1
|
Nieman K, García-García HM, Hideo-Kajita A, Collet C, Dey D, Pugliese F, Weissman G, Tijssen JGP, Leipsic J, Opolski MP, Ferencik M, Lu MT, Williams MC, Bruining N, Blanco PJ, Maurovich-Horvat P, Achenbach S. Standards for quantitative assessments by coronary computed tomography angiography (CCTA): An expert consensus document of the society of cardiovascular computed tomography (SCCT). J Cardiovasc Comput Tomogr 2024; 18:429-443. [PMID: 38849237 DOI: 10.1016/j.jcct.2024.05.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024]
Abstract
In current clinical practice, qualitative or semi-quantitative measures are primarily used to report coronary artery disease on cardiac CT. With advancements in cardiac CT technology and automated post-processing tools, quantitative measures of coronary disease severity have become more broadly available. Quantitative coronary CT angiography has great potential value for clinical management of patients, but also for research. This document aims to provide definitions and standards for the performance and reporting of quantitative measures of coronary artery disease by cardiac CT.
Collapse
Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford, CA, United States.
| | - Hector M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
| | | | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Francesca Pugliese
- NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Gaby Weissman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, Room G4-230, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, BC, Canada
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, MA, United States
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
2
|
Chen L, Cao L, Liu B, Li J, Qu T, Li Y, Li Y, Pan N, Cheng Y, Fan G, Jian Z, Guo J. Relationship between pericoronary adipose tissue attenuation value and image reconstruction parameters. Heliyon 2024; 10:e34763. [PMID: 39149087 PMCID: PMC11325791 DOI: 10.1016/j.heliyon.2024.e34763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Rationale and objectives To investigate the relationship between the pericoronary adipose tissue CT mean attenuation (PCATMA) measurement and image reconstruction parameters (adaptive statistical iterative reconstruction-veo (ASIR-V) percentage, kernel, and slice thickness). Materials and methods One hundred and ninety-eight consecutive patients underwent CT coronary angiography at 100 kilovoltage peak (kVp) (n = 102) and 120 kVp (n = 96) were included. All scans were reconstructed by three means: 1. with 11 different ASIR-V percentages, standard kernel and 0.625 mm; 2. with soft, standard, detail, and bone kernels, 60 % ASIR-V, and 0.625 mm; 3. at 0.625 mm and 1.25 mm slice thickness, standard kernel and 60 % ASIR-V. PCATMA of the three main coronary arteries was calculated using a dedicated software. Linear regression, analysis of variance (ANOVA), Friedman test, and paired t-test were used for statistical analysis. Results Linear regression of pooled average data showed that the PCATMA was positively and linearly correlated with the ASIR-V percentage (all R squared >0.99). Regression analysis of individual data showed that most R squared were greater than 0.8 or 0.9, but their slope consisted of a relatively wide range. The difference of PCATMA among different kernels for each coronary artery reached statistically significant levels (P < 0.001), particularly for the difference between standard and bone kernel. Most of the differences between 0.625 mm and 1.25 mm for LAD, LCX, and RCA at 100 kVp and 120 kVp reached statistical significance (P < 0.001). Conclusions PCATMA correlates linearly with the strength of ASIR-V. Reconstruction kernel and slice thickness also affect PCATMA, especially for the sharp kernels.
Collapse
Affiliation(s)
- Lihong Chen
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Le Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Bing Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianying Li
- CT Imaging Research Center, GE Healthcare, #1 GuangHua Road, Chaoyang District, Beijing, 100010, China
| | - Tingting Qu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Yanshou Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Yanan Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Ning Pan
- Bayer Healthcare Company Limited, #88 South Guanzheng Road, Xi'an, 710061, China
| | - Yannan Cheng
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Ganglian Fan
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Zhijie Jian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| |
Collapse
|
3
|
Gao Y, Pan Y, Jia C. Influencing factors and improvement methods of coronary artery plaque evaluation in CT. Front Cardiovasc Med 2024; 11:1395350. [PMID: 38984352 PMCID: PMC11232181 DOI: 10.3389/fcvm.2024.1395350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/14/2024] [Indexed: 07/11/2024] Open
Abstract
Accurate evaluation of the nature and composition of coronary plaque involves clinical follow-up and prognosis. Coronary CT angiography is the most commonly non-invasive method for plaque evaluation, however, the qualitative and quantitative evaluation of plaque based on CT value is inaccurate, due to the influence of luminal attenuation, tube voltage, parameter setting and the subjectivity.
Collapse
Affiliation(s)
- Yaqi Gao
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yao Pan
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chongfu Jia
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
4
|
Etter D, Warnock G, Koszarski F, Niemann T, Mikail N, Bengs S, Buechel RR, Kaufmann P, Gebhard C, Rossi A. Towards universal comparability of pericoronary adipose tissue attenuation: a coronary computed tomography angiography phantom study. Eur Radiol 2023; 33:2324-2330. [PMID: 36472700 PMCID: PMC10017558 DOI: 10.1007/s00330-022-09274-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Different computed tomography (CT) scanners, variations in acquisition protocols, and technical parameters employed for image reconstruction may introduce bias in the analysis of pericoronary adipose tissue (PCAT) attenuation derived from coronary computed tomography angiography (CCTA). Therefore, the aim of this study was to establish the effect of tube voltage, measured as kilovoltage peak (kVp), and iterative reconstruction on PCAT mean attenuation (PCATMA). METHODS Twelve healthy ex vivo porcine hearts were injected with iodine-enriched agar-agar to allow for ex vivo CCTA imaging on a 256-slice CT and a dual-source CT system. Images were acquired at tube voltages of 80, 100, 120, and 140 kVp and reconstructed by using both filtered back projection and iterative reconstruction algorithms. PCATMA was measured semi-automatically on CCTA images in the proximal segment of coronary arteries. RESULTS The tube voltage showed a significant effect on PCATMA measurements on both the 256-slice CT scanner (p < 0.001) and the dual-source CT system (p = 0.013), resulting in higher attenuation values with increasing tube voltage. Similarly, the use of iterative reconstructions was associated with a significant increase of PCATMA (256-slice CT: p < 0.001 and dual-source CT: p = 0.014). Averaged conversion factors to correct PCATMA measurements for tube voltage other than 120 kVp were 1.267, 1.080 and 0.947 for 80, 100, and 140 kVp, respectively. CONCLUSION PCATMA values are significantly affected by acquisition and reconstruction parameters. The same tube voltage and reconstruction type are recommended when PCAT attenuation is used in multicenter and longitudinal studies. KEY POINTS • The tube voltage used for CCTA acquisition affects pericoronary adipose tissue attenuation, resulting in higher attenuation values of fat with increasing tube voltage. • Conversion factors for pericoronary adipose tissue attenuation values could be used to adjust for differences in attenuation between scans performed at different tube voltages. • In longitudinal CCTA studies employing pericoronary adipose tissue attenuation as imaging endpoint, it is recommended to maintain tube voltage and image reconstruction type constant across serial scans.
Collapse
Affiliation(s)
- Dominik Etter
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Geoff Warnock
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Frederic Koszarski
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, 5400, Baden, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland.
| |
Collapse
|
5
|
Rotzinger DC, Qanadli SD, Fahrni G. Imaging the Vulnerable Carotid Plaque with CT: Caveats to Consider. Comment on Wang et al. Identification Markers of Carotid Vulnerable Plaques: An Update. Biomolecules 2022, 12, 1192. Biomolecules 2023; 13:biom13020397. [PMID: 36830766 PMCID: PMC9953174 DOI: 10.3390/biom13020397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
We read with great interest the review by Wang et al. entitled "Identification Markers of Carotid Vulnerable Plaques: An Update", recently published in Biomolecules [...].
