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Ternovoy S, Ustyuzhanin D, Shariya M, Shabanova M, Gaman S, Serova N, Mironov V, Merkulova I, Rienmueller A, Meyer EL, Rienmueler T. Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting. Heliyon 2021; 7:e06075. [PMID: 33553774 PMCID: PMC7856469 DOI: 10.1016/j.heliyon.2021.e06075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/19/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular computed tomography (cardiovascular CT) is currently used as a fast non-invasive method for the visualization of coronary plaques and walls and the assessment of lumen stenosis severity. Previous studies demonstrated the high negative predictive value of CT for the exclusion of coronary lumen stenoses. In this study we hypothesize that coronary CT angiography (CTA) represents a reliable method as diagnostic procedure in acute coronary syndrome (ACS) even in emergency settings. Methods 36 patients (51 lesions) with ACS who underwent cardiovascular CT, intravascular ultrasound (IVUS) and invasive coronary angiography (ICA) within 48 h were included. The percentage of coronary stenoses were measured and compared by three methods. Influence of available predictors that can potentially affect the measurement results was assessed. Results Cardiac CTA provided comparable results to IVUS (mean difference -0.45%, PPV: 98%, NPV: 75%). ICA tends to estimate lower stenoses degrees than cardiac CTA and IVUS (mean difference 13.19% and 13.64%, respectively). The final diagnosis and positive remodeling did not lead to any significant influence on measurements. Conclusions The cardiovascular CT results show that even in emergency settings it is possible to identify morphological changes as sequels of coronary artery sclerosis with comparable results to the reference method IVUS. Deviations of IVUS and cardiovascular CT from ICA are comparable and can to a large extent be explained by differences in the measurement technique.
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Affiliation(s)
- Sergey Ternovoy
- Sechenov First Moscow State Medical University (Sechenov University), 6-1 Bolshaya Pirogovskaya st., 119435 Moscow, Russian Federation
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
- Corresponding author.
| | - Dmitry Ustyuzhanin
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
| | - Merab Shariya
- Sechenov First Moscow State Medical University (Sechenov University), 6-1 Bolshaya Pirogovskaya st., 119435 Moscow, Russian Federation
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
| | - Maria Shabanova
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
| | - Svetlana Gaman
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
| | - Natalya Serova
- Sechenov First Moscow State Medical University (Sechenov University), 6-1 Bolshaya Pirogovskaya st., 119435 Moscow, Russian Federation
| | - Vsevolod Mironov
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
| | - Irina Merkulova
- National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation
| | - Anna Rienmueller
- Department of Orthopedic Surgery, Medical University Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Elias Laurin Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria
| | - Theresa Rienmueler
- Institute of Health Care Engineering, Graz University of Technology, Stremayrgasse 16/II, 8010 Graz, Austria
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Reduction of radiation dose for coronary computed tomography angiography using prospective electrocardiography-triggered high-pitch acquisition in clinical routine. Pol J Radiol 2019; 83:e260-e267. [PMID: 30627245 PMCID: PMC6323584 DOI: 10.5114/pjr.2018.76791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/23/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the image quality, radiation exposure, and means of application in a group of patients who underwent coronary computed tomography angiography (CCTA) performed with low-dose prospective electrocardiography (ECG)-triggered acquisition in which a standard sequence was added if the low-dose sequence did not allow reliable exclusion of coronary stenosis with respect to image quality. Material and methods The present study was approved by the Ethics Committee of the Faculty of Medicine, and informed consent was obtained from all patients. The authors performed a retrospective review of 256 consecutive patients referred for CCTA using dual-source CT scanner (Definition FLASH, Siemens, Germany). CCTA was performed using prospective ECG-triggered high-pitch acquisition. In patients with higher heart rates (> 65 bpm) or in whom irregular heart rates were noted prior to the scan, a subsequent CCTA was performed immediately (double flash protocol). The effective radiation dose was calculated for each patient. All images were evaluated by two independent observers for quality on a four-point scale with 1 being non-diagnostic image quality and 4 being excellent. Results Mean effective whole-body dose of CCTA was 1.6 ± 0.4 mSv (range, 0.4-5.4) for the entire cardiac examination and 0.9 ± 0.3 mSv (range, 0.4-2.8) for individual prospective ECG-triggered high-pitch CCTAs. In 27 of these patients with higher heart rates or occasional premature ventricular contractions or atrial fibrillation, subsequent CCTAs were performed immediately. The average image quality score was good to excellent with less than 1% unevaluable coronary segments. The double flash protocol resulted in a fully diagnostic CCTA in all cases. Conclusions The prospective ECG-triggered high-pitch CCTA technique is feasible and promising in clinical routine with good to excellent image quality and minimal radiation dose. The double flash protocol might become a more robust tool in patients with higher heart rates or arrhythmia.
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Abstract
Although recent advances in noninvasive imaging technologies have potentially improved diagnostic efficiency and clinical outcomes of patients with acute chest pain, controversy remains regarding much of the accumulated evidence. This article reviews the role of coronary computed tomography (CT) angiography in the assessment of coronary risk, and its usefulness in the emergency department in facilitating appropriate disposition decisions. Also discussed is coronary artery calcification incidentally found on CT scans when done for indications such as evaluation of pulmonary embolism or lung cancer. The evidence base and clinical applications for both techniques are described, together with cost-effectiveness and radiation exposure considerations.
