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Hassan A, Nazir SA, Alkadhi H. Technical challenges of coronary CT angiography: Today and tomorrow. Eur J Radiol 2011; 79:161-71. [PMID: 20227210 DOI: 10.1016/j.ejrad.2010.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 02/14/2010] [Accepted: 02/17/2010] [Indexed: 11/27/2022]
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Dougeni E, Faulkner K, Panayiotakis G. A review of patient dose and optimisation methods in adult and paediatric CT scanning. Eur J Radiol 2011; 81:e665-83. [PMID: 21684099 DOI: 10.1016/j.ejrad.2011.05.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 12/14/2022]
Abstract
An increasing number of publications and international reports on computed tomography (CT) have addressed important issues on optimised imaging practice and patient dose. This is partially due to recent technological developments as well as to the striking rise in the number of CT scans being requested. CT imaging has extended its role to newer applications, such as cardiac CT, CT colonography, angiography and urology. The proportion of paediatric patients undergoing CT scans has also increased. The published scientific literature was reviewed to collect information regarding effective dose levels during the most common CT examinations in adults and paediatrics. Large dose variations were observed (up to 32-fold) with some individual sites exceeding the recommended dose reference levels, indicating a large potential to reduce dose. Current estimates on radiation-related cancer risks are alarming. CT doses account for about 70% of collective dose in the UK and are amongst the highest in diagnostic radiology, however the majority of physicians underestimate the risk, demonstrating a decreased level of awareness. Exposure parameters are not always adjusted appropriately to the clinical question or to patient size, especially for children. Dose reduction techniques, such as tube-current modulation, low-tube voltage protocols, prospective echocardiography-triggered coronary angiography and iterative reconstruction algorithms can substantially decrease doses. An overview of optimisation studies is provided. The justification principle is discussed along with tools that assist clinicians in the decision-making process. There is the potential to eliminate clinically non-indicated CT scans by replacing them with alternative examinations especially for children or patients receiving multiple CT scans.
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Affiliation(s)
- E Dougeni
- Imaging Physics and Radiation Safety Section, Regional Medical Physics Department, Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, UK.
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Leschka S, Feuchtner G, Goetti R, Alkadhi H. Computed tomography of the coronary arteries in diagnosis. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2010; 4:171-183. [PMID: 23484449 DOI: 10.1517/17530051003657654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
IMPORTANCE OF THE FIELD Cardiac computed tomography (CT) has recently emerged as a non-invasive alternative to catheter angiography for the assessment of coronary artery disease. Rapid technological advances have rendered coronary CT angiography to a robust, accurate and fast imaging modality to assess coronary artery disease in selected patients. The list of further indications in which cardiac CT is an appropriate test remains a topic of discussion. AREAS COVERED IN THIS REVIEW This review discusses the main literature available on the use of cardiac CT in the indications considered appropriate in the 2006 Appropriateness Criteria by the American College of Radiology with special emphasis on the temporal trends in the utilization of cardiac CT in clinical practice and in the opinion of the experts, and provides an outlook on how cardiac CT might evolve in the future. WHAT THE READER WILL GAIN The reader will gain insight into the strengths and shortcomings of CT of the coronary arteries in coronary artery diagnosis and will learn why cardiac CT is appropriate in some indications but not in others. TAKE HOME MESSAGE Recent research in cardiac CT has substantially improved the evaluation of the coronary arteries with CT, and the list of indications cardiac CT is appropriate for might expand further in the coming years.
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Affiliation(s)
- Sebastian Leschka
- University Hospital Zurich, Institute of Diagnostic Radiology, Zurich, CH-8091, Switzerland
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Abstract
There are multiple imaging modalities currently available to noninvasively evaluate the heart and coronary arteries. Choosing the most appropriate modality depends on the pertinent clinical question and the underlying patient characteristics. This article provides an overview of the fields of echocardiography, myocardial perfusion imaging, cardiac computed tomography, and cardiac magnetic resonance imaging, with particular attention to specific clinical applications for cardiac surgery patients.
