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Tekinhatun M, Akbudak İ, Özbek M, Turmak M. Comparison of coronary CT angiography and invasive coronary angiography results. Ir J Med Sci 2024; 193:2239-2248. [PMID: 38965116 DOI: 10.1007/s11845-024-03745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Coronary artery disease (CAD) is a leading cause of death worldwide. Accurate diagnosis and management are critical. Non-invasive imaging, such as coronary computed tomography angiography (CCTA), is vital for early diagnosis and treatment planning. This study evaluates the accuracy of CAD-Reporting and Data System (CAD-RADS) scoring and the compatibility between CCTA and invasive coronary angiography (ICA) in patients suspected of having CAD. MATERIALS AND METHODS From January 1, 2022 to January 15, 2024, 214 patients suspected of CAD underwent both CCTA and ICA. CCTA artifacts led to the exclusion of 32 patients and 128 vessels, leaving 586 vessels for analysis. CAD-RADS scoring categorized coronary stenosis. Diagnostic performance was measured by specificity, sensitivity, accuracy, positive and negative predictive value (NPV). Extracardiac findings were analyzed with a wide field of view (FOV) during CCTA. RESULTS A total of 214 patients (67.3% male, median age 56) were examined. Hypertension, smoking, calcium score, and high-risk plaques correlated with CCTA and ICA CAD-RADS scores; calcium score also related to hypertension, smoking, diabetes, and dyslipidemia (p < 0.05). CCTA showed a sensitivity of 80.8% and NPV of 90.3% for detecting stenosis of 70% or more; for 50% stenosis, sensitivity was 93.5% and NPV 92.1%. Agreement between CCTA and ICA was excellent in bypass patients; stenosis detection in stented patients had 85.7% sensitivity and 96.2% NPV. CONCLUSION This study highlights the importance of CAD-RADS and CCTA in CAD diagnosis and treatment planning. CCTA effectively evaluates stents and grafts, emphasizing the benefits of extracardiac findings and a wide FOV.
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Affiliation(s)
- Muhammed Tekinhatun
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye.
| | - İbrahim Akbudak
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye
| | - Mehmet Özbek
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye
| | - Mehmet Turmak
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye
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Abdelkarim A, Roy SK, Kinninger A, Salek A, Baranski O, Andreini D, Pontone G, Conte E, O’Rourke R, Hamilton-Craig C, Budoff MJ. Evaluation of Image Quality for High Heart Rates for Coronary Computed Tomographic Angiography with Advancement in CT Technology: The CONVERGE Registry. J Cardiovasc Dev Dis 2023; 10:404. [PMID: 37754833 PMCID: PMC10532141 DOI: 10.3390/jcdd10090404] [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: 04/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE This study aims to evaluate image quality in patients with heart rates above or equal to 70 beats per minute (bpm), performed on a 16 cm scanner (256-slice General Electric Revolution) in comparison to a CT scanner with only 4 cm of coverage (64 slice Volume CT). BACKGROUND Recent advancements in image acquisition, such as whole-heart coverage in a single rotation and post-processing methods in coronary computed tomographic angiography (CCTA), include motion-correction algorithms, such as SnapShot Freeze (SSF), which improve temporal resolution and allow for the assessment of coronary artery disease (CAD) with lower motion scores and better image qualities. Studies from the comprehensive evaluation of high temporal- and spatial-resolution cardiac CT using a wide coverage system (CONVERGE) registry (a multicenter registry at four centers) have shown the 16 cm CT scanner having a better image quality in comparison to the 4 cm scanner. However, these studies failed to include patients with undesirable or high heart rates due to well-documented poor image acquisition on prior generations of CCTA scanners. METHODS A prospective, observational, multicenter cohort study comparing image quality, quantitively and qualitatively, on scans performed on a 16 cm CCTA in comparison to a cohort of images captured on a 4 cm CCTA at four centers. Participants were recruited based on broad inclusion criteria, and each patient in the 16 cm CCTA arm of the study received a CCTA scan using a 256-slice, whole-heart, single-beat scanner. These patients were then matched by age, gender, and heart rate to patients who underwent CCTA scans on a 4 cm CT scanner. Image quality was graded based on the signal-to-noise ratio, contrast-to-noise ratio, and on a Likert scale of 0-4: 0, very poor-4, excellent. RESULTS 104 patients were evaluated for this study. The mean heart rate was 75 ± 7 in the 4 cm scanner and 75 ± 7 in the 16 cm one (p = 0.426). The signal-to-noise and contrast-to-noise ratios were higher in the 16 cm scanner (p = 0.0001). In addition, more scans were evaluated as having an excellent quality on the 16 cm scanner than on the 4 cm scanner (p < 0.0001) based on a 4-point Likert scale. CONCLUSIONS The 16 cm scanner has a superior image quality for fast heart rates compared to the 4 cm scanner. This study shows that there is a significantly higher frequency of excellent and good studies showing better contrast-to-noise and signal-to-noise ratios with the 16 cm scanner compared to the 4 cm scanner.