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Affiliation(s)
- Swapnesh Parikh
- Internal Medicine Department, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Matthew J Budoff
- Internal Medicine Department, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA.
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Makaryus AN, Henry S, Loewinger L, Makaryus JN, Boxt L. Multi-Detector Coronary CT Imaging for the Identification of Coronary Artery Stenoses in a "Real-World" Population. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:13-22. [PMID: 25628513 PMCID: PMC4284987 DOI: 10.4137/cmc.s18223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/02/2014] [Accepted: 11/09/2014] [Indexed: 12/03/2022]
Abstract
BACKGROUND Multi-detector computed tomography (CT) has emerged as a modality for the non-invasive assessment of coronary artery disease (CAD). Prior studies have selected patients for evaluation and have excluded many of the “real-world” patients commonly encountered in daily practice. We compared 64-detector-CT (64-CT) to conventional coronary angiography (CA) to investigate the accuracy of 64-CT in determining significant coronary stenoses in a “real-world” clinical population. METHODS A total of 1,818 consecutive patients referred for 64-CT were evaluated. CT angiography was performed using the GE LightSpeed VCT (GE® Healthcare). Forty-one patients in whom 64-CT results prompted CA investigation were further evaluated, and results of the two diagnostic modalities were compared. RESULTS A total of 164 coronary arteries and 410 coronary segments were evaluated in 41 patients (30 men, 11 women, age 39–85 years) who were identified by 64-CT to have significant coronary stenoses and who thereafter underwent CA. The overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and accuracy at the 50% stenosis level were 86%, 84%, 65%, 95%, and 85%, respectively, and 77%, 93%, 61%, 97%, and 91%, respectively, in the per-segment analysis at the 50% stenosis level. CONCLUSION 64-CT is an accurate imaging tool that allows a non-invasive assessment of significant CAD with a high diagnostic accuracy in a “real-world” population of patients. The sensitivity and specificity that we noted are not as high as those in prior reports, but we evaluated a population of patients that is typically encountered in clinical practice and therefore see more “real-world” results.
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Affiliation(s)
- Amgad N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA. ; Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY, USA
| | - Sonia Henry
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - Lee Loewinger
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - John N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - Lawrence Boxt
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
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Wei J, Zhou C, Chan HP, Chughtai A, Agarwal P, Kuriakose J, Hadjiiski L, Patel S, Kazerooni E. Computerized detection of noncalcified plaques in coronary CT angiography: evaluation of topological soft gradient prescreening method and luminal analysis. Med Phys 2014; 41:081901. [PMID: 25086532 PMCID: PMC4105962 DOI: 10.1118/1.4885958] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 04/28/2014] [Accepted: 06/10/2014] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The buildup of noncalcified plaques (NCPs) that are vulnerable to rupture in coronary arteries is a risk for myocardial infarction. Interpretation of coronary CT angiography (cCTA) to search for NCP is a challenging task for radiologists due to the low CT number of NCP, the large number of coronary arteries, and multiple phase CT acquisition. The authors conducted a preliminary study to develop machine learning method for automated detection of NCPs in cCTA. METHODS With IRB approval, a data set of 83 ECG-gated contrast enhanced cCTA scans with 120 NCPs was collected retrospectively from patient files. A multiscale coronary artery response and rolling balloon region growing (MSCAR-RBG) method was applied to each cCTA volume to extract the coronary arterial trees. Each extracted vessel was reformatted to a straightened volume composed of cCTA slices perpendicular to the vessel centerline. A topological soft-gradient (TSG) detection method was developed to prescreen for NCP candidates by analyzing the 2D topological features of the radial gradient field surface along the vessel wall. The NCP candidates were then characterized by a luminal analysis that used 3D geometric features to quantify the shape information and gray-level features to evaluate the density of the NCP candidates. With machine learning techniques, useful features were identified and combined into an NCP score to differentiate true NCPs from false positives (FPs). To evaluate the effectiveness of the image analysis methods, the authors performed tenfold cross-validation with the available data set. Receiver operating characteristic (ROC) analysis was used to assess the classification performance of individual features and the NCP score. The overall detection performance was estimated by free response ROC (FROC) analysis. RESULTS With our TSG prescreening method, a prescreening sensitivity of 92.5% (111/120) was achieved with a total of 1181 FPs (14.2 FPs/scan). On average, six features were selected during the tenfold cross-validation training. The average area under the ROC curve (AUC) value for training was 0.87 ± 0.01 and the AUC value for validation was 0.85 ± 0.01. Using the NCP score, FROC analysis of the validation set showed that the FP rates were reduced to 3.16, 1.90, and 1.39 FPs/scan at sensitivities of 90%, 80%, and 70%, respectively. CONCLUSIONS The topological soft-gradient prescreening method in combination with the luminal analysis for FP reduction was effective for detection of NCPs in cCTA, including NCPs causing positive or negative vessel remodeling. The accuracy of vessel segmentation, tracking, and centerline identification has a strong impact on NCP detection. Studies are underway to further improve these techniques and reduce the FPs of the CADe system.