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Heyer CM, Hansmann J, Peters SA, Lemburg SP. Paediatrician awareness of radiation dose and inherent risks in chest imaging studies--a questionnaire study. Eur J Radiol 2009; 76:288-93. [PMID: 19581064 DOI: 10.1016/j.ejrad.2009.06.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 06/07/2009] [Accepted: 06/10/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess paediatricians' knowledge regarding radiation exposure of chest imaging. MATERIALS AND METHODS German paediatricians were surveyed using a questionnaire. Participants were asked to estimate effective dose (ED) of radiographs (CR) and computed tomography (CT). Further questions included dose-saving of paediatric CT-protocols, ALARA principle, and awareness of the link between radiation and cancer development. Length and type of occupation and amount of ordered procedures were evaluated. RESULTS 137 paediatricians participated with 59% and 39% correctly estimating ED of an adult (0.01-0.1mSv) and newborn CR (0.01-0.1mSv), respectively. ED of an adult chest CT (1-10mSv) was underestimated by 28%, whereas ED of cardiac CT (10-100mSv) was underestimated by 54%. 35% of participants correctly estimated ED of a chest CT in an infant (10-100mSv) which was underestimated by 56%. Neither length nor type of occupation showed significant impact on dose estimations. 14% of paediatricians stated that MRI causes radiation, whereas 4% correctly estimated the potential of paediatric CT-protocols. 15% were familiar with the ALARA principle and 26% were aware of a publication concerning radiation and malignancy. CONCLUSION Paediatricians demonstrated an increased level of awareness compared to previous surveys. However, estimation of ED of CT remained difficult. Increased information transfer and education seem pressing in the light of increasing radiological examinations.
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Affiliation(s)
- Christoph M Heyer
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum, Buerkle-de-la-Camp Platz 1, Bochum, Germany.
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Abstract
Multidetector computed tomography has come a long way in a short time, quickly becoming a standard tool in the cardiac imaging armamentarium. The promise of plaque imaging, combined with both anatomical visualization and stenosis detection, has made this a preferred first line test of many cardiologists and radiologists. This test is well suited to rule out coronary artery disease (obstruction) and still diagnosing subclinical plaque, with may be a good target for anti-atherosclerotic therapies. There has been recent criticism against CT imaging, and cardiac CT specifically, due to the high radiation doses that being employed. New advances have allowed for dramatic dose reductions. These include more routinely performed methods such as dose modulation, and newer methods such as prospective gating or minimizing the field of view. This paper will review the different applications to reduce cardiac CT radiation doses to nominal levels, potentially expanding the applications of cardiac CT by removing one of the biggest barriers.
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Dose reduction and image quality assessment in 64-detector row computed tomography of the coronary arteries using an automatic exposure control system. J Comput Assist Tomogr 2008; 32:668-78. [PMID: 18830094 DOI: 10.1097/rct.0b013e31815ea873] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate dose reduction and image quality in coronary 64-slice multidetector computed tomography using an automatic exposure control system (AECs). METHODS A total of 101 patients were divided into 4 groups. Tube current was 600 and 800 mAs in groups A and B and adapted at 600 and 800 quality-reference mAs using an AECs in groups C and D. Effective dose and organ-equivalent dose were evaluated. Image noise was quantified as standard deviation of air-space attenuation. Two observers assessed technical adequacy and image quality using a 4-point scale. RESULTS Effective dose ranged from 8.6 mSv (group C) to 15 mSv (group B) with significant dose reduction for examinations performed at 600 mAs (21.7%) and 800 mAs (29.4%). Contribution of organ-equivalent doses showed higher exposure for lungs (42%) and breast (22%). Noise was significantly higher in groups studied with AECs. Larger coronary segments resulted in higher image quality scores without differences between groups. CONCLUSION Automatic exposure control systems provides images of diagnostic quality with substantial dose reduction.
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Catalano C, Francone M, Ascarelli A, Mangia M, Iacucci I, Passariello R. Optimizing radiation dose and image quality. Eur Radiol 2008; 17 Suppl 6:F26-32. [PMID: 18376454 DOI: 10.1007/s10406-007-0225-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Radiation exposure is a critical issue in multidetector CT (MDCT) particularly since fast MDCT scanners have become widely available, and the method has been proposed as a noninvasive diagnostic tool for an increasing number of clinical applications. Additional features of MDCT imaging affecting individual dose are related to the inappropriate use of scanners caused by practices such as scanning beyond the area of interest or acquiring unnecessary multiphase image sets. In order to reduce individual exposure and in accordance with the ALARA principle, several strategies have been implemented over the last few years which are based on X-ray emission or optimization of scanning parameters (i.e. mAs, kV, pitch, collimation) or which take account of the individual patient's characteristics (automatic exposure control systems and ECG-pulsing techniques for ECG-gated acquisitions). These strategies allow optimization of image quality while keeping individual exposure at the lowest level. We review here these different strategies taking into account the relationship between image noise and different scanning parameters. Data from the literature are discussed, and current technological developments are considered, including initial results of dual source and SnapShot pulse technologies which have been shown to result in a significant dose reduction in ECG-gated cardiac acquisitions without compromising image quality.
