Padula WV, Arrieta A, Fialkow JA, Blumenthal RS, Blaha MJ, Krumholz HM, Nasir K. Implications of Coronary Artery Calcium Testing for Treatment Decisions Among Statin Candidates According to the ACC/AHA Cholesterol Management Guidelines: A Cost-Effectiveness Analysis. JACC Cardiovasc Imaging 2018; 10:938-952. [PMID: 28797417 DOI: 10.1016/j.jcmg.2017.04.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 01/08/2023]
Abstract
This review evaluates the cost-effectiveness of using coronary artery calcium (CAC) to guide long-term statin therapy compared with treating all patients eligible for statins according to 2013 American College of Cardiology/American Heart Association cholesterol management guidelines for atherosclerotic cardiovascular disease. The authors used a microsimulation model to compare costs and effectiveness from a societal perspective over a lifetime horizon. Both strategies resulted in similar costs and quality-adjusted life years (QALYs). CAC resulted in increased costs (+$81) and near-equal QALY (+0.01) for an incremental cost-effectiveness ratio of $8,100/QALY compared with the treat-all strategy. For 10,000 patients, the treat-all strategy would theoretically avert 21 atherosclerotic cardiovascular disease events, but would add 47,294 person-years of statins. With CAC costs <$100, and higher cost and/or disutility associated with statin therapy, CAC strategy was favored. These findings suggest the economic value of both approaches were similar. Clinicians should account for individual preferences in context of shared decision making when choosing the most appropriate strategy to guide statin decisions.
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Affiliation(s)
- Jonathan C Hong
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Ron Blankstein
- Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - William V Padula
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Alejandro Arrieta
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Jonathan A Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Khurram Nasir
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland; Center for Health Care Advancement and Outcomes, Baptist Health South Florida, Miami, Florida.
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Bos D, Leening MJG. Leveraging the coronary calcium scan beyond the coronary calcium score. Eur Radiol 2018; 28:3082-3087. [PMID: 29383526 PMCID: PMC5986828 DOI: 10.1007/s00330-017-5264-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
Non-contrast cardiac computed tomography in order to obtain the coronary artery calcium score has become an established diagnostic procedure in the clinical setting, and is commonly employed in clinical and population-based research. This state-of-the-art review paper highlights the potential gain in information that can be obtained from the non-contrast coronary calcium scans without any necessary modifications to the scan protocol. This includes markers of cardio-metabolic health, such as the amount of epicardial fat and liver fat, but also markers of general health including bone density and lung density. Finally, this paper addresses the importance of incidental findings and of radiation exposure accompanying imaging with non-contrast cardiac computed tomography. Despite the fact that coronary calcium scan protocols have been optimized for the visualization of coronary calcification in terms image quality and radiation exposure, it is important for radiologists, cardiologists and medical specialists in the field of preventive medicine to acknowledge that numerous additional markers of cardio-metabolic health and general health can be readily identified on a coronary calcium scan. KEY POINTS • The coronary artery calcium score substantially increased the use of cardiac CT. • Cardio-metabolic and general health markers may be derived without changes to the scan protocol. • Those include epicardial fat, aortic valve calcifications, liver fat, bone density, and lung density. • Clinicians must be aware of this potential additional yield from non-contrast cardiac CT.
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Affiliation(s)
- Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Luhur R, Schuijf JD, Mews J, Blobel J, Hamm B, Lembcke A. Accuracy of coronary artery calcium scoring with tube current reduction by 75%, using an adaptive iterative reconstruction algorithm. Br J Radiol 2018; 91:20170678. [PMID: 29260893 DOI: 10.1259/bjr.20170678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the accuracy of an iterative reconstruction (IR) technique for coronary artery calcium scoring with reduced radiation dose. METHODS 163 consecutive patients underwent twofold scanning by 320-row detector CT at 120 kVp. A low-dose scan at 25% tube current but with standard scan length (14 cm) was followed by a standard dose scan with routine tube current but reduced scan length (10 cm). Reduced dose images were constructed using filtered back-projection (FBP) and IR (adaptive iterative dose reduction in three dimensions). The standard dose scan reconstructed with FBP served as the gold standard for comparisons. Image noise and Agatston coronary calcium scores were determined and compared between the groups. RESULTS Compared with FBP at standard dose, noise at reduced dose increased markedly with FBP but remained low with IR. Mean Agatston score with FBP at reduced dose showed a significant increase as compared with FBP at standard dose. No significant difference was observed when applying IR at reduced dose. At reduced dose, 38 (23.3%) patients were reassigned to a different cardiovascular risk category with FBP but only 8 (4.9%) with IR. Out of 47 patients with a zero Agatston score, 15 patients (31.9%) were false-positive with FBP at reduced dose, but no false positives were found with IR. CONCLUSION IR allows accurate coronary artery calcium scoring with a radiation dose reduced by 75%. Advances in knowledge: The application of adaptive iterative dose reduction in three dimensions allows the maintenance of accurate Agatston scores and risk stratification at significantly reduced tube current, thus reducing the patient's exposure to ionizing radiation.
