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Feher A, Baldassarre LA, Sinusas AJ. Novel Cardiac Computed Tomography Methods for the Assessment of Anthracycline Induced Cardiotoxicity. Front Cardiovasc Med 2022; 9:875150. [PMID: 35571206 PMCID: PMC9094702 DOI: 10.3389/fcvm.2022.875150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022] Open
Abstract
Anthracyclines are among the most frequently utilized anti-cancer therapies; however, their use is frequently associated with off-target cardiotoxic effects. Cardiac computed tomography (CCT) is a validated and rapidly evolving technology for the evaluation of cardiac structures, coronary anatomy and plaque, cardiac function and preprocedural planning. However, with emerging new techniques, CCT is rapidly evolving to offer information beyond the evaluation of cardiac structure and epicardial coronary arteries to provide details on myocardial deformation, extracellular volume, and coronary vasoreactivity. The potential for molecular imaging in CCT is also growing. In the current manuscript we review these emerging computed tomography techniques and their potential role in the evaluation of anthracycline-induced cardiotoxicity.
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Affiliation(s)
- Attila Feher
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
- *Correspondence: Attila Feher,
| | - Lauren A. Baldassarre
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Albert J. Sinusas
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
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Tridandapani S, Banait-Deshmane S, Aziz MU, Bhatti P, Singh SP. Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose. J Med Imaging Radiat Sci 2021; 52:S1-S11. [PMID: 34565701 DOI: 10.1016/j.jmir.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a viable alternative to catheter coronary angiography for several clinical indications, chiefly because it is fast and non-invasive. For effective clinical use of CCTA, various technical and patient factors should be considered. In this brief review article, we discuss the indication and contraindications for CCTA, technical requirements for CCTA including radiation dose, patient preparation principles, image post-processing, and pitfalls and artifacts of CCTA.
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Affiliation(s)
- Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, AL, USA; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | | | | | - Pamela Bhatti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Satinder P Singh
- Department of Radiology, University of Alabama, Birmingham, AL, USA
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Günther A, Aaberge L, Abildgaard A, Ragnarsson A, Edvardsen T, Jakobsen J, Andersen R. Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose. Acta Radiol 2018; 59:1066-1073. [PMID: 29260577 DOI: 10.1177/0284185117748354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS). Results Interpretable CCTA images were acquired in 570 (95%) coronary artery segments ≥2 mm in diameter. Sensitivity, specificity, and positive and negative predictive values of CCTA for the detection of segments with significant stenosis (lumen reduction ≥50%) on ICA were 100%, 98%, 7.7%, and 100%, respectively. Twelve significant stenoses were located in segments with uninterpretable image quality or vessel diameter <2 mm; only one was eligible for intervention. IVUS detected CAV (maximal intimal thickness ≥0.5 mm) in 33/41 (81%) patients; CCTA and ICA identified CAV (any wall or luminal irregularity) in 18 (44%) and 14 (34%) of these 33 patients, respectively. The mean estimated radiation dose was 19.0 ± 3.4 mSv for CCTA and 5.7 ± 3.3 mSv for ICA ( P < 0.001). Conclusion CCTA with interpretable image quality had a high negative predictive value for ruling out significant stenoses suitable for intervention. The modest detection of CAV by CCTA implied a limited value in identifying subtle CAV. The high estimated radiation dose for 64-MDCT is of concern considering the need for repetitive examinations in the HTX population.
