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Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Image quality and radiation dose of ECG-triggered High-Pitch Dual-Source cardiac computed tomography angiography in children for the evaluation of central vascular stents. Int J Cardiovasc Imaging 2019; 35:367-374. [PMID: 30684082 DOI: 10.1007/s10554-019-01539-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Assess image quality and radiation dose of ECG-triggered High-Pitch Dual-Source CTA for the evaluation central vascular stents in children. We included all children ≤ 21 years old with one or more central vascular stents and available prospective ECG-triggered High-Pitch Dual-Source CTA performed at our institution between January 2015 and August 2017. Demographic and scanner information was retrieved. Two board-certified pediatric radiologists blinded to the clinical data, independently reviewed and scored each case using a four-point quality score. Scores 1, 2 and 3 were considered of diagnostic image quality. Inter-observer agreement and non-parametric test were used. 18 patients (10 girls, 8 boys) with a mean age of 9.47 ± 7.38 years (mean ± SD) met inclusion criteria. Thirty-two central vascular stents were evaluated. Mean quality score was 2.07 ± 0.94 with 12.5% (4/32) of the cases classified as unevaluable. Interobserver agreement was excellent (k = 0.86). There is no significant difference between quality score and stent location (p = 0.07). There is a significant difference with stent material as all non-diagnostic scores were only seen in covered stents made of platinum-iridium (p < 0.001). There was no association between image quality and age, height, weight, BSA, heart rate, radiation dose or stent lumen size (p > 0.05). ECG-triggered high-pitch spiral DS-CTA offers appropriate image quality for assessment of central vascular stents in children.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Saul
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Boccalini S, den Harder AM, Witsenburg M, Breur JPJM, Krestin GP, van Beynum IM, Attrach M, Stagnaro N, Marasini M, de Jong PA, Leiner T, Budde RPJ. Computed tomography image quality of aortic stents in patients with aortic coarctation: a multicentre evaluation. Eur Radiol Exp 2018; 2:17. [PMID: 33252748 PMCID: PMC6091724 DOI: 10.1186/s41747-018-0046-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stents are commonly used to treat aortic coarctation. The objective of this study was to evaluate the post-implantation computed tomography (CT) image quality of different stent types used to treat aortic coarctation. METHODS Adult and paediatric patients with stent-treated aortic coarctation who underwent contrast-enhanced CT were retrospectively included from three tertiary care centres. CT scans were subjectively scored for image quality using a 4-point scale (1 = unacceptable; 2 = poor; 3 = good; 4 = excellent). Furthermore, the amount of stent-induced blooming artefacts was measured as the percentage of the difference between outer and inner stent diameters over the outer stent diameter. RESULTS A total of 35 children and 34 adults implanted with 71 stents of six different types were included. The most commonly used stent type was the Cheatham Platinum stent (52 stents, 73%). The subjective image quality of the Cheatham Platinum stents was moderate with a score of 2.0±0.8 (mean ± standard deviation) in children and 2.3±0.6 in adults. The image quality in patients with Formula stents was 2.3±1.2. The Cheatham Platinum stents induced 34-48% blooming, the Formula stents 44-55%. The image quality in patients with the less commonly used Atrium Advanta V12, IntraStent, AndraStent and Palmaz stents was scored 3 (good) to 4 (excellent) with less blooming. The electrocardiographic gating and tube voltage (kVp) did not affect image quality. CONCLUSIONS There is a substantial variation in CT image quality and blooming artefacts for different stent types used to treat aortic coarctation.