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Affiliation(s)
- Ayman Abdelkarim
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Sion K. Roy
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - April Kinninger
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Azadeh Salek
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Olivia Baranski
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy (G.P.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20126 Milan, Italy
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy (G.P.)
| | - Rachael O’Rourke
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, 4032 QLD, Australia (C.H.-C.)
| | - Christian Hamilton-Craig
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, 4032 QLD, Australia (C.H.-C.)
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
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Urbanowicz T, Michalak M, Komosa A, Olasińska-Wiśniewska A, Filipiak KJ, Tykarski A, Jemielity M. Predictive value of systemic inflammatory response index (SIRI) for complex coronary artery disease occurrence in patients presenting with angina equivalent symptoms. Cardiol J 2023; 31:583-595. [PMID: 37314004 PMCID: PMC11374332 DOI: 10.5603/cj.a2023.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Currently, atherosclerotic cardiovascular disease is the major cause of mortality world-wide. Inflammatory processes are postulated to be a major driving force for coronary plaque initiation and progression and can be evaluated by simple inflammatory markers from whole blood count analysis. Among hematological indexes, systemic inflammatory response index (SIRI) is defined as a quotient of neutrophils and monocytes, divided by lymphocyte count. The aim of the present retrospective analysis was to present the predictive role of SIRI for coronary artery disease (CAD) occurrence. METHODS There were 256 patients (174 [68%] men and 82 [32%] women) in the median (Q1-Q3) age of 67 (58-72) years enrolled into retrospective analysis due to angina pectoris equivalent symptoms. A model for predicting CAD was created based on demographic data and blood cell parameters reflecting an inflammatory response. RESULTS In patients with single/complex coronary disease the logistic regression multivariable analysis revealed predictive value of male gender (odds ratio [OR]: 3.98, 95% confidence interval [CI]: 1.38-11.42, p = 0.010), age (OR: 5.57, 95% CI: 0.83-0.98, p = 0.001), body mass index (OR: 0.89, 95% CI: 0.81-0.98, p = 0.012), and smoking (OR: 3.66, 95% CI: 1.71-18.22, p = 0.004). Among laboratory parameters, SIRI (OR: 5.52, 95% CI: 1.89-16.15, p = 0.029) and red blood cell distribution width (OR: 3.66, 95% CI: 1.67-8.04, p = 0.001) were found significant. CONCLUSIONS Systemic inflammatory response index, a simple hematological index, may be helpful in patients with angina equivalent symptoms to diagnose CAD. Patients presenting with SIRI above 1.22 (area under the curve: 0.725, p < 0.001) have a higher probability of single and complex coronary disease.
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Affiliation(s)
- Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland.