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Affiliation(s)
- Anne Günther
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andreas Abildgaard
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Asgrimur Ragnarsson
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jarl Jakobsen
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rune Andersen
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Smettei OA, Sayed S, M Al Habib A, Alharbi F, Abazid RM. Ultra-fast, low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure. J Saudi Heart Assoc 2018; 30:165-171. [PMID: 29983492 PMCID: PMC6026393 DOI: 10.1016/j.jsha.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/27/2017] [Accepted: 11/02/2017] [Indexed: 01/08/2023] Open
Abstract
Background Coronary computed tomography angiography (CCTA) is increasingly being used for the evaluation of coronary artery disease; however, radiation exposure remains a major limitation of its use. Objective To compare image quality and radiation exposure in two groups of patients undergoing CCTA using a 256-slice dual-source helical computed tomography scanner with high-pitch (FLASH) or prospective [step-and-shoot (SAS)] gating protocols. Methods A prospective, single-center study was performed in our cardiac center. In total, 162 patients underwent CCTA with either FLASH or SAS scanning protocols. Subjective image quality was graded on the basis of a four-point grading system (1, non-diagnostic; 2, adequate; 3, good; 4, excellent). Objective image quality was assessed using image signal, noise, and signal-to-noise ratio (SNR). The effective radiation dose was also estimated. Results The clinical and demographic characteristics of the patients in both groups were similar. The median age of the patients in both groups was 48.43 years, and males accounted for 63% and 68.7% of the FLASH and SAS groups, respectively. We found that the subjective image quality obtained with the FLASH protocol was superior to that obtained with the SAS protocol (3.35 ± 0.6 mSv vs. 2.82 ± 0.61 mSv; p < 0.001). Image noise was higher in the FLASH group but was not statistically significant (25.0 ± 6.13 vs. 24.0 ± 6.8; p = 0.10), whereas the signal and SNR was significantly higher with the FLASH protocol than with the SAS protocol [(469 ± 116 vs. 397 ± 106; p > 0.001) and (21.6 ± 8.7 mSv vs. 16.6 ± 7.7 mSv; p < 0.001), respectively]. Radiation exposure was 62% lower in the FLASH protocol than in the SAS protocol, (1.9 ± 0.4 mSv vs. 5.12 ± 1.8 mSv; p < 0.001). Conclusion The use of 256-slice CCTA performed with the FLASH protocol has a better objective and subjective image quality as well as lower radiation exposure when compared with the use of prospective electrocardiography gating.
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Affiliation(s)
- Osama A Smettei
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, Saudi Arabiaa
| | - Sawsan Sayed
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, Saudi Arabiaa
| | - Abdullah M Al Habib
- Department of Radiology, King Fahad Specialist Hospital, Qassim, Saudi Arabiab
| | - Fahad Alharbi
- Department of Radiology, King Fahad Specialist Hospital, Qassim, Saudi Arabiab
| | - Rami M Abazid
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, Saudi Arabiaa
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Declining radiation dose of coronary computed tomography angiography: German cardiac CT registry experience 2009-2014. Clin Res Cardiol 2017; 106:905-912. [PMID: 28725938 DOI: 10.1007/s00392-017-1136-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/17/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) is increasingly used as a test to rule out coronary artery disease (CAD) in patients with a low to intermediate pre-test probability of the disease. We used the database of the German CT registry, collected between 2009 and 2014 in a broad patient population, to analyze contemporary radiation dose associated with coronary CTA in clinical practice. PATIENTS AND METHODS The prospective observational registry included a total of 7061 patients ≥18 years, referred to 12 participating centers for a clinically indicated cardiac CT examination. All centers were cardiology units well experienced in CTA and used multi-slice CT scanners with at least 64 rows. Coronary CTA was performed in a subset of 5001 patients, 59.6 ± 11.8 years, body mass index (BMI) 26.9 ± 4.5 kg/m2, 38% females. Three time periods with approximately equal numbers of patients were created (01/09-03/10, 04/10-03/11, 04/11-07/14). The dose-length product of all examinations and derived effective dose in mSv (conversion factor k = 0.014) as well as the influence of patient characteristics on dose were compared for the three time periods. RESULTS BMI and proportion of female patients remained stable over time, and mean heart rate decreased from 60.3 ± 9.0 to 58.5 ± 9.3 bpm from the first to the last time period (p < 0.001). Overall, the mean effective dose of coronary CTA was 3.6 mSv (Q1 1.8 mSv, Q3 7.4 mSv). Within the three time periods, it declined from 5.6 (2.7, 8.6) mSv during the first to 4.8 (2.1, 8.2) mSv during the second and 2.5 (1.3, 4.6) mSv during the last time period (p < 0.001). Paralleling the decline in radiation dose over time, the proportion of prospectively ECG-triggered examinations increased (68, 79, 83%; p < 0.001), and the proportion of examinations with retrospective gating and no tube current modulation decreased (5.3, 4.0, 1.6%; p < 0.001). Tube current (mAs) and voltage (kV) both decreased over time. In multivariable analysis, besides earlier time period, further independent predictors of an increased radiation dose were older age, higher heart rate, and higher BMI as well as the technical factors higher mAs, higher kV, and retrospective gating. At three sites, CT scanners with improved technology were installed during the last time period. CONCLUSIONS In current clinical practice among German cardiology units with specific expertise in cross-sectional cardiovascular imaging, overall radiation dose of coronary CTA was comparably low. Over time, a decline in radiation dose was demonstrated, probably due to a combination of improvements in data acquisition protocols and patient preparation as well as installation of new CT scanners with advanced technology.