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Affiliation(s)
- Carlo Catalano
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy.
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Burrill J, Dabbagh Z, Gollub F, Hamady M. Multidetector computed tomographic angiography of the cardiovascular system. Postgrad Med J 2007; 83:698-704. [PMID: 17989269 DOI: 10.1136/pgmj.2007.061804] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The introduction of multidetector computed tomography (MDCT) is considered a dramatic development in CT imaging that has direct implication in the imaging of various systems, in particular the cardiovascular system. The advantages of MDCT are an enormous increase in imaging acquisition speed, more coverage of the patient, and high spatial resolution. This article reviews the recent developments in CT angiography and discusses the clinical application relevant to diagnosis and endovascular treatment of cardiovascular diseases.
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Affiliation(s)
- Joshua Burrill
- Department of Interventional Radiology, St Mary's Hospital, Praed Street, London W2 1NY, UK.
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Cody DD, Mahesh M. Technologic Advances in Multidetector CT with a Focus on Cardiac Imaging. Radiographics 2007; 27:1829-37. [DOI: 10.1148/rg.276075120] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Carbone I, Francone M, Algeri E, Granatelli A, Napoli A, Kirchin MA, Catalano C, Passariello R. Non-invasive evaluation of coronary artery stent patency with retrospectively ECG-gated 64-slice CT angiography. Eur Radiol 2007; 18:234-43. [DOI: 10.1007/s00330-007-0756-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 06/25/2007] [Accepted: 07/26/2007] [Indexed: 12/31/2022]
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Litmanovich D, Litmanovitch D, Zamboni GA, Hauser TH, Lin PJP, Clouse ME, Raptopoulos V. ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain. Eur Radiol 2007; 18:308-17. [PMID: 17763855 DOI: 10.1007/s00330-007-0739-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 07/13/2007] [Accepted: 07/20/2007] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to evaluate chest CTA protocol using retrospective ECG-gating and triphasic IV contrast regimen for comprehensive evaluation of patients with acute non-specific chest pain. ECG-triggered dose modulation was used with a 64-MDCT scanner in 56 non-critically ill patients with acute nonspecific chest pain using triphasic IV regimen: 50 ml contrast followed by 50 ml 60% contrast/saline and 30 ml normal saline. Lungs, aorta, pulmonary and coronary arteries were graded on a 5-point scale (5, best). Aorta and pulmonary artery attenuation was measured and three coronary artery groups were evaluated. Comparison with invasive coronary angiography was obtained in nine patients on a per segment (16 total) basis. Dosimetry values were obtained. Studies were satisfactory in all patients (score >3). Aorta and pulmonary artery attenuation was >200 HU in 90.5%. Lung or pleura, non-cardiac vascular and coronary arteries disease were detected in 20, 11 and 16 patients, respectively. Median coronary angiography (grade 5) was significantly higher than acceptable for diagnosis grade 4 (p < 0.001). Per segment, weighted kappa statistic was 0.79 indicating substantial agreement with catheter angiography (p<0.001). Average DLP was 1,490 +/- 412 mGy-cm. Gated 64-MDCT angiography with triphasic IV contrast is a robust multipurpose technique for patients with acute non-specific chest pain.