Collapse
Affiliation(s)
- David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-44-75
| | - Salah D. Qanadli
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| |
Collapse
|
6
|
Jin X, Li Y, Yan F, Liu Y, Zhang X, Li T, Yang L, Chen H. Automatic coronary plaque detection, classification, and stenosis grading using deep learning and radiomics on computed tomography angiography images: a multi-center multi-vendor study. Eur Radiol 2022; 32:5276-5286. [PMID: 35290509 DOI: 10.1007/s00330-022-08664-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/12/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES An automatic system utilizing both the advantages of the neural network and the radiomics was proposed for coronary plaque detection, classification, and stenosis grading. METHODS This study retrospectively included 505 patients with 127,763 computed tomography angiography (CTA) images from 5 medical center. A convolutional neural network (CNN) model was used to segment the coronary artery, detect the plaque candidate, and extract the image patch with high computation efficiency. The manually designed radiomics feature extractor was utilized to collect plaque patterns, followed by the different classifiers to perform the plaque classification and stenosis grading. RESULTS The CNN model achieved 100% of sensitivity and the highest positive predictive value (83.9%) than U-Net and baseline model in plaque candidate detection. Twenty-six representative radiomics features were selected to construct the classifiers. Among different models, the gradient-boosting decision tree (GBDT) achieved the best performance in plaque classification (accuracy: 87.0%, sensitivity: 83.2%, specificity: 91.4%) and stenosis grading (accuracy: 90.9%, sensitivity: 84.1%, specificity: 95.7%). GBDT also achieved the highest AUC of 0.873 in plaque classification and 0.910 in stenosis grading. The computation time of processing one patient was 56.2 ± 5.7 s which was significantly less than radiologist manual analysis (285.6 ± 134.5 s, p = 0.0001). CONCLUSIONS In this study, an automatic workflow was proposed to detect and analyze coronary plaques with high accuracy and efficiency, showing the potential in clinical application. KEY POINTS • The proposed automatic system integrated deep learning and radiomics to perform the coronary plaque analysis. • The proposed automatic system achieved high accuracy in both plaque classification and stenosis grading. • The proposed automatic system was five times more efficient than radiologist manual analysis.
Collapse
Affiliation(s)
- Xin Jin
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yuze Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Room 109, Haidian District, Beijing, 100084, China
| | - Fei Yan
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ye Liu
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xinghua Zhang
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tao Li
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Li Yang
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Room 109, Haidian District, Beijing, 100084, China.
| |
Collapse
|
7
|
Williams MC, Earls JP, Hecht H. Quantitative assessment of atherosclerotic plaque, recent progress and current limitations. J Cardiovasc Comput Tomogr 2022; 16:124-137. [PMID: 34326003 DOI: 10.1016/j.jcct.2021.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
An important advantage of computed tomography coronary angiography (CCTA) is its ability to visualize the presence and severity of atherosclerotic plaque, rather than just assessing coronary artery stenoses. Until recently, assessment of plaque subtypes on CCTA relied on visual assessment of the extent of calcified/non-calcified plaque, or visually identifying high-risk plaque characteristics. Recent software developments facilitate the quantitative assessment of plaque volume or burden on CCTA, and the identification of subtypes of plaque based on their attenuation density. These techniques have shown promise in single and multicenter studies, demonstrating that the amount and type of plaque are associated with subsequent cardiac events. However, there are a number of limitations to the application of these techniques, including the limitations imposed by the spatial resolution of current CT scanners, challenges from variations between reconstruction algorithms, and the additional time to perform these assessments. At present, these are a valuable research technique, but not yet part of routine clinical practice. Future advances that improve CT resolution, standardize acquisition techniques and reconstruction algorithms and automate image analysis will improve the clinical utility of these techniques. This review will discuss the technical aspects of quantitative plaque analysis and present pro and con arguments for the routine use of quantitative plaque analysis on CCTA.
Collapse
Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - James P Earls
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Harvey Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
8
|
Quantitative plaque assessment by coronary computed tomography angiography: An up-to-date review. IMAGING 2021. [DOI: 10.1556/1647.2021.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Coronary computed tomography angiography has an emerging role in the diagnostic workup of coronary artery disease. Due to its high sensitivity and negative predictive value, coronary computed tomography angiography can rule out obstructive coronary artery diseases and substitute invasive coronary angiography in many cases. In addition, coronary computed tomography angiography provides a unique information beyond stenosis grading as it can visualize atherosclerosis and quantify its extent. Qualitative and quantitative plaque assessment provides an incremental value in the prediction of future major adverse cardiac events. Moreover, determining adverse plaque features has a potential to identify advanced atherosclerosis and patients at increased risk of acute coronary syndrome. Nevertheless, challenges may emerge with the process of quantifying coronary plaques due to limited reproducibility, lack of automated, standardized and validated techniques. Therefore, reliable quantified data are scarce due to the various computed tomography scanners and software platforms and investigations with small sample sizes. Radiomics and machine learning-based image processing methods are relatively new in the field of cardiovascular plaque imaging. These techniques hold the promise to improve diagnostic performance, reproducibility and prognostic value of computed tomography based plaque assessment.
Collapse
|
9
|
Cademartiri F, Casolo G, Clemente A, Seitun S, Mantini C, Bossone E, Saba L, Sverzellati N, Nistri S, Punzo B, Cavaliere C, La Grutta L, Gentile G, Maffei E. Coronary CT angiography: a guide to examination, interpretation, and clinical indications. Expert Rev Cardiovasc Ther 2021; 19:413-425. [PMID: 33884942 DOI: 10.1080/14779072.2021.1915132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The introduction of Cardiac Computed Tomography (CCT) has changed the paradigm in the field of diagnostic cardiovascular medicine. CCT is the primary tool in the assessment of suspected Coronary Artery Disease (CAD) and should be followed by functional assessment when needed to stratify disease and to plan potential interventional or surgical therapy. AREAS COVERED We provided the current state of the knowledge on the main aspects of technique of examination, image interpretation and clinical indications. We have focused our attention on the basic routine applications and activities. EXPERT OPINION The primary role of CCT in suspected CAD will progressively become the standard approach. In general, any situation in which anatomy of the heart and thoracic vessels/structures is mandatory must be approached using CT first, whenever possible. The quantity and quality of information that can be provided by CCT is big and the operators should learn how to deal with this information. On the other hand, CCT is only apparently a straightforward and simple examination. It is actually the most complex diagnostic procedure that can be performed on CT and requires highly skilled operators and state-of-art-technology.
Collapse
Affiliation(s)
| | - Giancarlo Casolo
- Department of Cardiology, Ospedale Della Versilia, Viareggio, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Sara Seitun
- Department of Radiology, Ospedale San Martino, Genova, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | | | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | | | | | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino, Italy
| |
Collapse
|
10
|
Maffei E, Punzo B, Cavaliere C, Bossone E, Saba L, Cademartiri F. Coronary atherosclerosis as the main endpoint of non-invasive imaging in cardiology: a narrative review. Cardiovasc Diagn Ther 2021; 10:1897-1905. [PMID: 33381433 DOI: 10.21037/cdt-20-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The change of paradigm determined by the introduction of cardiac computed tomography (CCT) in the field of cardiovascular medicine has allowed new evidence to emerge. These evidences point towards a major role, probably the most important one in terms of prognostic impact, in the detection, characterization and quantification of atherosclerosis as the main driver and endpoint for the management of coronary artery disease (CAD). Extensive literature has been published in the last decade with large numbers and patients' populations, investigating several aspects and correlations between atherosclerotic plaque features and risk factors; also, the relationship between plaque features, both with qualitative and quantitative approaches, and cardiovascular events has been investigated. More recent studies have also pointed out the relationship between the knowledge and classification of sub-clinical atherosclerosis and the induced modification of medical therapy (both aggressiveness and compliance) that is most likely able to increase the effect of anti-atherosclerotic drugs, hence significantly improving prognosis. Non-invasive assessment of CAD by means of CCT is becoming the primary tool for management and also the most important parameter for the comprehension of natural history of CAD and how the therapies we adopt are affecting plaque burden as a whole. In this review we will address the modern concepts of CAD driven understanding and management of cardiovascular disease.