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Komosa
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
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Azhar AZ, Rai D, Bandyopadhyay D, Rzechorzek W, Akhtar T, Aronow WS, Ranjan P. Use of coronary artery calcium and coronary tomography angiography in the evaluation of ischemic heart disease. Hosp Pract (1995) 2022; 50:9-16. [PMID: 35037541 DOI: 10.1080/21548331.2022.2030630] [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: 10/19/2022]
Abstract
Over the years, significant technological advances have been made in the field of cardiac CT imaging which has led to the widespread use of the modality in the evaluation of ischemic and structural heart disease. The advent of newer scanning techniques has led to a reduction in scanning time as well as a reduction in the radiation and contrast media dose required - making these scans both convenient and safer to perform. Research has shown that coronary CT angiography has a high negative predictive value in the evaluation of patients with coronary artery disease. There is more recent evidence that coronary CTA has a positive impact on clinical outcomes as well. In this review article, we discuss the clinical applications of coronary CTA in the evaluation of patients with stable ischemic heart disease, the most recent studies evaluating the efficacy and limitations of the modality, the role of coronary calcium in cardiovascular risk prediction in asymptomatic patients and the future applications of the modality.
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Affiliation(s)
| | - Devesh Rai
- Department of Cardiology, Rochester General Hospital, Rochester, NY, USA
| | | | - Wojciech Rzechorzek
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Tauseef Akhtar
- Medicine, John's Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Pragya Ranjan
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
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Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P. CAD-RADS: Pushing the Limits. Radiographics 2020; 40:629-652. [PMID: 32281902 DOI: 10.1148/rg.2020190164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography is now established as the first-line diagnostic imaging test to exclude coronary artery disease (CAD) in the population at low to intermediate risk. Wide variability exists in both the reporting of coronary CT angiography and the interpretation of these reports by referring physicians. The CAD Reporting and Data System (CAD-RADS) is sponsored by multiple societies and is a collaborative effort to provide standard classification of CAD, which is then integrated into patient clinical care. The main goals of the CAD-RADS are to decrease variability among readers; enhance communication between interpreting and referring clinicians, allowing collaborative determination of the best course of patient care; and generate consistent data for auditing, data mining, quality improvement, research, and education. There are several scenarios in which the CAD-RADS guidelines are ambiguous or do not provide definite recommendations for further management of CAD. The authors discuss the CAD-RADS categories and modifiers, highlight a variety of complex or ambiguous scenarios, and provide recommendations for managing these scenarios. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Aviram and Wolak.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Luis Landeras
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
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Patel N, Li D, Nakanishi R, Fatima B, Andreini D, Pontone G, Conte E, O'Rourke R, Jayawardena E, Hamilton-Craig C, Nimmagadda M, Budoff MJ. Comparison of Whole Heart Computed Tomography Scanners for Image Quality Lower Radiation Dosing in Coronary Computed Tomography Angiography: The CONVERGE Registry. Acad Radiol 2019; 26:1443-1449. [PMID: 30683612 DOI: 10.1016/j.acra.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Novel technology in coronary computed tomographic angiography allows assessment of coronary artery disease with high image quality (IQ). There are currently two wide detector "whole heart" coverage scanners available, which avoid misregistration artifacts. However, there are no data directly comparing IQ between the two scanners. The aim of the current study is to investigate if IQ is different between the most scanners of GE and Toshiba broad detector scanners. MATERIALS AND METHODS Prospective, observational, multicenter international cohort study comparing 236 consecutive patients who underwent coronary computed tomographic angiography using whole-heart scanners; 126 patients on scanner S1 ( Aquilion ONE Vision, Toshiba), and 110 patients on scanner S2 (Revolution CT, GE Healthcare). Hounsfield units were measured using regions of interest in the descending aorta at 6 points (cranial slice, level of the visualized first, second, third, and fourth spines, and the caudal slice). We also compared the coverage length (z-axis) of the full width field of view between a single rotation of the two scanners. RESULTS Evaluating mean CT attenuation values Hounsfield units through the scan range, are progressively reduced across the descending aorta in the S1 group, resulting in the larger difference of contrast brightness between the cranial and caudal slices compared to the S2 group (absolute difference: S2 13.0 ± 4.4 vs S1 141.9 ± 16.4, p < 0.0001; Percent difference: 19.3 ± 2.1 vs -3.4 ± 1.2, <0.0001). The standard deviation (SD) is similar at the cranial slice between the two scanners, however, the S1 group demonstrated higher SD-differential from cranial to caudal than S2 group. Median radiation exposure was significantly lower for the S2 scanner 1.50 ± 0.75 mSv vs the S1 system 1.9 mSv (IQR 1.7-2.7 mSv) (p = 0.01). Z-axis coverage was larger for the S2 scanner 152.5 mm (244 slices × 0.625 mm/slice) than 133 mm for S1 (266 slices × 0.5 mm/slice). CONCLUSION Although both "volume" scanners cover the whole heart z-axis with one beat, scans using the S1 scanner have a larger variability in attenuation values throughout the scan range, resulting in 20% increase in nonuniformity from cranial to caudal slice. Additionally, SD variation across the field of view, a metric of noise, is larger when using the S1 scanner vs the S2 scanner. These results indicate that the GE Revolution CT has more uniform contrast enhancement and more coverage, lower radiation and lower image noise compared to the Toshiba Aquilion ONE Vision system.