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Affiliation(s)
- Diana Litmanovich
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Abstract
Coronary artery disease and other acquired and congenital cardiac diseases are major medical and socio-economic problems. Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease. Advances in computed tomography (CT), with multidetector CT and electron beam CT technology, and magnetic resonance (MR) imaging, now make it possible to noninvasively image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and assess cardiac function, and CT and MR imaging are becoming increasingly important in the evaluation of cardiac disease. Radiologists, because of their extensive experience in CT and MR imaging, have an important role in imaging cardiac patients using these modalities. This clinical statement of the ACR discusses various technical and patient safety issues related to cardiac CT and MR imaging, and it suggests appropriate qualifications for radiologists until such time as ACR practice guidelines for the performance of cardiac CT and cardiac MR imaging are written and approved through the usual ACR process. It stresses that the interpreting physician is responsible for examining not only the cardiac structures of interest but also all the visualized noncardiac structures and must report any clinically relevant abnormalities of these adjacent structures.
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Hollingsworth CL, Yoshizumi TT, Frush DP, Chan FP, Toncheva G, Nguyen G, Lowry CR, Hurwitz LM. Pediatric Cardiac-Gated CT Angiography: Assessment of Radiation Dose. AJR Am J Roentgenol 2007; 189:12-8. [PMID: 17579144 DOI: 10.2214/ajr.06.1507] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine a dose range for cardiac-gated CT angiography (CTA) in children. MATERIALS AND METHODS ECG-gated cardiac CTA simulating scanning of the heart was performed on an anthropomorphic phantom of a 5-year-old child on a 16-MDCT scanner using variable parameters (small field of view; 16 x 0.625 mm configuration; 0.5-second gantry cycle time; 0.275 pitch; 120 kVp at 110, 220, and 330 mA; and 80 kVp at 385 mA). Metal oxide semiconductor field effect transistor (MOSFET) technology measured 20 organ doses. Effective dose calculated using the dose-length product (DLP) was compared with effective dose determined from measured absorbed organ doses. RESULTS Highest organ doses included breast (3.5-12.6 cGy), lung (3.3-12.1 cGy), and bone marrow (1.7-7.6 cGy). The 80 kVp/385 mA examination produced lower radiation doses to all organs than the 120 kVp/220 mA examination. MOSFET effective doses (+/- SD) were as follows: 110 mA: 7.4 mSv (+/- 0.6 mSv), 220 mA: 17.2 mSv (+/- 0.3 mSv), 330 mA: 25.7 mSv (+/- 0.3 mSv), 80 kVp/385 mA: 10.6 mSv (+/- 0.2 mSv). DLP effective doses for diagnostic runs were as follows: 110 mA: 8.7 mSv, 220 mA: 19 mSv, 330 mA: 28 mSv, 80 kVp/385 mA: 12 mSv. DLP effective doses exceeded MOSFET effective doses by 9.7-17.2%. CONCLUSION Radiation doses for a 5-year-old during cardiac-gated CTA vary greatly depending on parameters. Organ doses can be high; the effective dose may reach 28.4 mSv. Further work, including determination of size-appropriate mA and image quality, is important before routine use of this technique in children.
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Affiliation(s)
- Caroline L Hollingsworth
- Department of Radiology, Division of Pediatric Radiology, 1905 McGovern-Davison Children's Health Center, Durham, NC 27710, USA.
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Semelka RC, Armao DM, Elias J, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 2007; 25:900-9. [PMID: 17457809 DOI: 10.1002/jmri.20895] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
"When one admits that nothing is certain one must, I think, also admit that some things are much more nearly certain than others." Bertrand Russell (1872-1970) Computed tomography (CT) is one of the largest contributors to man-made radiation doses in medical populations. CT currently accounts for over 60 million examinations in the United States, and its use continues to grow rapidly. The principal concern regarding radiation exposure is that the subject may develop malignancies. For this systematic review we searched journal publications in MEDLINE (1966-2006) using the terms "CT," "ionizing radiation," "cancer risks," "MRI," and "patient safety." We also searched major reports issued from governmental U.S. and world health-related agencies. Many studies have shown that organ doses associated with routine diagnostic CT scans are similar to the low-dose range of radiation received by atomic-bomb survivors. The FDA estimates that a CT examination with an effective dose of 10 mSv may be associated with an increased chance of developing fatal cancer for approximately one patient in 2000, whereas the BEIR VII lifetime risk model predicts that with the same low-dose radiation, approximately one individual in 1000 will develop cancer. There are uncertainties in the current radiation risk estimates, especially at the lower dose levels encountered in CT. To address what should be done to ensure patient safety, in this review we discuss the "as low as reasonably achievable" (ALARA) principle, and the use of MRI as an alternative to CT.