Collapse
Affiliation(s)
- Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
| | | |
Collapse
|
11
|
Hennessey B, Vera-Urquiza R, Mejía-Rentería H, Gonzalo N, Escaned J. Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention. Int J Cardiovasc Imaging 2020; 36:2441-2459. [DOI: 10.1007/s10554-020-02052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
|
12
|
Nakanishi R, Motoyama S, Leipsic J, Budoff MJ. How accurate is atherosclerosis imaging by coronary computed tomography angiography? J Cardiovasc Comput Tomogr 2019; 13:254-260. [DOI: 10.1016/j.jcct.2019.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/11/2019] [Accepted: 06/10/2019] [Indexed: 02/01/2023]
|
13
|
Kolossváry M, Szilveszter B, Merkely B, Maurovich-Horvat P. Plaque imaging with CT-a comprehensive review on coronary CT angiography based risk assessment. Cardiovasc Diagn Ther 2017; 7:489-506. [PMID: 29255692 PMCID: PMC5716945 DOI: 10.21037/cdt.2016.11.06] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/08/2016] [Indexed: 01/07/2023]
Abstract
CT based technologies have evolved considerably in recent years. Coronary CT angiography (CTA) provides robust assessment of coronary artery disease (CAD). Early coronary CTA imaging-as a gate-keeper of invasive angiography-has focused on the presence of obstructive stenosis. Coronary CTA is currently the only non-invasive imaging modality for the evaluation of non-obstructive CAD, which has been shown to contribute to adverse cardiac events. Importantly, improved spatial resolution of CT scanners and novel image reconstruction algorithms enable the quantification and characterization of atherosclerotic plaques. State-of-the-art CT imaging can therefore reliably assess the extent of CAD and differentiate between various plaque features. Recent studies have demonstrated the incremental prognostic value of adverse plaque features over luminal stenosis. Comprehensive coronary plaque assessment holds potential to significantly improve individual risk assessment incorporating adverse plaque characteristics, the extent and severity of atherosclerotic plaque burden. As a result, several coronary CTA based composite risk scores have been proposed recently to determine patients at high risk for adverse events. Coronary CTA became a promising modality for the evaluation of functional significance of coronary lesions using CT derived fractional flow reserve (FFR-CT) and/or rest/dynamic myocardial CT perfusion. This could lead to substantial reduction in unnecessary invasive catheterization procedures and provide information on ischemic burden of CAD. Discordance between the degree of stenosis and ischemia has been recognized in clinical landmark trials using invasive FFR. Both lesion stenosis and composition are possibly related to myocardial ischemia. The evaluation of lesion-specific ischemia using combined functional and morphological plaque information could ultimately improve the diagnostic performance of CTA and thus patient care. In this review we aimed to summarize current evidence on comprehensive coronary artery plaque assessment using coronary CTA.
Collapse
Affiliation(s)
- Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
14
|
Incremental Prognostic Value of Quantified Vulnerable Plaque by Cardiac Computed Tomography: A Pilot Study. J Thorac Imaging 2017; 31:373-379. [PMID: 27753753 DOI: 10.1097/rti.0000000000000236] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coronary computed tomography (CT) angiography (CCTA) has the ability to detect, characterize, and quantify atherosclerotic plaques. The aim of our study was to evaluate the prognostic power of CCTA-quantified plaque subtypes. MATERIALS AND METHODS A total of 36 patients with adverse events and 36 Morise score-matched patients who remained event free on follow-up were identified. Using CCTA images, plaque subtype volumes in the major epicardial arteries were analyzed using predetermined attenuation ranges in Hounsfield units (HU): 1 to 30 HU (low attenuating), 31 to 70 HU (intermediate attenuating), 71 to 150 HU (high attenuating), and mean coronary lumen+2 SD to 1000 HU (calcified). Each epicardial artery was divided into proximal, mid, and distal segments, and plaque volumes were normalized for arterial segment length. RESULTS The baseline characteristics of the 2 cohorts were similar. Low-attenuation and intermediate-attenuation plaque volumes were greater in the proximal segments as well as in the entire length in the adverse event compared with the event-free group. High-attenuation plaque volume was increased only in the proximal segments in the adverse event group. There was no difference in the volume of calcified plaque between the 2 groups. The log rank test using a cutoff of 3.99 mm/mm for combined intermediate and low plaque volume showed more adverse events in patients with a plaque volume of ≥3.99 mm/mm. CONCLUSIONS Adverse events appear to be associated with greater volumes of low-attenuation and intermediate-attenuation plaques that reflect lipid and fibrous atherosclerosis. The difference between the 2 groups is most apparent in the proximal epicardial arteries.
Collapse
|
15
|
Linsen PVM, Coenen A, Lubbers MM, Dijkshoorn ML, Ouhlous M, Nieman K. Computed Tomography Angiography with a 192-slice Dual-source Computed Tomography System: Improvements in Image Quality and Radiation Dose. J Clin Imaging Sci 2016; 6:44. [PMID: 27833784 PMCID: PMC5093882 DOI: 10.4103/2156-7514.192840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/07/2016] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to compare image quality, radiation dose, and the influence of the heart rate on image quality of high-pitch spiral coronary computed tomography angiography (CCTA) using 128-slice (second generation) dual-source CT (DSCT) and a 192-slice DSCT (third generation) scanner. MATERIALS AND METHODS Two consecutive cohorts of fifty patients underwent CCTA by high-pitch spiral scan mode using 128 or 192-slice DSCT. The 192-slice DSCT system has a more powerful roentgen tube (2 × 120 kW) that allows CCTA acquisition at lower tube voltages, wider longitudinal coverage for faster table speed (732 m/s), and the use of iterative reconstruction. Objective image quality was measured as the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was evaluated using a Likert scale. RESULTS While the effective dose was lower with 192-slice DSCT (1.2 ± 0.5 vs. 0.6 ± 0.3 mSv; P < 0.001), the SNR (18.9 ± 4.3 vs. 11.0 ± 2.9; P < 0.001) and CNR (23.5 ± 4.8 vs. 14.3 ± 4.1; P < 0.001) were superior to 128-slice DSCT. Although patients scanned with 192-slice DSCT had a faster heart rate (59 ± 7 vs. 56 ± 6; P = 0.045), subjective image quality was scored higher (4.2 ± 0.8 vs. 3.0 ± 0.7; P < 0.001) compared to 128-slice DSCT. CONCLUSIONS High-pitch spiral CCTA by 192-slice DSCT provides better image quality, despite a higher average heart rate, at lower radiation doses compared to 128-slice DSCT.
Collapse
Affiliation(s)
- Philip V M Linsen
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adriaan Coenen
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marisa M Lubbers
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Mohamed Ouhlous
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen Nieman
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Hoy CFO, Naguib HE, Paul N. Fabrication and control of CT number through polymeric composites based on coronary plaque CT phantom applications. J Med Imaging (Bellingham) 2016; 3:016001. [PMID: 26958580 DOI: 10.1117/1.jmi.3.1.016001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/22/2016] [Indexed: 11/14/2022] Open
Abstract
Biomedical phantoms are commonly used for various medical imaging modalities to improve imaging quality and procedures. Current biomedical phantoms fabricated commercially are high in cost and limited in the specificity of human environments and structures that can be mimicked. This study aimed to control the measurable computed tomography (CT) number in Hounsfield units through polymeric biomedical phantom materials using controlled amounts of hydroxyapatite (hA). The purpose was to fabricate CT phantoms capable of mimicking various coronary plaque types while introducing a fabrication technique and basis for a numerical model to which the technique may be applied. The CT number is tunable based on the controlled material properties of electron density and atomic numbers. Three different polymeric matrices of polyethylene (PE), thermoplastic polyurethane (TPU), and polyvinylidene fluoride (PVDF) were selected due to their varied specific densities and ease of fabrication acting as integral properties for CT phantom fabrication. These polymers were processed together with additions of hA in mass percentages of 2.5, 5, 10, and 20% hA as well as a 0% hA as a control for each polymeric material. By adding hA to PE, TPU, and PVDF an increasing trend was exhibited between CT number and weight percent of hA.