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Affiliation(s)
- Nirali Patel
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Dong Li
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Rine Nakanishi
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA; Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Badiha Fatima
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
| | | | | | - Rachael O'Rourke
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Eranthi Jayawardena
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Christian Hamilton-Craig
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Manojna Nimmagadda
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA.
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Diagnostic performance of a fast non-invasive fractional flow reserve derived from coronary CT angiography: an initial validation study. Clin Radiol 2019; 74:973.e1-973.e6. [PMID: 31537312 DOI: 10.1016/j.crad.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/19/2019] [Indexed: 11/23/2022]
Abstract
AIM To validate the computed tomography (CT)-derived fractional flow reserve (FFRCT) that was computed by new, fast, automatic software and to compare the diagnostic accuracy between FFRCT and stenosis diagnosed at coronary CT angiography (CCTA). MATERIALS AND METHODS A total of 110 patients (76 males, 59±9 years) and 125 vessels underwent CCTA. FFRCT was computed by fast automatic software and compared with invasive FFR. The diagnostic performance between FFRCT and CCTA-diagnosed stenosis were compared on the per-patient and per-vessel level. RESULTS The computational time of FFRCT is 10±5 minutes (averaged over 125 vessels). The FFRCT has a good correlation with invasive FFR (r=0.59, p<0.0001) with a small bias of -0.02 (-0.26-0.23). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FFRCT were 76.5, 89.5, 89.7, and 76.1% on a vessel level. The area under the receiver operating characteristic curve of FFRCT was higher than CCTA-diagnosed stenosis (0.82 versus 0.72, P=0.034). CONCLUSION The computation of FFRCT is possible and reliable when using the new, fast, automatic software first employed in the present clinical study. The FFRCT has a good correlation with invasive FFR and provides better diagnostic performance than CCTA-diagnosed stenosis.
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Initial exploration of coronary stent image subtraction using dual-layer spectral CT. Eur Radiol 2019; 29:4239-4248. [PMID: 30666447 DOI: 10.1007/s00330-018-5990-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aimed to investigate the feasibility of coronary stent image subtraction using spectral tools derived from dual-layer spectral computed tomography (CT). METHODS Forty-three patients (65 stents) who underwent coronary CT angiography using dual-layer spectral CT were included. Conventional, 50-keV (kilo electron-volt), 100-keV, and virtual non-contrast (VNC) images were reconstructed from the same cardiac phase. Stents were subtracted on VNC images from conventional (convsub), 100-keV (100-keVsub), and 50-keV (50-keVsub) images. The in-stent lumen diameters were measured on subtraction, conventional, and 100-keV images. Subjective evaluation of reader confidence and subtractive quality was evaluated. Friedman tests were performed to compare in-stent lumen diameters and subjective evaluation among different images. Correlation between stent diameter and subjective evaluation was expressed as Spearman's rank correlation coefficient (rs). The diagnostic accuracy was assessed according to invasive coronary angiography (ICA) performed in 11 patients (20 stents). RESULTS In-stent lumen diameters were significantly larger on subtraction images than those on conventional and 100-keV images (p < 0.05). Higher reader confidence was found on 100-keV, convsub, 100-keVsub, and 50-keVsub images compared with conventional images (p < 0.05). Subtractive quality of 100-keVsub images was better than that of convsub images (p = 0.037). A moderate-to-strong correlation between stent diameter and subjective evaluation was found (rs = 0.527~0.790, p < 0.05). Higher specificity, positive predictive value, and negative predictive value of subtraction images were shown by ICA results. CONCLUSIONS Subtraction images derived from dual-layer spectral CT enhanced in-stent lumen visibility and could potentially improve diagnostic performance for evaluating coronary stents. KEY POINTS • Dual-layer spectral CT enabled good subtractive quality of coronary stents without misregistration artifacts. • Subtraction images could improve in-stent lumen visibility. • Reader confidence and diagnostic performance were enhanced with subtraction images.