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Affiliation(s)
- Sara Boccalini
- Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands.
| | - Annemarie M den Harder
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508GA, Utrecht, The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Johannes P J M Breur
- Department of Pediatric Cardiology, University Medical Center Utrecht, PO Box 85500, 3508GA, Utrecht, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Erasmus Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Mohamed Attrach
- Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Nicola Stagnaro
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Maurizio Marasini
- Department of Cardiology, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508GA, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508GA, Utrecht, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
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den Harder AM, Suchá D, van Doormaal PJ, Budde RPJ, de Jong PA, Schilham AMR, Breur JMPJ, Leiner T. Radiation dose reduction in pediatric great vessel stent computed tomography using iterative reconstruction: A phantom study. PLoS One 2017; 12:e0175714. [PMID: 28410386 PMCID: PMC5391930 DOI: 10.1371/journal.pone.0175714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/30/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To study dose reduction using iterative reconstruction (IR) for pediatric great vessel stent computed tomography (CT). METHODS Five different great vessel stents were separately placed in a gel-containing plastic holder within an anthropomorphic chest phantom. The stent lumen was filled with diluted contrast gel. CT acquisitions were performed at routine dose, 52% and 81% reduced dose and reconstructed with filtered back projection (FBP) and IR. Objective image quality in terms of noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) as well as subjective image quality were evaluated. RESULTS Noise, SNR and CNR were improved with IR at routine and 52% reduced dose, compared to FBP at routine dose. The lowest dose level resulted in decreased objective image quality with both FBP and IR. Subjective image quality was excellent at all dose levels. CONCLUSION IR resulted in improved objective image quality at routine dose and 52% reduced dose, while objective image quality deteriorated at 81% reduced dose. Subjective image quality was not affected by dose reduction.
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Affiliation(s)
- Annemarie M. den Harder
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - Dominika Suchá
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | | | - Pim A. de Jong
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Arnold M. R. Schilham
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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den Harder AM, Suchá D, van Hamersvelt RW, Budde RPJ, de Jong PA, Schilham AMR, Bos C, Breur JMPJ, Leiner T. Imaging of pediatric great vessel stents: Computed tomography or magnetic resonance imaging? PLoS One 2017; 12:e0171138. [PMID: 28141852 PMCID: PMC5283725 DOI: 10.1371/journal.pone.0171138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
Background Complications might occur after great vessel stent implantation in children. Therefore follow-up using imaging is warranted. Purpose To determine the optimal imaging modality for the assessment of stents used to treat great vessel obstructions in children. Material and methods Five different large vessel stents were evaluated in an in-vitro setting. All stents were expanded to the maximal vendor recommended diameter (20mm; n = 4 or 10mm; n = 1), placed in an anthropomorphic chest phantom and imaged with a 256-slice CT-scanner. MRI images were acquired at 1.5T using a multi-slice T2-weighted turbo spin echo, an RF-spoiled three-dimensional T1-weighted Fast Field Echo and a balanced turbo field echo 3D sequence. Two blinded observers assessed stent lumen visibility (measured diameter/true diameter *100%) in the center and at the outlets of the stent. Reproducibility of diameter measurements was evaluated using the intraclass correlation coefficient for reliability and 95% limits of agreement for agreement analysis. Results Median stent lumen visibility was 88 (IQR 86–90)% with CT for all stents at both the center and outlets. With MRI, the T2-weighted turbo spin echo sequence was preferred which resulted in 82 (78–84%) stent lumen visibility. Interobserver reliability and agreement was good for both CT (ICC 0.997, mean difference -0.51 [-1.07–0.05] mm) and MRI measurements (ICC 0.951, mean difference -0.05 [-2.52 –-2.41] mm). Conclusion Good in-stent lumen visibility was achievable in this in-vitro study with both CT and MRI in different great vessel stents. Overall reliability was good with clinical acceptable limits of agreement for both CT and MRI. However, common conditions such as in-stent stenosis and associated aneurysms were not tested in this in-vitro study, limiting the value of the in-vitro study.