Collapse
Affiliation(s)
- Carlton F O Hoy
- University of Toronto , Department of Mechanical and Industrial Engineering, 5 King's College Road, Toronto, Ontario M5S 3G8, Canada
| | - Hani E Naguib
- University of Toronto, Department of Mechanical and Industrial Engineering, 5 King's College Road, Toronto, Ontario M5S 3G8, Canada; University of Toronto, Department of Materials Science and Engineering, 184 College Street, Suite 140, Toronto, Ontario M5S 3E4, Canada; University of Toronto, Institute of Biomaterials and Biomedical Engineering, Rosebrugh Building, Suite 407, 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - Narinder Paul
- University of Toronto, Institute of Biomaterials and Biomedical Engineering, Rosebrugh Building, Suite 407, 164 College Street, Toronto, Ontario M5S 3G9, Canada; University Health Network, Department of Medical Imaging, R. Fraser Elliott Building, 1st Floor, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| |
Collapse
|
17
|
Cademartiri F, Maffei E. Cardiac CT for the detection of vulnerable plaque. Eur Heart J Cardiovasc Imaging 2015; 17:260-1. [PMID: 26628618 DOI: 10.1093/ehjci/jev307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute, Universitè de Montreal, Montreal, Canada Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands
| | - Erica Maffei
- Centre de Recherche, Montreal Heart Institute, Universitè de Montreal, Montreal, Canada
| |
Collapse
|
18
|
Hell MM, Achenbach S, Schuhbaeck A, Klinghammer L, May MS, Marwan M. CT-based analysis of pericoronary adipose tissue density: Relation to cardiovascular risk factors and epicardial adipose tissue volume. J Cardiovasc Comput Tomogr 2015; 10:52-60. [PMID: 26256553 DOI: 10.1016/j.jcct.2015.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) can promote atherosclerosis. Metabolically active and inactive PCAT may display different CT densities. However, CT density could be influenced by partial volume effects and image interpolation. OBJECTIVE To investigate whether PCAT density values in CT displays differences that are larger than those attributable to interpolation and partial volume effects, which would manifest themselves through the relationship between PCAT density and distance from the contrast-enhanced coronary lumen. METHODS PCAT density analysis was performed (417 non-atherosclerotic segments, 63 patients) using dual-source CT with a threshold-based measurement method. Changes in PCAT density values depending on distance from the contrast-enhanced coronary lumen and the influence of cardiovascular risk profile were analyzed. RESULTS Mean PCAT density was -78.1 ± 5.6 HU. PCAT density decreased from proximal to distal segments in the LAD (-78.0 ± 7.3 vs. -82.4 ± 7.7 HU; p < 0.001). PCAT density was higher close to the lumen compared to more peripheral locations (-76.0 ± 6.7 vs. -78.5 ± 5.4 HU; p < 0.001). Decreasing PCAT density was significantly associated with higher epicardial adipose tissue (EAT) volume and body mass index. There was a trend of lower PCAT values with a family history of coronary artery disease. CONCLUSION CT-measured attenuation of PCAT is influenced by EAT volume and body mass index. A decrease of PCAT attenuation with increasing distance from the vessel and from proximal to distal segments may suggest variations in CT density of PCAT due to partial volume effects and image interpolation rather than solely due to differences in tissue composition or metabolic activity.
Collapse
Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Lutz Klinghammer
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| |
Collapse
|
19
|
Hell MM, Achenbach S, Shah PK, Berman DS, Dey D. Noncalcified Plaque in Cardiac CT: Quantification and Clinical Implications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9343-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
20
|
Ulrich A, Burg MC, Raupach R, Bunck A, Schuelke C, Maintz D, Heindel W, Seifarth H. Coronary stent imaging with dual-source CT: assessment of lumen visibility using different convolution kernels and postprocessing filters. Acta Radiol 2015; 56:42-50. [PMID: 24399513 DOI: 10.1177/0284185113517229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assesment of the coronary arteries after stent placement using coronary computed tomography angiography (CCTA) currently requires reconstruction of images with soft kernels for the assessment of atherosclerotic plaques and dedicated edge enhancing kernels for the evaluation of the stent lumen. PURPOSE To evaluate a two-dimensional filter tool that provides instant postprocessing of images reconstructed with soft kernels into edge-enhanced images and vice versa and thus may eliminate the need for two separate reconstrcutions for the assessment of coronary artery stents using CCTA. MATERIAL AND METHODS Twenty stents with a diameter of 3.0 mm placed in a vascular phantom were scanned with a dual-source CT using standard parameters. Images were reconstructed with a soft B30f and an edge-enhancing B46f kernel and postprocessed with the corresponding filter algorithm (F30 for B30f images; F46 for B46f images). The resulting four data-sets were evaluated for lumen visibility, intraluminal attenuation, and image noise by two independent readers. Results were validated in vivo against invasive coronary angiography in data-sets from patients with coronary artery stents. RESULTS Average intraluminal attenuation was 552.6 HU, 527.3 HU, 207.9 HU, and 267.5 HU for B30f, F30, B46f, and F46 images, respectively (P < 0.0001). Average image noise was 11.3, 10.6, 19.2, and 15.0 HU, respectively (P < 0.0001). The visible stent diameter was significantly higher in the B46f (59.6%) and F46 images (54%) compared to the B30f (48.3%) and F30 (51.5%) images (P < 0.0001). In the patient study, lumen assessability was significantly better in B46f images than in F46 images. Sensitivity for stenosis detection was best in the original B46f images with a sensitivity of 67% and a specificity of 94%. CONCLUSION The postprocessing filter reduces image noise, however currently it does not offer an alternative to image reconstruction using the edge-enhancing kernels for the evaluation of the stent lumen.
Collapse
Affiliation(s)
- Anne Ulrich
- Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Matthias C Burg
- Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Rainer Raupach
- Siemens Medical Solutions, Computed Tomography CTE PA, Forchheim, Germany
| | - Alexander Bunck
- Department of Clinical Radiology, University of Muenster, Münster, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Christoph Schuelke
- Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Harald Seifarth
- Department of Clinical Radiology, University of Muenster, Münster, Germany
- Department of Diagnostic and Interventional Radiology, Esslingen Hospital, Esslingen, Germany
| |
Collapse
|
21
|
Mannelli L, MacDonald L, Mancini M, Ferguson M, Shuman WP, Ragucci M, Monti S, Xu D, Yuan C, Mitsumori LM. Dual energy computed tomography quantification of carotid plaques calcification: comparison between monochromatic and polychromatic energies with pathology correlation. Eur Radiol 2014; 25:1238-46. [PMID: 25537980 DOI: 10.1007/s00330-014-3523-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/30/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We compared carotid plaque calcification detection sensitivity and apparent cross-sectional area on CT as a function of CT beam energy using conventional CT techniques and virtual mono-energetic CT images generated from dual-energy acquisitions. METHODS & MATERIALS Five ex-vivo carotid endarterectomy (CEA) specimens were imaged with dual-energy computed tomography. Virtual monochromatic spectrum (VMS) CT images were reconstructed at energies between 40-140 keV. The same specimens were imaged using conventional polyenergetic spectrum (PS) CT with peak beam energies 80, 100, 120, and 140 kVp. The histological calcium areas on each corresponding CEA specimen were traced manually on digitized images of Toluidine-Blue/Basic-Fuchsin stained plastic sections. RESULTS 40 keV VMS CT images provided high detection sensitivity (97 %) similar to conventional PS CT images (~96 %). The calcification size measured on CT decreased systematically with increasing CT beam energy; the rate of change was larger for the VMS images than for PS images. CONCLUSION From a single dual-energy CT, multiple VMS-CT images can be generated, yielding equivalent detection sensitivity and size correlations as conventional PS-CT in CEA calcification imaging. VMS-CT at 80-100 keV provided the most accurate estimates of calcification size, as compared to histology, but detection sensitivity was reduced for smaller calcifications on these images. KEY POINTS • Calcifications depicted at 80-100 keV were most similar to the histology standard. • Conventional polychromatic images demonstrated excellent correlation with plaque size at pathology. • Conventional polychromatic images systematically overestimate plaque size. • Plaque calcifications can be missed on high energy monochromatic images.
Collapse
Affiliation(s)
- Lorenzo Mannelli
- Departments of Radiology, University of Washington, Seattle, WA, USA,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Correction of lumen contrast-enhancement influence on non-calcified coronary atherosclerotic plaque quantification on CT. Int J Cardiovasc Imaging 2014; 31:429-36. [DOI: 10.1007/s10554-014-0554-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022]
|
23
|
Schuhbaeck A, Dey D, Otaki Y, Slomka P, Kral BG, Achenbach S, Berman DS, Fishman EK, Lai S, Lai H. Interscan reproducibility of quantitative coronary plaque volume and composition from CT coronary angiography using an automated method. Eur Radiol 2014; 24:2300-8. [PMID: 24962824 DOI: 10.1007/s00330-014-3253-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/08/2014] [Accepted: 05/16/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Quantitative measurements of coronary plaque volume may play a role in serial studies to determine disease progression or regression. Our aim was to evaluate the interscan reproducibility of quantitative measurements of coronary plaque volumes using a standardized automated method. METHODS Coronary dual source computed tomography angiography (CTA) was performed twice in 20 consecutive patients with known coronary artery disease within a maximum time difference of 100 days. The total plaque volume (TP), the volume of non-calcified plaque (NCP) and calcified plaque (CP) as well as the maximal remodelling index (RI) were determined using automated software. RESULTS Mean TP volume was 382.3 ± 236.9 mm(3) for the first and 399.0 ± 247.3 mm(3) for the second examination (p = 0.47). There were also no significant differences for NCP volumes, CP volumes or RI. Interscan correlation of the plaque volumes was very good (Pearson's correlation coefficients: r = 0.92, r = 0.90 and r = 0.96 for TP, NCP and CP volumes, respectively). CONCLUSIONS Automated software is a time-saving method that allows accurate assessment of coronary atherosclerotic plaque volumes in coronary CTA with high reproducibility. With this approach, serial studies appear to be possible. KEY POINTS Reproducibility of coronary atherosclerotic plaque volume in coronary CTA is high. Using automated software facilitates quantitative measurements. Serial studies to determine progression or regression of coronary plaque are possible.