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Affiliation(s)
- Reny Luhur
- 1 Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Berlin , Germany
| | - Joanne D Schuijf
- 2 Center for Medical Research & Development Europe,Toshiba Medical Systems Europe BV , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Jürgen Mews
- 2 Center for Medical Research & Development Europe,Toshiba Medical Systems Europe BV , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Jörg Blobel
- 2 Center for Medical Research & Development Europe,Toshiba Medical Systems Europe BV , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Bernd Hamm
- 1 Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Berlin , Germany
| | - Alexander Lembcke
- 1 Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Charité - Universitätsmedizin Berlin, Campus Charité Mitte , Berlin , Germany
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Vonder M, van der Aalst CM, Vliegenthart R, van Ooijen PMA, Kuijpers D, Gratama JW, de Koning HJ, Oudkerk M. Coronary Artery Calcium Imaging in the ROBINSCA Trial: Rationale, Design, and Technical Background. Acad Radiol 2018; 25:118-128. [PMID: 28843465 DOI: 10.1016/j.acra.2017.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES To describe the rationale, design, and technical background of coronary artery calcium (CAC) imaging in the large-scale population-based cardiovascular disease screening trial (Risk Or Benefit IN Screening for CArdiovascular Diseases [ROBINSCA]). MATERIALS AND METHODS First, literature search was performed to review the logistics, setup, and settings of previously performed CAC imaging studies, and current clinical CAC imaging protocols of participating centers in the ROBINSCA trial were evaluated. A second literature search was performed to evaluate the impact of computed tomography parameter settings on CAC score. RESULTS Based on literature reviews and experts opinion an imaging protocol accompanied by data management protocol was created for ROBINSCA. The imaging protocol should consist of a fixed tube voltage, individually tailored tube current setting, mid-diastolic electrocardiography-triggering, fixed field-of-view, fixed reconstruction kernel, fixed slice thickness, overlapping reconstruction and without iterative reconstruction. The analysis of scans is performed with one type and version of CAC scoring software, by two dedicated and experienced researchers. The data management protocol describes the organization of data handling between the coordinating center, participating centers, and core analysis center. CONCLUSION In this paper we describe the rationale and technical considerations to be taken in developing CAC imaging protocol, and we present a detailed protocol that can be implemented for CAC screening purposes.
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Affiliation(s)
- Marleen Vonder
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands
| | - Carlijn M van der Aalst
- Erasmus MC-University Medical Centre, Department of Public Health, Rotterdam, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Dirkjan Kuijpers
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; Department of Radiology, Haaglanden Medical Center Bronovo, The Hague, The Netherlands
| | - Jan Willem Gratama
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; Department of Radiology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Harry J de Koning
- Erasmus MC-University Medical Centre, Department of Public Health, Rotterdam, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
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Lemon JA, Phan N, Boreham DR. Multiple CT Scans Extend Lifespan by Delaying Cancer Progression in Cancer-Prone Mice. Radiat Res 2017; 188:495-504. [DOI: 10.1667/rr14575.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jennifer A. Lemon
- Medical Sciences, Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6
| | - Nghi Phan
- Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Canada, L8S 4K1
| | - Douglas R. Boreham
- Medical Sciences, Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6
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Gassenmaier T, Allmendinger T, Kunz AS, Veyhl-Wichmann M, Ergün S, Bley TA, Petritsch B. In vitro evaluation of a new iterative reconstruction algorithm for dose reduction in coronary artery calcium scoring. Acta Radiol Open 2017; 6:2058460117710682. [PMID: 28607763 PMCID: PMC5453409 DOI: 10.1177/2058460117710682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/27/2017] [Indexed: 11/17/2022] Open
Abstract
Background Coronary artery calcium (CAC) scoring is a widespread tool for cardiac risk assessment in asymptomatic patients and accompanying possible adverse effects, i.e. radiation exposure, should be as low as reasonably achievable. Purpose To evaluate a new iterative reconstruction (IR) algorithm for dose reduction of in vitro coronary artery calcium scoring at different tube currents. Material and Methods An anthropomorphic calcium scoring phantom was scanned in different configurations simulating slim, average-sized, and large patients. A standard calcium scoring protocol was performed on a third-generation dual-source CT at 120 kVp tube voltage. Reference tube current was 80 mAs as standard and stepwise reduced to 60, 40, 20, and 10 mAs. Images were reconstructed with weighted filtered back projection (wFBP) and a new version of an established IR kernel at different strength levels. Calcifications were quantified calculating Agatston and volume scores. Subjective image quality was visualized with scans of an ex vivo human heart. Results In general, Agatston and volume scores remained relatively stable between 80 and 40 mAs and increased at lower tube currents, particularly in the medium and large phantom. IR reduced this effect, as both Agatston and volume scores decreased with increasing levels of IR compared to wFBP (P < 0.001). Depending on selected parameters, radiation dose could be lowered by up to 86% in the large size phantom when selecting a reference tube current of 10 mAs with resulting Agatston levels close to the reference settings. Conclusion New iterative reconstruction kernels may allow for reduction in tube current for established Agatston scoring protocols and consequently for substantial reduction in radiation exposure.
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Affiliation(s)
- Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Andreas S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Maike Veyhl-Wichmann
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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