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Affiliation(s)
- Jun Wei
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Chuan Zhou
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Aamer Chughtai
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Prachi Agarwal
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Jean Kuriakose
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Smita Patel
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Ella Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
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Accuracy of automated software-guided detection of significant coronary artery stenosis by CT angiography: comparison with invasive catheterisation. Eur Radiol 2012. [DOI: 10.1007/s00330-012-2717-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Johnson PT, Fishman EK. Computed tomography dataset postprocessing: from data to knowledge. ACTA ACUST UNITED AC 2012; 79:412-21. [PMID: 22678864 DOI: 10.1002/msj.21316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The introduction of spiral computed tomography from the days of single-slice spiral to today's 64-row multidetector computed tomography and beyond creates datasets with unprecedented spatial and temporal resolution. The key to computed tomography imaging in the big picture is not in the acquisition of data, but in the use of the data acquired. By supplementing traditional axial interpretation with 3-dimensional rendering of the computed tomography volume, the greatest amount of information available is extracted. The information provided by a comprehensive postprocessed study, which includes multiplanar reconstruction in the coronal, sagittal, and oblique plane, as well as 3-dimensional maps of both the arterial and venous phase datasets using volume rendering and maximum intensity projection techniques, allows for key clinical decisions to be made with a high degree of accuracy. Postprocessing of computed tomography data is thus no longer an option, but a true requirement in this era of 64-row multidetector computed tomography and beyond.
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Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA.
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Biermann C, Tsiflikas I, Thomas C, Kasperek B, Heuschmid M, Claussen CD. Evaluation of computer-assisted quantification of carotid artery stenosis. J Digit Imaging 2012; 25:250-7. [PMID: 21786073 DOI: 10.1007/s10278-011-9413-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to evaluate the influence of advanced software assistance on the assessment of carotid artery stenosis; particularly, the inter-observer variability of readers with different level of experience is to be investigated. Forty patients with suspected carotid artery stenosis received head and neck dual-energy CT angiography as part of their pre-interventional workup. Four blinded readers with different levels of experience performed standard imaging interpretation. At least 1 day later, they performed quantification using an advanced vessel analysis software including automatic dual-energy bone and hard plaque removal, automatic and semiautomatic vessel segmentation, as well as creation of curved planar reformation. Results were evaluated for the reproducibility of stenosis quantification of different readers by calculating the kappa and correlation values. Consensus reading of the two most experienced readers was used as the standard of reference. For standard imaging interpretation, experienced readers reached very good (k = 0.85) and good (k = 0.78) inter-observer variability. Inexperienced readers achieved moderate (k = 0.6) and fair (k = 0.24) results. Sensitivity values 80%, 91%, 83%, 77% and specificity values 100%, 84%, 82%, 53% were achieved for significant area stenosis >70%. For grading using advanced vessel analysis software, all readers achieved good inter-observer variability (k = 0.77, 0.72, 0.71, and 0.77). Specificity values of 97%, 95%, 95%, 93% and sensitivity values of 84%, 78%, 86%, 92% were achieved. In conclusion, when supported by advanced vessel analysis software, experienced readers are able to achieve good reproducibility. Even inexperienced readers are able to achieve good results in the assessment of carotid artery stenosis when using advanced vessel analysis software.
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Affiliation(s)
- Christina Biermann
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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Nakazato R, Dey D, Alexánderson E, Meave A, Jiménez M, Romero E, Jácome R, Peña M, Berman DS, Slomka PJ. Automatic alignment of myocardial perfusion PET and 64-slice coronary CT angiography on hybrid PET/CT. J Nucl Cardiol 2012; 19:482-91. [PMID: 22419224 PMCID: PMC3527130 DOI: 10.1007/s12350-012-9528-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 02/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hybrid PET/CT allows for acquisition of cardiac PET and coronary CT angiography (CCTA) in one session. However, PET and CCTA are acquired with differing breathing protocols and require software registration. We aimed to validate automatic correction for breathing misalignment between PET and CCTA acquired on hybrid scanner. METHODS Single-session hybrid PET/CT studies of rest/stress (13)N-ammonia PET and CCTA in 32 consecutive patients were considered. Automated registration of PET left ventricular (LV) surfaces with CCTA volumes was evaluated by comparing with expert manual alignment by two observers. RESULTS The average initial misalignments between the position of LV on PET and CCTA were 27.2 ± 11.8, 13.3 ± 11.5, and 14.3 ± 9.1 mm in x, y, and z axes on rest, and 26.3 ± 10.2, 11.1 ± 9.5, and 11.7 ± 7.1 mm in x, y, and z axes on stress, respectively. The automated PET-CCTA co-registration had 95% agreement as judged visually. Compared with expert manual alignment, the translation errors of the algorithm were 5.3 ± 2.8 mm (rest) and 6.0 ± 3.5 mm (stress). 3D visualization of combined coronary vessel anatomy and hypoperfusion from PET could be made without further manual adjustments. CONCLUSION Software co-registration of CCTA and PET myocardial perfusion imaging on hybrid PET/CT scanners is necessary, but can be performed automatically, facilitating integrated 3D display on PET/CT.