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Image Quality and Radiation Dose for Prospectively Triggered Coronary CT Angiography: 128-Slice Single-Source CT versus First-Generation 64-Slice Dual-Source CT. Sci Rep 2016; 6:34795. [PMID: 27752040 PMCID: PMC5067634 DOI: 10.1038/srep34795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/19/2016] [Indexed: 12/02/2022] Open
Abstract
This study sought to compare the image quality and radiation dose of coronary computed tomography angiography (CCTA) from prospectively triggered 128-slice CT (128-MSCT) versus dual-source 64-slice CT (DSCT). The study was approved by the Medical Ethics Committee at Tongji Medical College of Huazhong University of Science and Technology. Eighty consecutive patients with stable heart rates lower than 70 bpm were enrolled. Forty patients were scanned with 128-MSCT, and the other 40 patients were scanned with DSCT. Two radiologists independently assessed the image quality in segments (diameter >1 mm) according to a three-point scale (1: excellent; 2: moderate; 3: insufficient). The CCTA radiation dose was calculated. Eighty patients with 526 segments in the 128-MSCT group and 544 segments in the DSCT group were evaluated. The image quality 1, 2 and 3 scores were 91.6%, 6.9% and 1.5%, respectively, for the 128-MSCT group and 97.6%, 1.7% and 0.7%, respectively, for the DSCT group, and there was a statistically significant inter-group difference (P ≤ 0.001). The effective doses were 3.0 mSv in the 128-MSCT group and 4.5 mSv in the DSCT group (P ≤ 0.001). Compared with DSCT, CCTA with prospectively triggered 128-MSCT had adequate image quality and a 33.3% lower radiation dose.
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He G, Liu X, Liu Y, Wang W, Ke Z. Dose study of electrocardiogram automatic tube current modulation technology in prospective coronary computed tomography angiography scans of overweight patients. Exp Ther Med 2015; 9:2384-2388. [PMID: 26136992 DOI: 10.3892/etm.2015.2412] [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: 09/09/2014] [Accepted: 03/06/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the X-ray absorption dose and clinical applications of electrocardiogram (ECG)-gated automatic tube current modulation (ATCM) technology in prospective sequential computed tomography coronary angiography (CTCA) scans of overweight patients. A total of 40 patients with a body mass index of >24 were divided at random into groups A and B. Group A consisted of 20 patients, who were examined using ECG-ATCM scanning. For the patients in group A with heart rates <70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose X-rays for 60-80% of the R-R interval. For the group A patients with heart rates >70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose scanning for 35-55% of the R-R interval. For the 20 patients in group B, the scanning range was 20-80% of the R-R interval and patients received a full dose of X-ray radiation for the entire scanning period. The image quality and radiation dose was compared between the two groups. The average radiation dose in groups A and B was 6.91±2.78 and 10.43±3.36, respectively. The radiation doses in group A were reduced by 33.77% when compared with group B (P<0.05). However, there was no marked difference observed in image quality. In summary, using ECG-ATCM technology in prospective sequential CTCA scanning may significantly reduce the radiation dose required for overweight patients.