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Affiliation(s)
- Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA.
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Cook SC, Raman SV. Unique application of multislice computed tomography in adults with congenital heart disease. Int J Cardiol 2007; 119:101-6. [PMID: 17055084 DOI: 10.1016/j.ijcard.2006.07.074] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 06/23/2006] [Accepted: 07/15/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE Adults with congenital heart disease (CHD) form a growing population of patients requiring coronary artery assessment. In light of their increased incidence of coronary anomalies and need for reoperations, it is important to define their coronary anatomy. The purpose of this study was to define the spectrum of coronary artery anatomies and feasibility of coronary artery delineation in adults with CHD using 16- and 64-slice computed tomography angiography. MATERIALS AND METHODS Coronary multislice computed tomography (MSCT) examinations performed in adults with CHD between 2004 and 2005 were reviewed with institutional review board approval. Informed consent was not required. In addition to image quality, the following coronary parameters were evaluated by analysis of axial, multiplanar reformatted, and volume-rendered images: (1) relationship to great arteries, (2) ostia number and location, (3) proximal course, (4) length of vessel seen, and (5) dominance. RESULTS Eighty-five examinations in adults with CHD adults were identified. The relationship of the great vessels, number and location of the coronary ostia, and proximal course of the coronaries could be identified in all studies. Coronary anomalies were detected in 16 (19%) subjects. The entire coronary tree was visible in 77 (91%) of subjects. CONCLUSIONS MSCT provides detailed, noninvasive assessment of complex coronary artery anatomy in adults with CHD. MSCT should be considered a useful modality in the assessment of these patients, as it does not require arterial access and provides detailed 3-dimensional anatomic information that has important implications for long-term management.
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Affiliation(s)
- Stephen C Cook
- Adolescent and Young Adult Congenital Heart Disease Program, The Heart Center, Columbus Children's Hospital, The Ohio State University Division of Cardiovascular Medicine, USA
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Jacquier A, Higgins CB, Saeed M. MR imaging in assessing cardiovascular interventions and myocardial injury. CONTRAST MEDIA & MOLECULAR IMAGING 2007; 2:1-15. [PMID: 17326039 DOI: 10.1002/cmmi.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Performing an MR-guided endovascular intervention requires (1) real-time tracking and guidance of catheters/guide wires to the target, (2) high-resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X-ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR-guidance. Iron particles, or gadolinium- or dysprosium-chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR-guided minimally invasive catheter-based procedures will open up new avenues in treating end-stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real-time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non-invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications.
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Affiliation(s)
- Alexis Jacquier
- Department of Radiology, University of California San Francisco, CA 94134-0628, USA
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Doğan H, Kroft LJM, Huisman MV, van der Geest RJ, de Roos A. Right Ventricular Function in Patients with Acute Pulmonary Embolism: Analysis with Electrocardiography-synchronized Multi–Detector Row CT. Radiology 2007; 242:78-84. [PMID: 17090717 DOI: 10.1148/radiol.2421052089] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess electrocardiography (ECG)-synchronized multi-detector row computed tomography (CT) for the evaluation of right ventricular (RV) function in patients suspected of having pulmonary embolism (PE). MATERIALS AND METHODS All patients gave informed consent after the study details, including radiation exposure, were explained; institutional ethical committee approval was obtained. Nonsynchronized multi-detector row CT of the chest was performed in 66 consecutive patients (29 men, 37 women; mean age, 58 years+/-15 [standard deviation]) who were suspected of having PE. ECG-synchronized cardiac multi-detector row CT was performed to assess cardiac function. Dimension ratios for the RV and left ventricle (LV) were measured on nonsynchronized transverse and angulated four-chamber views. Furthermore, the RV end-diastolic and end-systolic volumes were measured on ECG-synchronized multi-detector row CT scans. An independent samples t test was performed to compare the mean value of different groups. An analysis of variance post hoc test was performed to investigate whether the values of the variables varied between groups. RESULTS PE was detected in 29 of 66 patients. The location of PE was categorized as central (n=17) or peripheral (n=12). The RV/LV dimension ratio was larger on the four-chamber view (P=.002), and RV end-systolic volume was larger (P=.01) and ejection fraction was lower (P=.01) in patients with PE. The RV end-systolic volumes and RV/LV volume ratios, as assessed by using ECG-synchronized multi-detector row CT, showed significant differences (P<.005) between patients with central PE and those with peripheral PE. However, the RV/LV dimensions on nonsynchronized images revealed no significant differences. CONCLUSION Retrospective ECG-synchronized multi-detector row CT facilitates detection of RV dysfunction, depending on pulmonary embolus location.