Collapse
Affiliation(s)
- Annika Schuhbaeck
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Assessment of dose exposure and image quality in coronary angiography performed by 640-slice CT: a comparison between adaptive iterative and filtered back-projection algorithm by propensity analysis. Radiol Med 2014; 119:642-9. [DOI: 10.1007/s11547-014-0382-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/01/2013] [Indexed: 10/25/2022]
|
25
|
Taniguchi T, Iwata T, Sasaki Y, Ichikawa K, Sugiura A. [Assessing the influence of reconstruction kernel in plaque imaging in computed tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:135-142. [PMID: 24573227 DOI: 10.6009/jjrt.2014_jsrt_70.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Plaque imaging using computed tomography (CT) is an important diagnostic method for predicting the risk of vascular events. However, the CT value variability of plaques, which depends on the scan parameters, remains a key challenge. The aim of this study was to evaluate the effect of reconstruction properties on the CT value, area, and shape reproducibility of plaques. In general, the types of reconstruction kernels in a CT system are limited, thus impeding the acquisition of the necessary resolution properties (modulation transfer functions: MTFs). We therefore obtained images with eight types (smoothed to edge-enhanced) of resolution property by applying frequency processing to the original CT images. We made phantoms of simulated 6-mm-diameter vessels with plaque and scanned them at different doses. The CT values, areas, and shape reproducibility of plaques were measured from each processed image. Enhanced-type resolution with no edge enhancement (not exceeding 1.0) effectively raised the CT value and shape reproducibility accuracies. However, edge-enhancement type resolution caused errors in the CT value, area and shape reproducibility.
Collapse
Affiliation(s)
- Takuya Taniguchi
- Radiology Department, Murakami Memorial Hospital, Asahi University
| | | | | | | | | |
Collapse
|
26
|
Dey D, Schuhbaeck A, Min JK, Berman DS, Achenbach S. Non-invasive measurement of coronary plaque from coronary CT angiography and its clinical implications. Expert Rev Cardiovasc Ther 2014; 11:1067-77. [DOI: 10.1586/14779072.2013.823707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
27
|
Lam R, Niessen SJ, Lamb CR. X-RAY ATTENUATION OF THE LIVER AND KIDNEY IN CATS CONSIDERED AT VARYING RISK OF HEPATIC LIPIDOSIS. Vet Radiol Ultrasound 2013; 55:141-6. [DOI: 10.1111/vru.12113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/21/2013] [Indexed: 12/12/2022] Open
Affiliation(s)
- Richard Lam
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| | - Stijn J. Niessen
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| | - Christopher R. Lamb
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| |
Collapse
|
28
|
Kang D, Slomka PJ, Nakazato R, Arsanjani R, Cheng VY, Min JK, Li D, Berman DS, Kuo CCJ, Dey D. Automated knowledge-based detection of nonobstructive and obstructive arterial lesions from coronary CT angiography. Med Phys 2013; 40:041912. [PMID: 23556906 DOI: 10.1118/1.4794480] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Visual analysis of three-dimensional (3D) coronary computed tomography angiography (CCTA) remains challenging due to large number of image slices and tortuous character of the vessels. The authors aimed to develop a robust, automated algorithm for unsupervised computer detection of coronary artery lesions. METHODS The authors' knowledge-based algorithm consists of centerline extraction, vessel classification, vessel linearization, lumen segmentation with scan-specific lumen attenuation ranges, and lesion location detection. Presence and location of lesions are identified using a multi-pass algorithm which considers expected or "normal" vessel tapering and luminal stenosis from the segmented vessel. Expected luminal diameter is derived from the scan by automated piecewise least squares line fitting over proximal and mid segments (67%) of the coronary artery considering the locations of the small branches attached to the main coronary arteries. RESULTS The authors applied this algorithm to 42 CCTA patient datasets, acquired with dual-source CT, where 21 datasets had 45 lesions with stenosis ≥ 25%. The reference standard was provided by visual and quantitative identification of lesions with any stenosis ≥ 25% by three expert readers using consensus reading. The authors algorithm identified 42 lesions (93%) confirmed by the expert readers. There were 46 additional lesions detected; 23 out of 39 (59%) of these were less-stenosed lesions. When the artery was divided into 15 coronary segments according to standard cardiology reporting guidelines, per-segment basis, sensitivity was 93% and per-segment specificity was 81% using 10-fold cross-validation. CONCLUSIONS The authors' algorithm shows promising results in the detection of both obstructive and nonobstructive CCTA lesions.
Collapse
Affiliation(s)
- Dongwoo Kang
- Department of Electrical Engineering, University of Southern California, Los Angeles, California 90089, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
A meta analysis and hierarchical classification of HU-based atherosclerotic plaque characterization criteria. PLoS One 2013; 8:e73460. [PMID: 24019924 PMCID: PMC3760884 DOI: 10.1371/journal.pone.0073460] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/21/2013] [Indexed: 12/26/2022] Open
Abstract
Background Many computed tomography (CT) studies have reported that lipid-rich, presumably rupture-prone atherosclerotic plaques can be characterized according to their Hounsfield Unit (HU) value. However, the published HU-based characterization criteria vary considerably. The present study aims to systematically analyze these values and empirically derive a hierarchical classification of the HU-based criteria which can be referred in clinical situation. Material and Methods A systematic search in PubMed and Embase for publications with HU-criteria to characterize lipid-rich and fibrous atherosclerotic plaques resulted in 36 publications, published between 1998 and 2011. The HU-criteria were systematically analyzed based on the characteristics of the reporting study. Significant differences between HU-criteria were checked using Student’s t-test. Subsequently, a hierarchical classification of HU-criteria was developed based on the respective study characteristics. Results No correlation was found between HU-criteria and the reported lumen contrast-enhancement. Significant differences were found for HU-criteria when pooled according to the respective study characteristics: examination type, vessel type, CT-vendor, detector-rows, voltage-setting, and collimation-width. The hierarchical classification resulted in 21 and 22 CT attenuation value categories, for lipid-rich and fibrous plaque, respectively. More than 50% of the hierarchically classified HU-criteria were significantly different. Conclusion In conclusion, variations in the reported CT attenuation values for lipid-rich and fibrous plaque are so large that generalized values are unreliable for clinical use. The proposed hierarchical classification can be used to determine reference CT attenuation values of lipid-rich and fibrous plaques for the local setting.
Collapse
|
30
|
Nakanishi R, Min JK. Coronary CT Angiographic Measures of Adverse Atherosclerotic Plaque Features. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0299-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
31
|
La Grutta L, Galia M, Gentile G, Lo Re G, Grassedonio E, Coppolino F, Maffei E, Maresi E, Lo Casto A, Cademartiri F, Midiri M. Comparison of iodinated contrast media for the assessment of atherosclerotic plaque attenuation values by CT coronary angiography: observations in an ex vivo model. Br J Radiol 2013; 86:20120238. [PMID: 23255542 DOI: 10.1259/bjr.20120238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the influence of different iodinated contrast media with several dilutions on plaque attenuation in an ex vivo coronary model studied by multislice CT coronary angiography. METHODS In six ex vivo left anterior descending coronary arteries immersed in oil, CT (slices/collimation 64×0.625 mm, temporal resolution 210 ms, pitch 0.2) was performed after intracoronary injection of a saline solution, and solutions of a dimeric isosmolar contrast medium (Iodixanol 320 mgI ml(-1)) and a monomeric high-iodinated contrast medium (Iomeprol 400 mgI ml(-1)) with dilutions of 1/80 (low concentration), 1/50 (medium concentration), 1/40 (high concentration) and 1/20 (very high concentration). Two radiologists drew regions of interest in the lumen and in calcified and non-calcified plaques for each solution. 29 cross-sections with non-calcified plaques and 32 cross-sections with calcified plaques were evaluated. RESULTS Both contrast media showed different attenuation values within lumen and plaque (p<0.0001). The correlation between lumen and non-calcified plaque values was good (Iodixanol r=0.793, Iomeprol r=0.647). Clustered medium- and high-concentration solutions showed similar plaque attenuation values, signal-to-noise ratios (SNRs) (non-calcified plaque: medium solution SNR 31.3±15 vs 31.4±20, high solution SNR 39.4±17 vs 37.4±22; calcified plaque: medium solution SNR 305.2±133 vs 298.8±132, high solution SNR 323.9±138 vs 293±123) and derived contrast-to-noise ratios (p>0.05). CONCLUSION Differently iodinated contrast media have a similar influence on plaque attenuation profiles. ADVANCES IN KNOWLEDGE Since iodine load affects coronary plaque attenuation linearly, different contrast media may be equally employed for coronary atherosclerotic plaque imaging.