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Gambre AS, Liew C, Hettiarachchi G, Lee SSG, MacDonald M, Kam CJW, Poh ACC. Accuracy and clinical outcomes of coronary CT angiography for patients with suspected coronary artery disease: a single-centre study in Singapore. Singapore Med J 2018; 59:413-418. [PMID: 30175374 DOI: 10.11622/smedj.2018096] [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: 11/18/2022]
Abstract
INTRODUCTION This study aimed to assess the accuracy and outcomes of coronary computed tomography angiography (CCTA) performed in a regional hospital in Singapore. METHODS The Changi General Hospital CCTA database was retrospectively analysed over a 24-month period. Electronic hospital records, catheter coronary angiography (CCA) and CCTA electronic databases were used to gather data on major adverse cardiovascular events (MACE) and CCA results. CCTA findings were deemed positive if coronary artery stenosis ≥ 50% was reported or if the stenosis was classified as moderate or severe. CCA findings were considered positive if coronary artery stenosis ≥ 50% was reported. RESULTS The database query returned 679 patients who had undergone CCTA for the evaluation of suspected coronary artery disease. Of the 101 patients in the per-patient accuracy analysis group, there were six true negatives, one false negative, 81 true positives and 13 false positives, resulting in a negative predictive value of 85.7% and positive predictive value of 86.2%. The mean age of the study sample was 53 ± 13 years and 255 (37.6%) patients were female. Mean duration of patient follow-up was 360 days. Of the 513 negative CCTA patients, none developed MACE during the follow-up period, and of the 164 positive CCTA patients, 19 (11.6%) developed MACE (p < 0.001). CONCLUSION Analysis of CCTA studies suggested accuracy and outcomes that were consistent with published clinical data. There was a one-year MACE-free warranty period following negative CCTA findings.
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Affiliation(s)
| | - Charlene Liew
- Department of Radiology, Changi General Hospital, Singapore
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Kočka V, Toušek P, Widimský P. Absorb bioresorbable stents for the treatment of coronary artery disease. Expert Rev Med Devices 2016; 12:545-57. [PMID: 26305838 DOI: 10.1586/17434440.2015.1080119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bioresorbable stents are considered to be the 'fourth revolution' in percutaneous coronary intervention. The first clinically available Absorb(®) bioresorbable device is made of poly-l-lactic acid polymer and elutes everolimus. The process of bioresorption is completed in 3 years. The introduction of this device into clinical practice went through several logical phases: first-in-man studies, randomized Absorb II study with moderately complex patients and lesions, registries of real life patient population and reports of challenging cases. The procedural results are excellent; many insights have been gained by intracoronary imaging. Intermediate-term outcomes are very encouraging both from imaging and from clinical perspectives. The issue of increased stent thrombosis rate was raised in one study, but other studies have been reassuring. Excellent lesion preparation, sizing and complete expansion of the Absorb device are crucial for optimal procedural and clinical results. Results of ongoing large randomized studies will determine the future role of this technology.
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Affiliation(s)
- Viktor Kočka
- a Cardiocentre, Third Medical Faculty, Charles University in Prague, Ruská 87, Prague 10, 100 00, Czech Republic
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