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Affiliation(s)
- Halil Doğan
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, C2-S, 2333 ZA Leiden, the Netherlands
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Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JAC, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006; 114:1761-91. [PMID: 17015792 DOI: 10.1161/circulationaha.106.178458] [Citation(s) in RCA: 998] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haraikawa T, Higashino H, Sugawara Y, Miki H, Kurata A, Higaki J, Mochizuki T. Assessment of left ventricular wall motion using 16-channel multislice computed tomography: comparison with left ventriculography. ACTA ACUST UNITED AC 2006; 24:159-64. [PMID: 16875302 DOI: 10.1007/s11604-005-1468-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Using the raw data from coronary computed tomography (CT) angiography, multislice CT (MSCT) can be used to evaluate cardiac function. However, the accuracy of left ventricular (LV) wall motion assessment by MSCT has not been thoroughly investigated. We investigated whether 16-channel MSCT could accurately assess LV wall motion by comparing its results with those of conventional biplane left ventriculography (LVG). MATERIALS AND METHODS The study included 20 patients with various kinds of heart disease. All patients underwent both contrast-enhanced MSCT and biplane LVG. Using a retrospective electrocardiography-gating technique, 10 phases over one cardiac cycle were extracted. The left ventricle was divided into seven segments according to the American Heart Association classification. Wall motion was scored as follows: 1, normal; 2, mild to moderate hypokinesis; 3, severe hypokinesis; 4, akinesis; 5, dyskinesis; and 6, aneurysm. The scores obtained by MSCT were compared with those obtained by LVG. The wall motion scores were analyzed using the chi-squared independence test (6 x 6 contingency table). RESULTS Wall motion could be assessed in all segments of the 20 patients using interactive multiplanar animation. Among a total of 140 segments in 20 patients, scores in 118 were concordant between MSCT and LVG (118/140, 84.3%). CONCLUSION The 16-MSCT can accurately assess LV wall motion.
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Affiliation(s)
- Toyoaki Haraikawa
- Department of Radiology, Ehime University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Thompson RC, Cullom SJ. Issues regarding radiation dosage of cardiac nuclear and radiography procedures. J Nucl Cardiol 2006; 13:19-23. [PMID: 16464713 DOI: 10.1016/j.nuclcard.2005.11.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abada HT, Larchez C, Daoud B, Sigal-Cinqualbre A, Paul JF. MDCT of the Coronary Arteries: Feasibility of Low-Dose CT with ECG-Pulsed Tube Current Modulation to Reduce Radiation Dose. AJR Am J Roentgenol 2006; 186:S387-90. [PMID: 16714613 DOI: 10.2214/ajr.05.0216] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to show the feasibility of coronary CT using low kilovoltage (80 kV) combined with ECG-pulsed tube current modulation in selected patients. CONCLUSION This study showed the combined effect of lowering the kilovoltage setting (80 kV) and using an automatic modulation technique (ECG-pulsed tube current modulation) for coronary CT. Radiation dose exposure can be reduced by up to 88% for slim patients without impairing image quality.
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Affiliation(s)
- Hicham T Abada
- Department of Radiology, Centre Chirurgical Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France
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23
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Achenbach S. Current and future status on cardiac computed tomography imaging for diagnosis and risk stratification. J Nucl Cardiol 2006; 12:703-13. [PMID: 16344233 DOI: 10.1016/j.nuclcard.2005.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Computed tomography (CT) permits cross-sectional imaging with high spatial resolution and has, during the past years, undergone tremendous development mainly concerning the temporal resolution. By use of multidetector spiral technology, as well as electrocardiography-gated image acquisition and reconstruction techniques, 16- and 64-slice CT permits visualization of cardiac morphology and function. In this context, however, CT imaging does not play a major clinical role because other imaging methods (mainly echocardiography) usually provide all necessary information. Under certain conditions, multidetector CT also permits visualization of the coronary arteries. Detection of coronary calcification, as well as coronary CT angiography, can provide clinically useful information if applied to suitable patient groups. It is foreseeable that CT angiography will become part of the routine workup in some subsets of patients with suspected coronary artery disease, either alone or in combination with other imaging techniques. Among the limitations of cardiac CT are the requirement of a regular (and preferably low) heart rate, the associated x-ray exposure, and the need for an iodinated contrast agent for most applications. It is important to note that reliable and accurate results will require use of the most advanced CT scanner technology, optimal image quality, and sufficient experience in the acquisition and interpretation of cardiac CT data sets.