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Affiliation(s)
- Ryo Nakazato
- Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Fernandez-Friera L, Garcia-Alvarez A, Guzman G, Garcia MJ. Coronary CT and the coronary calcium score, the future of ED risk stratification? Curr Cardiol Rev 2012; 8:86-97. [PMID: 22708911 PMCID: PMC3406277 DOI: 10.2174/157340312801784989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 08/17/2011] [Accepted: 09/01/2011] [Indexed: 01/07/2023] Open
Abstract
Accurate and efficient evaluation of acute chest pain remains clinically challenging because traditional diagnostic modalities have many limitations. Recent improvement in non-invasive imaging technologies could potentially improve both diagnostic efficiency and clinical outcomes of patients with acute chest pain while reducing unnecessary hospitalizations. However, there is still controversy regarding much of the evidence for these technologies. This article reviews the role of coronary artery calcium score and the coronary computed tomography in the assessment of individual coronary risk and their usefulness in the emergency department in facilitating appropriate disposition decisions. The evidence base and clinical applications for both techniques are also described, together with cost- effectiveness and radiation exposure considerations.
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Affiliation(s)
- Leticia Fernandez-Friera
- Departamento de Cardiologia, Hospital Universitario Marqués de Valdecilla, Santander. Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid. Spain
| | - Ana Garcia-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid. Spain
- Thorax Institute Cardiology Department, Hospital Clinic, Barcelona, Spain
| | - Gabriela Guzman
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid. Spain
- Hospital La Paz, Madrid. Spain
| | - Mario J Garcia
- Montefiore Heart Center-Albert Einstein School of Medicine. New York
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Erbel R, Budoff M. Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J 2012; 33:1201-13. [PMID: 22547221 DOI: 10.1093/eurheartj/ehs076] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Deaths from diseases of the heart are decreasing. Cardiovascular diseases (CVD) will be the main cause of morbidity and mortality in 2015 according to a WHO report. The main problem is related to the long-time delay between the start of the development of atherosclerosis in young adults and the manifestation many decades later. Despite a recent decline in a CVD mortality rate in men and women, the main problem is related to the acute manifestation as the acute coronary syndrome, which leads 30-50% of subjects to sudden and fatal outcomes. In addition, about 20% of first and recurrent acute myocardial infarctions are silent. The lifetime risk of coronary artery disease after 40 years is 49% for men and 32% for women. That means, we are confronted with a major health care problem. This is even more obvious, when the rate of coronary heart disease deaths out of the hospital are taken into account which amount to 70% in 2007. These data are confirmed for Europe despite a strong decline of hospital deaths. Another problem is related to the fact that the number of sudden cardiac death amounts to >300 000 in the general US population. It is about 10 times higher than in those patients who are defined as prone to sudden death due to low ejection fraction, ventricular arrhythmias, and acute myocardial infarction. For cardiologists, this general topic becomes even more obvious, because even well-known cardiologists experienced early (≤65 years) sudden cardiac deaths such as RW Campbell, JM Isner, PA Poole-Wilson, H Drexler, and recently the paediatric cardiologist from Hannover, A Wessels. These events underline again what has been emphasized 15 years ago by the MONICA study that two-thirds of patients die outside the hospital and that we have to concentrate on primary and secondary prevention, also in memory of these colleagues. This review will demonstrate the potential value of coronary artery calcification screening which can be used as a sign of subclinical coronary arteriosclerosis for improved risk prediction, the first step to prevention. Subclinical atherosclerosis represents the vessel memory of risk factor exposure.
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Affiliation(s)
- Raimund Erbel
- Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Hufelandstrasse 55, Essen, Germany.
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Anders K, Ropers U, Kuettner A, Wechsel M, Daniel WG, Uder M, Achenbach S. Individually adapted, interactive multiplanar reformations vs. semi-automated coronary segmentation and curved planar reformations for stenosis detection in coronary computed tomography angiography. Eur J Radiol 2011; 80:89-95. [DOI: 10.1016/j.ejrad.2010.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/08/2010] [Indexed: 11/29/2022]
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Malagò R, Pezzato A, Barbiani C, Mantovani W, Caliari G, Alfonsi U, Tavella D, Mucelli RP. Comparison between different kernel reformatting filters in 3D quantitative analysis of MDCT coronary angiography. Radiol Med 2011; 116:1203-16. [PMID: 21892715 DOI: 10.1007/s11547-011-0719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/26/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Coronary angiography with multidetector-row computed tomography (MDCT-CA) allows quantification of coronary artery stenosis with a high level of accuracy; however, a better estimation of stenosis can be achieved by using appropriate reformatting filters, especially in stents and calcified segments. Quantitative computed tomography angiography (QCTA) is intended to overcome the limitations of the visual score. The aim of this study was to evaluate the accuracy of QCTA with different filters in comparison with quantitative coronary angiography (QCA) and visual score. MATERIALS AND METHODS Two blinded operators visually scored 17 consecutive patients referred for MDCT-CA with a per-segment analysis. The degree of stenosis was classified as 0-20%, 20-50% (wall irregularities), 50-70% (significant disease) and 70-100% (vessel occlusion). Each segment was then analysed using the electronic callipers of the QCTA system with 15 different filters. No contour editing was performed. Data were compared with QCA and conventional coronary angiography (CCA). Comparison between QCTA, visual score and QCA were performed using Spearman's rank correlation. RESULTS Of 25 segments analysed (mean 1.4 diseased segment per patient), 375 measurements were considered. Good correlation was found between the visual score and QCA [Pearson correlation coefficient (rho=0.852; p<0.0001)] and between QCA and CCA (rho=0.804; p<0.0001). Moderate correlation was found between QCA and QCTA only using two filters (rho=0.444; p<0.0001 for YA filter and rho=0.450; p<0.0001 for YB filter). CONCLUSIONS Overall QCTA accuracy is low if contour editing is not applied, especially in calcified vessels. Certain filters can help to better estimate the exact percentage of stenosis.