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Affiliation(s)
- A. M. den Harder
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - D. Suchá
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - R. W. van Hamersvelt
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - R. P. J. Budde
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P. A. de Jong
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - A. M. R. Schilham
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - C. Bos
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - J. M. P. J. Breur
- Department of Pediatric Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - T. Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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Sunidja AP, Prabhu SP, Lee EY, Sena L. 64-Row-MDCT Evaluation of Postoperative Congenital Heart Disease in Children: Review of Technique and Imaging Findings. Semin Roentgenol 2012; 47:66-78. [DOI: 10.1053/j.ro.2011.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dual-Source CT Angiography of Peripheral Arterial Stents: In Vitro Evaluation of 22 Different Stent Types. Radiol Res Pract 2011; 2011:103873. [PMID: 22091369 PMCID: PMC3195368 DOI: 10.1155/2011/103873] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. To test different peripheral arterial stents using four image reconstruction approaches with respect to lumen visualization, lumen attenuation and image noise in dual-source multidetector row CT (DSCT) in vitro. Methods and Materials. 22 stents (nitinol, steel, cobalt-alloy, tantalum, platinum alloy) were examined in a vessel phantom. All stents were imaged in axial orientation with standard parameters. Image reconstructions were obtained with four different convolution kernels. To evaluate visualization characteristics of the stent, the lumen diameter, intraluminal density and noise were measured. Results. The mean percentage of the visible stent lumen diameter from the nominal stent diameter was 74.5% ± 5.7 for the medium-sharp kernel, 72.8% ± 6.4 for the medium, 70.8% ± 6.4 for the medium-smooth and 67.6% ± 6.6 for the smooth kernel. Mean values of lumen attenuation were 299.7HU ± 127 (medium-sharp), 273.9HU ± 68 (medium), 270.7HU ± 53 (medium-smooth) and 265.8HU ± 43. Mean image noise was: 54.6 ± 6.3, 20.5 ± 1.7, 16.3 ± 1.7, 14.0 ± 2 respectively. Conclusion. Visible stent lumen diameter varies depending on stent type and scan parameters. Lumen diameter visibility increases with the sharpness of the reconstruction kernel. Smoother kernels provide more realistic density measurements inside the stent lumen and less image noise.
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Tyner D, Reese DJ, Maisenbacher HW. Computed tomography angiography of bilateral peripheral pulmonary arterial stenoses in a dog. J Vet Cardiol 2011; 13:57-62. [DOI: 10.1016/j.jvc.2010.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 10/13/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
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Valverde I, Parish V, Hussain T, Rosenthal E, Beerbaum P, Krasemann T. Planning of catheter interventions for pulmonary artery stenosis: Improved measurement agreement with magnetic resonance angiography using identical angulations. Catheter Cardiovasc Interv 2011; 77:400-8. [DOI: 10.1002/ccd.22695] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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MRI may be sufficient for noninvasive assessment of great vessel stents: an in vitro comparison of MRI, CT, and conventional angiography. AJR Am J Roentgenol 2010; 195:865-71. [PMID: 20858811 DOI: 10.2214/ajr.09.4166] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the diagnostic performance of MRI and CT assessment of great vessel stents in an in vitro model. MATERIALS AND METHODS Three contemporary great vessel stent materials (nitinol, platinum-iridium, and stainless steel) were assessed with three luminal conditions: no stenosis, internal stenosis, and external stenosis. Stents of the same material were implanted into an aorta model that was attached to an animal bypass pump with pulsatile flow. Each stent was imaged with conventional angiography as reference standard, 10 different MRI sequences, and CT. The sensitivity and specificity for the identification of stent stenosis was determined and stent lumen measurements compared. RESULTS Of the investigated MRI sequences, three had the highest overall sensitivity and specificity for the identification of stent stenosis in all studied materials: through-plane gradientrecalled echo (GRE) with 75° flip angle (100% and 95%, respectively), in- and through-plane steady-state free precession (SSFP) (99% and 90%) and MR angiography (MRA) with 75° flip angle (93% and 85%). Comparable sensitivity and specificity were achieved with CT (98% and 93%). GRE, SSFP, and MRA sequences tended to underestimate stent lumen diameter in externally nonstenosed stents and overestimate diameter in internally stenosed stents (p < 0.05). CT slightly underestimated external stenoses in all stent types (p < 0.05). CONCLUSION Defined MRI sequences are feasible to assess nitinol, platinum-iridium, and stainless steel great vessel stents with diagnostic performance comparable with CT.
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Brown DW, Powell AJ, Geva T. Imaging complex congenital heart disease — functional single ventricle, the Glenn circulation and the Fontan circulation: A multimodality approach. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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