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Affiliation(s)
- Stephan Achenbach
- Medizinische Klinik 2 (Kardiologie, Angiologie), Universitätsklinikum Erlangen, Erlangen, Germany.
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González-Pastrana L, Iglesias-Garriz I, Balboa O, Garrote C, Rodríguez-García MA, Jiménez-García de Marina JM. Metaanálisis sobre la utilidad de la tomografía computarizada multicorte para la deteccion de lesiones coronarias estenóticas. Análisis coronario segmentario. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Weinreb JC, Larson PA, Woodard PK, Stanford W, Rubin GD, Stillman AE, Bluemke DA, Duerinckx AJ, Dunnick NR, Smith GG. American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging. Radiology 2005; 235:723-7. [PMID: 15845799 DOI: 10.1148/radiol.2353050358] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey C Weinreb
- Department of Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT, USA.
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26
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Raman SV, Cook SC, McCarthy B, Ferketich AK. Usefulness of multidetector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries. Am J Cardiol 2005; 95:683-6. [PMID: 15721122 DOI: 10.1016/j.amjcard.2004.11.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 11/08/2004] [Accepted: 11/08/2004] [Indexed: 11/18/2022]
Abstract
An ever-increasing number of patients with congenital heart disease are reaching adulthood; follow-up often requires right ventricular (RV) quantification. Complex anatomy, acoustic window, and active implants such as pacemakers may limit modalities, such as echocardiography and cardiac magnetic resonance imaging (MRI), in this population. Recent advances in multidetector row cardiac computed tomography (MDCT) allow multiphase, multislice reconstructions in any plane but have not been applied to RV quantification. Fourteen patients with tetralogy of Fallot or transposition of the great arteries underwent cardiac MRI and MDCT examinations, with comparable quantification of RV volumes and ejection fractions and no systematic error by Bland-Altman analysis using MRI as the gold standard.
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27
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Schuijf JD, Bax JJ, Jukema JW, Lamb HJ, Vliegen HW, Salm LP, de Roos A, van der Wall EE. Noninvasive angiography and assessment of left ventricular function using multislice computed tomography in patients with type 2 diabetes. Diabetes Care 2004; 27:2905-10. [PMID: 15562205 DOI: 10.2337/diacare.27.12.2905] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Early identification of coronary artery disease (CAD) in patients with diabetes is important because these patients are at increased risk for CAD and have worse outcome than nondiabetic patients after CAD is diagnosed. Recently, noninvasive coronary angiography and assessment of left ventricular function has been demonstrated with multislice computed tomography (MSCT). The purpose of the present study was to validate this approach in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS MSCT was performed in 30 patients with confirmed type 2 diabetes. From the MSCT images, coronary artery stenoses (> or =50% luminal narrowing) and left ventricular function (left ventricular ejection fraction, regional wall motion) were evaluated and compared with results of conventional angiography and two-dimensional echocardiography. RESULTS Two hundred twenty of 256 coronary artery segments (86%) were interpretable with MSCT. In these segments, sensitivity and specificity for detection of coronary artery stenoses were 95%. Including the uninterpretable segments, sensitivity and specificity were 81 and 82%, respectively. Bland-Altman analysis in the comparison of left ventricular ejection fractions demonstrated a mean difference of -0.48 +/- 3.8% for MSCT and echocardiography, which was not significantly different from 0. Agreement between the two modalities for assessment of regional contractile function was excellent (91%, kappa statistic 0.81). CONCLUSIONS Accurate noninvasive evaluation of both the coronary arteries and left ventricular function with MSCT is feasible in patients with type 2 diabetes. This noninvasive approach may allow optimal identification of high-risk patients.
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Affiliation(s)
- Joanne D Schuijf
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
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