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Affiliation(s)
- R Malagò
- Department of Radiology, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy.
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Arbab-Zadeh A, Hoe J. Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography methods, caveats, and implications. JACC Cardiovasc Imaging 2011; 4:191-202. [PMID: 21329905 DOI: 10.1016/j.jcmg.2010.10.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 10/06/2010] [Accepted: 10/12/2010] [Indexed: 12/14/2022]
Abstract
Multidetector computed tomography (MDCT) is a rapidly evolving technology for performing noninvasive coronary angiography. Despite good sensitivity and specificity for detecting significant coronary artery disease in patients, disagreement on individual coronary arterial stenosis severity is common between MDCT and the current gold standard, conventional angiography. The reasons for such disagreement are numerous, but are at least partly inherent to MDCT's modest spatial and temporal resolution at present. Less well acknowledged, however, is the fact that MDCT and conventional angiography are fundamentally different technologies, rendering good agreement on the degree of lumen narrowing rather unrealistic, given both of their respective limitations. Discrepant stenosis assessment by MDCT and conventional angiography receives remarkable attention, whereas its significance for patient outcome is less certain. On the other hand, the ability to noninvasively assess coronary arterial plaque characteristics and composition in addition to lumen obstruction shows strong promise for improved risk assessment and may at last enable us to move beyond mere coronary stenosis assessment for the management of patients with coronary artery disease.
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Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
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Halpern EJ, Halpern DJ. Diagnosis of coronary stenosis with CT angiography comparison of automated computer diagnosis with expert readings. Acad Radiol 2011; 18:324-33. [PMID: 21215663 DOI: 10.1016/j.acra.2010.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/29/2010] [Accepted: 10/23/2010] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES To compare computer-generated interpretation of coronary computed tomography angiography (cCTA) by commercially available COR Analyzer software with expert human interpretation. MATERIALS AND METHODS This retrospective Health Insurance Portability and Accountability Act‑compliant study was approved by the institutional review board. Among 225 consecutive cCTA examinations, 207 were of adequate quality for automated evaluation. COR Analyzer interpretation was compared to human expert interpretation for detection of stenosis defined as ≥50% vessel diameter reduction in the left main, left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), or a branch vessel (diagonal, ramus, obtuse marginal, or posterior descending artery). RESULTS Among 207 cases evaluated by COR Analyzer, human expert interpretation identified 48 patients with stenosis. COR Analyzer identified 44/48 patients (sensitivity 92%) with a specificity of 70%, a negative predictive value of 97% and a positive predictive value of 48%. COR Analyzer agreed with the expert interpretation in 75% of patients. With respect to individual segments, COR Analyzer detected 9/10 left main lesions, 33/34 LAD lesions, 14/15 LCX lesions, 27/31 RCA lesions, and 8/11 branch lesions. False-positive interpretations were localized to the left main (n = 16), LAD (n = 26), LCX (n = 21), RCA (n = 21), and branch vessels (n = 23), and were related predominantly to calcified vessels, blurred vessels, misidentification of vessels and myocardial bridges. CONCLUSIONS Automated computer interpretation of cCTA with COR Analyzer provides high negative predictive value for the diagnosis of coronary disease in major coronary arteries as well as first-order arterial branches. False-positive automated interpretations are related to anatomic and image quality considerations.
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Affiliation(s)
- Ethan J Halpern
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, 7th Floor Main Bldg, Philadelphia, PA 19107-5244, USA.
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Cheneau E, Vahdat B, Bernard L, Molon A, Panagides D. Routine use of coronary computed tomography as initial diagnostic test for angina pectoris. Arch Cardiovasc Dis 2011; 104:29-34. [PMID: 21276575 DOI: 10.1016/j.acvd.2010.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Coronary computed tomography (CCT) detects coronary obstruction with high sensitivity and might be useful for diagnosis of angina pectoris. AIM In this pilot study, we sought to prospectively evaluate the performance of CCT as initial work up and determine the significance of this strategy according to the pretest likelihood of having coronary artery disease (CAD). METHODS One hundred and eighty patients with chest discomfort and suspected angina were prospectively referred for CCT with a 64-slice CT scan. Invasive coronary angiography (ICA) was performed on the basis of CCT findings (stenosis>50%). Patients were classified into tertiles according to estimated pretest probability of obstructive CAD using the Duke Clinical Score (low, intermediate and high). Strategy failure was defined as unnecessary ICA or major adverse cardiac event (MACE) within 6 months in patients without significant stenosis by CCT. RESULTS Pretest probability for CAD was 53 ± 29%. Significant stenosis was detected by CCT in 51 patients; 47 (26%) underwent ICA. Sixteen strategy failures were reported: 15 patients (10%) were referred for ICA that did not confirm significant coronary stenosis and one MACE occurred in a patient without significant stenosis by CCT. Strategy failures were 8% in low-probability, 1.7% in intermediate-probability and 15% in high-probability patients (P=0.03). CONCLUSIONS CCT as an initial step for angina diagnosis is most effective in patients with an intermediate probability of CAD. In patients with low or high likelihood, it is associated with a high rate of unnecessary ICA but not with adverse events.