Collapse
Affiliation(s)
- L La Grutta
- Department of Radiology, University of Palermo, Palermo, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Morsbach F, Berger N, Desbiolles L, Poropat T, Leschka S, Alkadhi H, Stolzmann P. Systematic analysis on the relationship between luminal enhancement, convolution kernel, plaque density, and luminal diameter of coronary artery stenosis: a CT phantom study. Int J Cardiovasc Imaging 2013; 29:1129-35. [PMID: 23329389 DOI: 10.1007/s10554-012-0173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022]
Abstract
To systematically investigate into the relationships between luminal enhancement, convolution kernel, plaque density, and stenosis severity in coronary computed tomography (CT) angiography. A coronary phantom including 63 stenoses (stenosis severity, 10-90%; plaque densities, -100 to 1,000 HU) was loaded with increasing solutions of contrast material (luminal enhancement, 0-700 HU) and scanned in an anthropomorphic chest. CT data was acquired with prospective triggering using 64-section dual-source CT; reconstructions were performed with soft-tissue (B26f) and sharp convolution kernels (B46f). Two blinded and independent readers quantitatively assessed luminal diameter and CT number of plaque using electronic calipers. Measurement bias between phantom dimensions and CT measurements were calculated. Multivariate linear regression models identified predictors of bias. Inter- and intra-reader agreements of luminal diameter and CT number measurements were excellent (ICCs > 0.91, p < 0.01, each). Measurement bias of luminal diameter and plaque density was significantly (p < 0.01, each) lower (-12% and 58 HU, respectively) with B46f as opposed to B26f, especially in plaque densities >200 HU. Measurement bias was significantly (p < 0.01, each) correlated (ρ = 0.37-55 and ρ = -0.70-85) with the differences between luminal enhancement and plaque density. In multivariate models, bias of luminal diameter assessment with CT was correlated with plaque density (β = 0.09, p < 0.05). Convolution kernel (β = -0.29 and -0.38), stenosis severity (β = -0.45 and -0.38), and luminal enhancement (β = -0.11 and -0.29) represented independent (p < 0.05,each) predictors of measurement bias of luminal diameter and plaque number, respectively. Significant independent relationships exist between luminal enhancement, convolution kernel, plaque density, and luminal diameter, which have to be taken into account when performing, evaluating, and interpreting coronary CT angiography.
Collapse
Affiliation(s)
- Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
33
|
Aldrovandi A, Cademartiri F, Arduini D, Lina D, Ugo F, Maffei E, Menozzi A, Martini C, Palumbo A, Bontardelli F, Gherli T, Ruffini L, Ardissino D. Computed Tomography Coronary Angiography in Patients With Acute Myocardial Infarction Without Significant Coronary Stenosis. Circulation 2012; 126:3000-7. [DOI: 10.1161/circulationaha.112.117598] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
It is known that a significant number of patients experiencing an acute myocardial infarction have normal coronary arteries or nonsignificant coronary disease at coronary angiography (CA). Computed tomography coronary angiography (CTCA) can identify the presence of plaques, even in the absence of significant coronary stenosis. This study evaluated the role of 64-slice CTCA in detecting and characterizing coronary atherosclerosis in these patients.
Methods and Results—
Consecutive patients with documented acute myocardial infarction but without significant coronary stenosis at CA underwent late gadolinium-enhanced magnetic resonance and CTCA. Only the 50 patients with an area of myocardial infarction identified by late gadolinium-enhanced magnetic resonance were included in the study. All of the coronary segments were assessed for the presence of plaques. CTCA identified 101 plaques against the 41 identified by CA: 61 (60.4%) located in infarct-related arteries (IRAs) and 40 (39.6%) in non-IRAs. In the IRAs, 22 plaques were noncalcified, 17 mixed, and 22 calcified; in the non-IRAs, 5 plaques were noncalcified, 8 mixed, and 27 calcified (
P
=0.005). Mean plaque area was greater in the IRAs than in the non-IRAs (6.1±5.4 mm
2
versus 4.2±2.1 mm
2
;
P
=0.03); there was no significant difference in mean percentage stenosis (33.5%±14.6 versus 31.7%±12.2;
P
=0.59), but the mean remodeling index was significantly different (1.25±0.41 versus 1.08±0.21;
P
=0.01).
Conclusions—
CTCA detects coronary plaques in nonstenotic coronary arteries that are underestimated by CA, and identifies a different distribution of plaque types in IRAs and non-IRAs. It may therefore be valuable for diagnosing coronary atherosclerosis in acute myocardial infarction patients without significant coronary stenosis.
Collapse
Affiliation(s)
- Annachiara Aldrovandi
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Filippo Cademartiri
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Daniele Arduini
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Daniela Lina
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Fabrizio Ugo
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Erica Maffei
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Alberto Menozzi
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Chiara Martini
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Alessandro Palumbo
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Federico Bontardelli
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Tiziano Gherli
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Livia Ruffini
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| | - Diego Ardissino
- From the Divisions of Cardiology (A.A., D.A., D.L., F.U., A.M., F.B., D.A.), Radiology (F.C., E.M., C.M., A.P., L.R.), and Heart Surgery (T.G.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M., C.M.); and the Cardio-Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M., C.M.)
| |
Collapse
|
34
|
Willemink MJ, Habets J, de Jong PA, Schilham AMR, Mali WPTM, Leiner T, Budde RPJ. Iterative reconstruction improves evaluation of native aortic and mitral valves by retrospectively ECG-gated thoracoabdominal CTA. Eur Radiol 2012; 23:968-74. [PMID: 23064676 DOI: 10.1007/s00330-012-2673-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/05/2012] [Accepted: 09/13/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare native aortic (AV) and mitral valve (MV) image quality on limited-dose retrospectively ECG-gated CTA of the thoracoabdominal aorta reconstructed with iterative reconstruction (IR) and filtered back projection (FBP). METHODS Fifty patients underwent routine care retrospectively ECG-gated thoracoabdominal limited-dose 256-slice CTA. At 30 % (systole) and 75 % (diastole) of the R-R interval AV and MV were reconstructed using FBP and IR. Objective image quality [density and noise (SD of density measurement)] was measured. Two independent observers scored subjective valve image quality using four-point Likert scales. RESULTS IR significantly decreased image noise, but did not alter the aorta and interventricular septum density. Interobserver variability was moderate to good. Valve image quality was scored at least moderate in most cases. IR scored one or two Likert scale points higher than FBP in 10 (first observer) and 27 (second observer) scores. Conversely, IR scored one Likert scale point lower than FBP in 1 (first observer) and 4 (second observer) scores. CONCLUSIONS Limited-dose retrospectively ECG-gated thoracoabdominal CTA enables moderate to excellent evaluation of AV and MV in most patients, in addition to the primary diagnostic question. Image quality is further improved by IR.
Collapse
Affiliation(s)
- Martin J Willemink
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
35
|
Changes in measured size of atherosclerotic plaque calcifications in dual-energy CT of ex vivo carotid endarterectomy specimens: effect of monochromatic keV image reconstructions. Eur Radiol 2012; 23:367-74. [DOI: 10.1007/s00330-012-2623-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
|
36
|
Characterisation of non-calcified coronary plaque by 16-slice multidetector computed tomography: comparison with histopathological specimens obtained by directional coronary atherectomy. Int J Cardiovasc Imaging 2011; 28:1749-62. [DOI: 10.1007/s10554-011-9992-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/28/2011] [Indexed: 11/26/2022]
|
37
|
Renker M, Nance JW, Schoepf UJ, O'Brien TX, Zwerner PL, Meyer M, Kerl JM, Bauer RW, Fink C, Vogl TJ, Henzler T. Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction. Radiology 2011; 260:390-9. [PMID: 21693660 DOI: 10.1148/radiol.11103574] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare traditional filtered back projection (FBP) and iterative image reconstruction for the evaluation of heavily calcified arteries with coronary computed tomography (CT) angiography. MATERIALS AND METHODS The study had institutional review board approval and was HIPAA compliant. Written informed consent was obtained from all patients. Fifty-five consecutive patients (35 men, 20 women; mean age, 58 years ± 12 [standard deviation]) with Agatston scores of at least 400 underwent coronary CT angiography and cardiac catheterization. Image data were reconstructed with both FBP and iterative reconstruction techniques with corresponding cardiac algorithms. Image noise and subjective image quality were compared. To objectively assess the effect of FBP and iterative reconstruction on blooming artifacts, volumes of circumscribed calcifications were measured with dedicated volume analysis software. FBP and iterative reconstruction series were independently evaluated for coronary artery stenosis greater than 50%, and their diagnostic accuracy was compared, with cardiac catheterization as the reference standard. Statistical analyses included paired t tests, Kruskal-Wallis analysis of variance, and a modified McNemar test. RESULTS Image noise measured significantly lower (P = .011-.035) with iterative reconstruction instead of FBP. Image quality was rated significantly higher (P = .031 and .042) with iterative reconstruction series than with FBP. Calcification volumes measured significantly lower (P = .019 and .026) with iterative reconstruction (44.3 mm(3) ± 64.7 and 46.2 mm(3) ± 68.8) than with FBP (54.5 mm(3) ± 69.5 and 56.3 mm(3) ± 72.5). Iterative reconstruction significantly improved some measures of per-segment diagnostic accuracy of coronary CT angiography for the detection of significant stenosis compared with FBP (accuracy: 95.9% vs 91.8%, P = .0001; specificity: 95.8% vs 91.2%, P = .0001; positive predictive value: 76.9% vs 61.1%, P = .0001). CONCLUSION Iterative reconstruction reduces image noise and blooming artifacts from calcifications, leading to improved diagnostic accuracy of coronary CT angiography in patients with heavily calcified coronary arteries.
Collapse
Affiliation(s)
- Matthias Renker
- Heart and Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Maffei E, Martini C, Seitun S, Arcadi T, Tedeschi C, Guaricci A, Malagò R, Tarantini G, Aldrovandi A, Cademartiri F. Computed tomography coronary angiography in the selection of outlier patients: a feasibility report. Radiol Med 2011; 117:214-29. [PMID: 21643634 DOI: 10.1007/s11547-011-0695-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/27/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated criteria, presence and distribution of outlier patients by means of computed tomography coronary angiography (CTCA) in a large institutional database. MATERIAL AND METHODS From a population of 2,881 consecutive patients (1,842 men, mean age 62 ± 13 years) in sinus rhythm who underwent CTCA, we extracted data on patients with suspected coronary artery disease (CAD). We selected patient outliers in the fifth and sixth decades of life with the following criteria: ≥ 3 risk factors and absence of CAD, zero to one risk factors and ≥ 5 diseased coronary segments. Diabetes was excluded from risk factors because of the different impact on CAD. RESULTS The patient population consisted of 2,432 individuals with suspected CAD (1,495 men, age 62 ± 13 years). The prevalence of obstructive CAD (≥ 50% lumen reduction at CTCA) was 36% (863/2,432). Patients with normal coronary arteries accounted for 34% of the total (837/2,432; 431 men, age 55 ± 14 years). Of these, 210 were in the fifth and 231 in the 6th decade (men 196, women 245); those with ≥ 3 risk factors accounted for 4.2% of the total (102/2,432; men 42, women 60). Patients with ≥ 5 diseased coronary segments accounted for 28% of the total (686/2,432; 510 men, age 68 ± 10 years). Of these, 115 were in the fifth and 270 in the sixth decade (men 309, women 76); those with zero to one risk factors accounted for 3.0% (73/2,432; men 66, women 7). CONCLUSIONS CTCA is a reliable noninvasive diagnostic modality that can be used to identify outlier patients. This will enable dedicated trials aimed at characterising biomarkers and genomics of protective and nonprotective factors against CAD and its complications.
Collapse
Affiliation(s)
- E Maffei
- Dipartimento di Radiologia e del Cuore, c/o Piastra Tecnica - Piano 0, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Nikolaou K, Alkadhi H, Bamberg F, Leschka S, Wintersperger BJ. MRI and CT in the diagnosis of coronary artery disease: indications and applications. Insights Imaging 2010; 2:9-24. [PMID: 22347932 PMCID: PMC3259311 DOI: 10.1007/s13244-010-0049-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 09/27/2010] [Accepted: 10/19/2010] [Indexed: 01/16/2023] Open
Abstract
In recent years, technical advances and improvements in cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease (CAD) and correct patient selection for these emerging imaging techniques. In the primary detection or exclusion of significant CAD, e.g. in the patient with unspecific thoracic complaints, and also in patients with known CAD or advanced stages of CAD, both CT and MRI yield specific advantages. In this review, the major aspects of non-invasive MR and CT imaging in the diagnosis of CAD will be discussed. The first part describes the clinical value of contrast-enhanced non-invasive CT coronary angiography (CTCA), including the diagnostic accuracy of CTCA for the exclusion or detection of significant CAD with coronary artery stenoses that may require angioplastic intervention, as well as potentially valuable information on the coronary artery vessel wall. In the second section, the potential of CT for the imaging of myocardial viability and perfusion will be highlighted. In the third and final part, the range of applications of cardiac MRI in CAD patients will be outlined.
Collapse
|
40
|
De Cecco C, Buffa V, Fedeli S, Vallone A, Ruopoli R, Luzietti M, Miele V, Maurizi Enrici M, Musumeci F, David V. Dual-source CT coronary angiography: prospective versus retrospective acquisition technique. Radiol Med 2010; 116:178-88. [DOI: 10.1007/s11547-010-0584-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 11/25/2009] [Indexed: 12/14/2022]
|
41
|
Dalager MG, Bøttcher M, Andersen G, Thygesen J, Pedersen EM, Dejbjerg L, Gøtzsche O, Bøtker HE. Impact of luminal density on plaque classification by CT coronary angiography. Int J Cardiovasc Imaging 2010; 27:593-600. [PMID: 20820922 DOI: 10.1007/s10554-010-9695-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 08/25/2010] [Indexed: 12/22/2022]
Abstract
UNLABELLED Non-invasive coronary CT angiography (CCTA) has the potential to characterize the composition of non-calcified coronary plaques. CT-density values characterized by Hounsfield Units (HU) may classify non-calcified plaques as fibrous or lipid-rich, but the luminal density caused by the applied contrast material influences HU in the plaques in vitro. The influence of luminal density on HU in non-calcified plaques in vivo is unknown. Hence the purpose of this study was to test whether plaque characterization by CCTA in vivo depends on luminal density. Two CCTA-scans using two different contrast protocols were obtained from 14 male patients with coronary artery disease. The two contrast protocols applied resulted in high and low luminal density. Eleven non- calcified and 13 calcified plaques were identified and confirmed by intravascular ultrasound. Luminal attenuation differed with the two contrast protocols; 326[284;367] vs. 118[103;134] HU (P < 0.00001). In non-calcified plaques mean HU-values was lower 48[28;69] vs. 11[-4;25] HU (P = 0.004) with the low density protocol. As a consequence three out of eleven non-calcified plaques (27%) were reclassified from fibrous (high) to lipid rich (low). For calcified plaques a less pronounced but still significant difference in HU-values was found with the low luminal density. 770[622;919] vs. 675[496;855] HU (P = 0.02). CONCLUSION Non-calcified plaques can be identified and classified by CCTA. However, the luminal density affects the absolute HU of both non-calcified and calcified plaques. Characterization and classification of non-calcified plaques by absolute CT values therefore requires standardization of contrast protocols.
Collapse
Affiliation(s)
- Maiken Glud Dalager
- Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Influence of statin treatment on coronary atherosclerosis visualised using multidetector computed tomography. Eur Radiol 2010; 20:2824-33. [DOI: 10.1007/s00330-010-1880-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 06/07/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022]
|
43
|
Torres FS, Crean AM, Nguyen ET, Paul N. Strategies for radiation-dose reduction and image-quality optimization in multidetector computed tomographic coronary angiography. Can Assoc Radiol J 2010; 61:271-9. [PMID: 20605399 DOI: 10.1016/j.carj.2009.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/17/2022] Open
Abstract
The technological evolution of computed tomography (CT) in the last decade has placed CT coronary angiography (CTCA) in the spotlight of imaging modalities available to evaluate patients with coronary artery disease. Widespread utilisation of CTCA has generated concern from the medical community regarding potential health issues related to the significant radiation exposure associated with this method, and several modifications of the CTCA technique have been proposed to reduce the radiation exposure without affecting the diagnostic image quality. This review will discuss a practical approach to performing CTCA to ensure that the radiation dose is minimized while maintaining diagnostic image quality.