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Affiliation(s)
- Edouard Cheneau
- Centre de cardiologie interventionnelle, clinique Bouchard, 77, rue du docteur-Escat, 13006 Marseille, France.
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18
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CT comparison of visual and computerised quantification of coronary stenosis according to plaque composition. Eur Radiol 2010; 21:712-21. [DOI: 10.1007/s00330-010-1970-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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19
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Thomas C, Korn A, Krauss B, Ketelsen D, Tsiflikas I, Reimann A, Brodoefel H, Claussen C, Kopp A, Ernemann U, Heuschmid M. Automatic bone and plaque removal using dual energy CT for head and neck angiography: Feasibility and initial performance evaluation. Eur J Radiol 2010; 76:61-7. [DOI: 10.1016/j.ejrad.2009.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 04/01/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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Arnoldi E, Henzler T, Bastarrika G, Thilo C, Nikolaou K, Schoepf UJ. Evaluation of Plaques and Stenosis. Radiol Clin North Am 2010; 48:729-44. [DOI: 10.1016/j.rcl.2010.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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HUSMANN L, GAEMPERLI O, VALENTA I, SCHEPIS T, SCHEFFEL H, STOLZMANN P, LESCHKA S, DESBIOLLES L, MARINCEK B, ALKADHI H, KAUFMANN PA. Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT. Br J Radiol 2009; 82:649-53. [DOI: 10.1259/bjr/40319502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schaap M, Metz CT, van Walsum T, van der Giessen AG, Weustink AC, Mollet NR, Bauer C, Bogunović H, Castro C, Deng X, Dikici E, O'Donnell T, Frenay M, Friman O, Hernández Hoyos M, Kitslaar PH, Krissian K, Kühnel C, Luengo-Oroz MA, Orkisz M, Smedby O, Styner M, Szymczak A, Tek H, Wang C, Warfield SK, Zambal S, Zhang Y, Krestin GP, Niessen WJ. Standardized evaluation methodology and reference database for evaluating coronary artery centerline extraction algorithms. Med Image Anal 2009; 13:701-14. [PMID: 19632885 DOI: 10.1016/j.media.2009.06.003] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 04/15/2009] [Accepted: 06/11/2009] [Indexed: 11/25/2022]
Abstract
Efficiently obtaining a reliable coronary artery centerline from computed tomography angiography data is relevant in clinical practice. Whereas numerous methods have been presented for this purpose, up to now no standardized evaluation methodology has been published to reliably evaluate and compare the performance of the existing or newly developed coronary artery centerline extraction algorithms. This paper describes a standardized evaluation methodology and reference database for the quantitative evaluation of coronary artery centerline extraction algorithms. The contribution of this work is fourfold: (1) a method is described to create a consensus centerline with multiple observers, (2) well-defined measures are presented for the evaluation of coronary artery centerline extraction algorithms, (3) a database containing 32 cardiac CTA datasets with corresponding reference standard is described and made available, and (4) 13 coronary artery centerline extraction algorithms, implemented by different research groups, are quantitatively evaluated and compared. The presented evaluation framework is made available to the medical imaging community for benchmarking existing or newly developed coronary centerline extraction algorithms.
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Affiliation(s)
- Michiel Schaap
- Biomedical Imaging Group Rotterdam, Dept. of Radiology and Med. Informatics, Erasmus MC, Rotterdam, The Netherlands.
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Kristensen TS, Engstrøm T, Kelbæk H, von der Recke P, Nielsen MB, Kofoed KF. Correlation between coronary computed tomographic angiography and fractional flow reserve. Int J Cardiol 2009; 144:200-5. [PMID: 19427706 DOI: 10.1016/j.ijcard.2009.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 03/31/2009] [Accepted: 04/11/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established technique to determine the hemodynamic severity of a coronary artery lesion. The aim of this study was to compare CCTA with FFR. METHODS In 56 coronary artery stenoses (42 patients) we performed CCTA, quantitative coronary angiography and FFR. CCTA measurements included diameter stenosis (DS, %), area stenosis (AS, %), minimal lumen diameter (MLD, mm), minimal lumen area (MLA, mm(2)), lesion length (LL, mm), plaque volume (mm(3)) and burden (%). RESULTS FFR averaged 0.81±0.14, and 10 lesions had an abnormal FFR (<0.75). We found significant correlations between FFR and DS (r=-0.67, p<0.001), AS (r=-0.68, p<0.001), MLD (r=0.58, p<0.001), MLA (r=0.53, p<0.001), LL (r=-0.36, p=0.02), plaque volume (r=-0.36, p=0.02) and plaque burden (r=-0.59, p<0.001). By multivariate regression analysis AS and LL were the strongest determinants of an abnormal FFR. The optimal cut-off value for AS was >73% (sensitivity 90%, specificity 80%, negative predictive value 97%, and positive predictive value 50%) and for LL >10 mm (sensitivity 60% and specificity 49%). CONCLUSION This study demonstrates that quantitative CCTA is correlated to FFR. Using our CCTA criteria of abnormality, significant coronary artery stenoses can be ruled out with a high negative predictive value.
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Arnoldi E, Johnson TR, Rist C, Wintersperger BJ, Sommer WH, Becker A, Becker CR, Reiser MF, Nikolaou K. Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques. Eur Radiol 2009; 19:2147-55. [PMID: 19415293 DOI: 10.1007/s00330-009-1411-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 02/18/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
Abstract
The goal of our study was to compare a prospective triggering (PT) CT technique with retrospectively gated (RG) CT techniques in coronary computed tomographic angiograms (CCTA) with respect to image quality and radiation dose. Sixty consecutive patients were enrolled. CCTAs using the RG technique were obtained with a dual-source 64-slice CT system in 40 patients, using ECG-triggered tube current modulation, with either a broad pulsing window at 30-80% of the RR interval (group RGb, 20 patients, heart rate > 70 bpm) or a small pulsing window at 70% (group RGs, 20 patients, heart rate < 70 bpm). The other 20 patients underwent CCTA using the PT technique on a 128-slice CT system (group PT, heart rate < 70 bpm). All images were evaluated by two observers for quality on a three-point scale, with 1 being excellent and 3 being insufficient. The effective radiation dose was calculated for each patient. The average image quality score was 1.5 +/- 0.6 for PT, 1.35 +/- 0.5 for RGs and 1.65 +/- 0.5 for RGb. The mean effective dose for RGb was 9 +/- 4 mSv, for RGs 7 +/- 3 mSv and for PT 3 +/- 1 mSv. This represents a 57% dose reduction for PT compared with RGs and a 67% dose reduction for PT compared with RGb. In conclusion, in selected patients CCTA with the PT technique offers adequate image quality with a significantly lower radiation dose compared with CCTA using RG techniques.
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Affiliation(s)
- Elisabeth Arnoldi
- Department of Clinical Radiology, University Hospitals Munich-Grosshadern Campus, Ludwig-Maximilians University, Marchioninistrasse 15, Munich 81377, Germany.
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Gibbons RJ, Araoz PA, Williamson EE. The year in cardiac imaging. J Am Coll Cardiol 2009; 53:54-70. [PMID: 19118725 DOI: 10.1016/j.jacc.2008.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 09/25/2008] [Indexed: 02/06/2023]
Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Dennie CJ, Leipsic J, Brydie A. Canadian Association of Radiologists: Consensus Guidelines and Standards for Cardiac CT. Can Assoc Radiol J 2009; 60:19-34. [DOI: 10.1016/j.carj.2009.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Carole J. Dennie
- Department of Diagnostic Imaging, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Jonathan Leipsic
- Department of Radiology, Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alan Brydie
- Department of Radiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: A systematic review. Int J Cardiol 2008; 130:386-404. [DOI: 10.1016/j.ijcard.2008.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 05/21/2008] [Accepted: 06/28/2008] [Indexed: 11/22/2022]
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Efficacy of computer aided analysis in detection of significant coronary artery stenosis in cardiac using dual source computed tomography. Int J Cardiovasc Imaging 2008; 25:195-203. [DOI: 10.1007/s10554-008-9372-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 09/09/2008] [Indexed: 01/26/2023]
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Dodd JD, Rieber J, Pomerantsev E, Chaithiraphan V, Achenbach S, Moreiras JM, Abbara S, Hoffmann U, Brady TJ, Cury RC. Quantification of Nonculprit Coronary Lesions: Comparison of Cardiac 64-MDCT and Invasive Coronary Angiography. AJR Am J Roentgenol 2008; 191:432-438. [DOI: 10.2214/ajr.07.3315] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jonathan D. Dodd
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Johannes Rieber
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Eugene Pomerantsev
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Vithaya Chaithiraphan
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stephan Achenbach
- Department of Medicine 2, University Hospital Erlangen, Erlangen, Germany
| | - Javier M. Moreiras
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Suhny Abbara
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Thomas J. Brady
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ricardo C. Cury
- Department of Radiology, Cardiac MRI-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Quantification of Coronary Artery Stenoses by Computed Tomography. JACC Cardiovasc Imaging 2008; 1:472-4. [DOI: 10.1016/j.jcmg.2008.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 05/16/2008] [Indexed: 11/23/2022]
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32
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Accuracy of quantitative coronary angiography with computed tomography and its dependency on plaque composition. Int J Cardiovasc Imaging 2008; 24:895-904. [DOI: 10.1007/s10554-008-9327-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 06/04/2008] [Indexed: 11/30/2022]
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Meijs MFL, Meijboom WB, Cramer MJM, Pugliese F, Prokop M, Doevendans PA, De Feyter PJ. Computed tomography of the coronary arteries: an alternative? SCAND CARDIOVASC J 2008; 41:277-86. [PMID: 17852787 DOI: 10.1080/14017430701509862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Multislice Computed Tomography Coronary Angiography (CTCA) has emerged as a promising non-invasive modality for the detection of coronary artery stenosis. Image quality is still limited when compared to conventional coronary angiography. However, CTCA has been demonstrated to be highly reliable to rule out coronary artery stenosis. Technological improvements and the combination of CTCA with other non-invasive modalities are expected to further increase diagnostic accuracy. Although CTCA has clearly left the research environment, the precise role of CTCA in the diagnostic work-up of coronary artery disease needs further research.