Collapse
Affiliation(s)
- Felipe S Torres
- Department of Medical Imaging, University of Toronto and University Health Network, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
44
|
Schindler TH. Adapting the contrast material protocol to the body surface area for an optimized low-dose CT coronary angiography with prospective ECG-triggering: a new evolving concept? Int J Cardiovasc Imaging 2010; 26:599-600. [DOI: 10.1007/s10554-010-9604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/12/2010] [Indexed: 11/30/2022]
|
45
|
Achenbach S, Boehmer K, Pflederer T, Ropers D, Seltmann M, Lell M, Anders K, Kuettner A, Uder M, Daniel WG, Marwan M. Influence of slice thickness and reconstruction kernel on the computed tomographic attenuation of coronary atherosclerotic plaque. J Cardiovasc Comput Tomogr 2010; 4:110-5. [PMID: 20430341 DOI: 10.1016/j.jcct.2010.01.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/09/2009] [Accepted: 01/10/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND The computed tomographic (CT) attenuation of coronary atherosclerotic plaque has been proposed as a marker for tissue characterization and may thus potentially contribute to the assessment of plaque instability. OBJECTIVE We analyzed the influence of reconstruction parameters on CT attenuation measured within noncalcified coronary atherosclerotic lesions. METHODS Seventy-two patients were studied by contrast-enhanced dual-source CT coronary angiography (330 millisecond rotation time, 2 x 64 x 0.6 mm collimation, 120 kV, 400 mAs, 80 mL contrast agent intravenously at 6 mL/s), and a total of 100 distinct noncalcified coronary atherosclerotic plaques were identified. Image data sets were reconstructed with a soft (B20f), medium soft (B26f), and sharp (B46f) reconstruction kernel. With the medium soft kernel, image data sets were reconstructed with a slice thickness/increment of 0.6/0.3 mm, 0.75/0.4 mm, and 1.0/0.5mm. Within each plaque, CT attenuation was measured. RESULTS Mean CT attenuation using the medium soft kernel was 109 +/- 58 HU (range, -16 to 168 HU). Using the soft kernel, mean density was 113 +/- 57 HU (range, -13 to 169 HU), and using a sharp kernel, mean density was 97 +/- 49 HU (range, -23 to 131 HU). Similarly, reconstructed slice thickness had a significant influence on the measured CT attenuation (mean values for medium soft kernel: 102 +/- 52 HU versus 109 +/- 58 HU versus 113 +/- 57 HU for 0.6-mm, 0.75-mm, and 1.0-mm slice thickness). The differences between 0.75-mm and 0.6-mm slice thickness (P = 0.05) and between medium sharp and sharp kernels (P = 0.02) were statistically significant. CONCLUSIONS Image reconstruction significantly influences CT attenuation of noncalcified coronary atherosclerotic plaque. With decreasing spatial resolution (softer kernel or thicker slices), CT attenuation increases significantly. Using absolute CT attenuation values for plaque characterization may therefore be problematic.
Collapse
Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Pugliese F, Meijboom WB, Ligthart J, La Grutta L, Vourvouri EC, Rodriguez-Granillo G, Mollet NR, Krestin GP, de Feyter PJ, Cademartiri F. Parameters for coronary plaque vulnerability assessed with multidetector computed tomography and intracoronary ultrasound correlation. J Cardiovasc Med (Hagerstown) 2009; 10:821-6. [DOI: 10.2459/jcm.0b013e32832e8ce5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
47
|
Dey D, Cheng VY, Slomka PJ, Nakazato R, Ramesh A, Gurudevan S, Germano G, Berman DS. Automated 3-dimensional quantification of noncalcified and calcified coronary plaque from coronary CT angiography. J Cardiovasc Comput Tomogr 2009; 3:372-82. [PMID: 20083056 DOI: 10.1016/j.jcct.2009.09.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 08/21/2009] [Accepted: 09/16/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We aimed to develop an automated algorithm (APQ) for accurate volumetric quantification of non-calcified (NCP) and calcified plaque (CP) from coronary CT angiography (CCTA). METHODS APQ determines scan-specific attenuation thresholds for lumen, NCP, CP and epicardial fat, and applies knowledge-based segmentation and modeling of coronary arteries, to define NCP and CP components in 3D. We tested APQ in 29 plaques for 24 consecutive scans, acquired with dual-source CT scanner. APQ results were compared to volumes obtained by manual slice-by-slice NCP/CP definition and by interactive adjustment of plaque thresholds (ITA) by 2 independent experts. RESULTS APQ analysis time was <2 sec per lesion. There was strong correlation between the 2 readers for manual quantification (r = 0.99, p < 0.0001 for NCP; r = 0.85, p < 0.0001 for CP). The mean HU determined by APQ was 419 +/- 78 for luminal contrast at mid-lesion, 227 +/- 40 for NCP upper threshold, and 511 +/- 80 for the CP lower threshold. APQ showed a significantly lower absolute difference (26.7 mm(3) vs. 42.1 mm(3), p = 0.01), lower bias than ITA (32.6 mm(3) vs 64.4 mm(3), p = 0.01) for NCP. There was strong correlation between APQ and readers (R = 0.94, p < 0.0001 for NCP volumes; R = 0.88, p < 0.0001, for CP volumes; R = 0.90, p < 0.0001 for NCP and CP composition). CONCLUSIONS We developed a fast automated algorithm for quantification of NCP and CP from CCTA, which is in close agreement with expert manual quantification.
Collapse
Affiliation(s)
- Damini Dey
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building, A238, Los Angeles, CA 90048, USA.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography. Eur Radiol 2009; 19:2373-82. [DOI: 10.1007/s00330-009-1421-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 02/23/2009] [Accepted: 03/07/2009] [Indexed: 10/20/2022]
|
49
|
Assessment of left main coronary artery atherosclerotic burden using 64-slice CT coronary angiography: correlation between dimensions and presence of plaques. Radiol Med 2009; 114:358-69. [DOI: 10.1007/s11547-008-0293-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 10/25/2008] [Indexed: 10/20/2022]
|
50
|
Petranovic M, Soni A, Bezzera H, Loureiro R, Sarwar A, Raffel C, Pomerantsev E, Jang IK, Brady TJ, Achenbach S, Cury RC. Assessment of nonstenotic coronary lesions by 64-slice multidetector computed tomography in comparison to intravascular ultrasound: evaluation of nonculprit coronary lesions. J Cardiovasc Comput Tomogr 2008; 3:24-31. [PMID: 19201374 DOI: 10.1016/j.jcct.2008.12.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 12/15/2008] [Accepted: 12/15/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multidetector computed tomography (MDCT) has recently emerged as a potential noninvasive alternative for high-resolution imaging of coronary arteries. OBJECTIVE In this study, we evaluated 64-slice MDCT for detection, quantification, and characterization of atherosclerotic plaque burden in nonculprit lesions. METHODS Data from 11 patients who underwent both MDCT and intravascular ultrasound (IVUS) for suspected coronary artery disease were collected, and a total of 17 coronary segments and 122 cross-sectional slices were analyzed by MDCT and IVUS. Coronary segments on MDCT were coregistered to IVUS, and each obtained slice was scored by 2 blinded observers for presence and type of plaque. Quantitative measurements included cross-sectional vessel area, lumen area, wall area, plaque volume, and plaque burden. Mean and standard deviation of Hounsfield units (HUs) were recorded for plaque when present. RESULTS Overall sensitivity for plaque detection was 95.0%, and specificity, positive predictive value, negative predictive value were 88.7%, 89.1%, and 94.8%, respectively. Spearman's correlation coefficients were 0.85, 0.75, 0.70, 0.89, and 0.54 for cross-sectional vessel area, lumen area, wall area, plaque volume, and plaque burden, respectively. The interobserver variability for plaque burden and plaque volume measurements between readers on 64-MDCT was high at 32.7% and 30.4%, respectively. Combined noncalcified plaque had a mean MDCT density significantly different from that of calcified plaque. Soft and fibrous plaques were not able to be distinguished based on their HU values. CONCLUSION Sixty-four-slice MDCT had good correlation with IVUS but with high interobserver variability. Plaque characterization remains a challenge with present MDCT technology.
Collapse
Affiliation(s)
- Milena Petranovic
- Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street Suite 400, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|