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Affiliation(s)
- Matthijs F L Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 2007; 42:684-91. [PMID: 17984765 DOI: 10.1097/rli.0b013e31806907d0] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic accuracy of dual-source computed tomography (DSCT) with reference to invasive coronary angiography in the diagnosis of coronary artery disease (CAD) on a per-patient as well as on a per-segment basis. MATERIALS AND METHODS Thirty-five patients with known or suspected CAD underwent both DSCT (Somatom Definition, Siemens Medical Solutions) and quantitative x-ray coronary angiography (QCA). Parameters of CT acquisition were gantry rotation time 0.330 seconds (ie, temporal resolution 83 milliseconds), tube voltage 120 kV, tube current 560 mA with ECG-triggered tube current modulation and full current at 70% of the cardiac cycle for heart rates below 70 beats per minute or full current between 30% and 80% for higher and arrhythmic heart rates. The pitch was also adapted to the heart rate, ranging from 0.2 to 0.43. Volume and flow rate of contrast material (Ultravist 370, Schering AG) were adapted to the patient's body weight. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DSCT in the detection or exclusion of significant CAD (ie, stenoses >50%) were evaluated on a per-patient and per-segment basis. RESULTS All 35 CT angiograms were of diagnostic image quality. QCA demonstrated significant CAD in 48% (n = 17) and nonsignificant disease or normal coronary angiograms in 52% (n = 18) of the patients. Sensitivity, specificity, PPV, and NPV of DSCT on a per-patient basis were 100%, 89%, 89%, and 100%, respectively. On a per-segment basis, 473 of 481 coronary artery segments were assessable (98%). QCA demonstrated stenoses >50% in 32 segments (7%), and no disease or nonsignificant disease in 433 segments (93%). For the detection of stenoses >50% on a per-segment basis, DSCT showed a sensitivity, specificity, PPV, and NPV of 88%, 98%, 78%, and 99%, respectively. CONCLUSIONS The comparison of coronary DSCT with QCA shows a very robust image quality and a high diagnostic accuracy in a patient-based as well as a per-segment analysis. Maximal sensitivity and NPV in the per-patient analysis show the strength of the technique in ruling out significant CAD.
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Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol 2007; 18:576-83. [PMID: 17934740 DOI: 10.1007/s00330-007-0773-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/28/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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Gibbons RJ, Araoz PA, Williamson EE. The Year in Cardiac Imaging. J Am Coll Cardiol 2007; 50:988-1003. [PMID: 17765127 DOI: 10.1016/j.jacc.2007.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 05/28/2007] [Indexed: 12/21/2022]
Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Pouleur AC, le Polain de Waroux JB, Kefer J, Pasquet A, Coche E, Vanoverschelde JL, Gerber BL. Usefulness of 40-slice multidetector row computed tomography to detect coronary disease in patients prior to cardiac valve surgery. Eur Radiol 2007; 17:3199-207. [PMID: 17549488 DOI: 10.1007/s00330-007-0676-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 03/21/2007] [Accepted: 04/20/2007] [Indexed: 10/23/2022]
Abstract
Preoperative identification of significant coronary artery disease (CAD) in patients prior to valve surgery requires systematic invasive coronary angiography. The purpose of this current prospective study was to evaluate whether exclusion of CAD by multi-detector CT (MDCT) might potentially avoid systematic cardiac catheterization in these patients. Eighty-two patients (53 males, 62 +/- 13 years) scheduled to undergo valve surgery underwent 40-slice MDCT before invasive quantitative coronary angiography (QCA). According to QCA, 15 patients had CAD (5 one-vessel, 6 two-vessel and 4 three-vessel disease). The remaining 67 patients had no CAD. On a per-vessel basis, MDCT correctly identified 27/29 (sensitivity 93%) vessels with and excluded 277/299 vessels (specificity 93%) without CAD. On a per-patient basis, MDCT correctly identified 14/15 patients with (sensitivity 93%) and 60/67 patients without CAD (specificity 90%). Positive and negative predictive values of MDCT were 67% and 98%. Performing invasive angiography only in patients with abnormal MDCT might have avoided QCA in 60/82 (73%). MDCT could be potentially useful in the preoperative evaluation of patients with valve disease. By selecting only those patients with coronary lesions to undergo invasive coronary angiography, it could avoid cardiac catheterization in a large number of patients without CAD.
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Affiliation(s)
- Anne-Catherine Pouleur
- Cardiology Division, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200, Woluwe St. Lambert, Belgium
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Choe YH. Noninvasive Detection of Coronary Atherosclerotic Plaques and Assessment of Stenosis Degree at Multidetector CT Coronary Angiography. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.2.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yeon Hyeon Choe
- Department of Radiology, Sungkyunkwan University School of Medicine, Korea.
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