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Affiliation(s)
- Guiru He
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Xiaopei Liu
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Yan Liu
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Wei Wang
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Zhiliang Ke
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
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Li Q, Li P, Su Z, Yao X, Wang Y, Wang C, Du X, Li K. Effect of a novel motion correction algorithm (SSF) on the image quality of coronary CTA with intermediate heart rates: Segment-based and vessel-based analyses. Eur J Radiol 2014; 83:2024-32. [DOI: 10.1016/j.ejrad.2014.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/11/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
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Khan AN, Khosa F, Nikolic B, Shuaib W, Lin PJP, Khan MK. Cancerogenesis Risks between 64 and 320 Row Detector CT for Coronary CTA Screening. J Clin Imaging Sci 2014; 4:18. [PMID: 24987565 PMCID: PMC4060400 DOI: 10.4103/2156-7514.131640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/28/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study compares cancerogenesis risks posed by the 64 row detector and the 320 row detector computed tomography scanners used during coronary computed tomography angiography (CCTA) following decennial screening guidelines. MATERIAL AND METHODS Data of the radiation absorbed after CCTA by lung, thyroid, and female breast in patients between 50 and 70 years of age obtained from prior published literature for the 64 row CT scanner were compared with data from our study using 320 row detector CT scanner. Data from the 64 row and the 320 row detector CT scanners was used to determine lifetime attributable risks (LAR) of cancer based on the biological effects of ionizing radiation (BEIR) VII report. RESULTS The relative reduction of LAR (%) for 50-, 60-, and 70-year-old patients undergoing scanning with the 320 row detector CT scanner was 30% lower for lung, and more than 50% lower for female breast when compared with results from 64 row detector CT scanner. The use of 320 row detector CT would result in a combined cumulative cancer incidence of less than 1/500 for breast in women and less than 1/1000 for lung in men; By comparison, this is much lower than other more common risk factors: 16-fold for lung cancer in persistent smokers, 2-fold for breast cancer with a first degree family member history of breast cancer, and 10-fold for thyroid cancer with a family member with thyroid cancer. Decennial screening would benefit at least 355,000 patients from sudden cardiac death each year, 94% of whom have significant coronary artery disease, with at least one stenosis >75%. LAR for thyroid cancer was negligible for both scanners. CONCLUSION Lung and female breast LAR reductions with 320 row detector compared with 64 row detector CT are substantial, and the benefits would outweigh increased cancer risks with decennial screening in the age group of 50-70 years.
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Affiliation(s)
- Atif N Khan
- Department of Radiology, BIDMC, Harvard Medical School, Boston, MA, USA
| | - Faisal Khosa
- Department of Radiology, Emory University Hospital Atlanta, GA, USA
| | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Waqas Shuaib
- Department of Radiology, Emory University Hospital Atlanta, GA, USA
| | - Pei-Jan Paul Lin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammad K Khan
- Department of Radiology, Emory University Hospital Atlanta, GA, USA
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Cury RC, Kitt TM, Feaheny K, Akin J, George RT. Regadenoson-stress myocardial CT perfusion and single-photon emission CT: rationale, design, and acquisition methods of a prospective, multicenter, multivendor comparison. J Cardiovasc Comput Tomogr 2013; 8:2-12. [PMID: 24314823 DOI: 10.1016/j.jcct.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/29/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
Pharmacologic stress myocardial CT perfusion (CTP) has been reported to be a viable imaging modality for detection of myocardial ischemia compared with single-photon emission CT (SPECT) in several single-center studies. However, regadenoson-stress CTP has not previously been compared with SPECT in a multicenter, multivendor study. The rationale and design of a phase 2, randomized, cross-over study of regadenoson-stress myocardial perfusion imaging by CTP compared with SPECT are described herein. The study will be conducted at approximately 25 sites by using 6 different CT scanner models, including 64-, 128-, 256-, and 320-slice systems. Subjects with known/suspected coronary artery disease will be randomly assigned to 1 of 2 imaging procedure sequences; rest and regadenoson-stress SPECT on day 1, then regadenoson-stress CTP and rest CTP/coronary CT angiography (same acquisition) on day 2; or regadenoson-stress CTP and rest CTP/CT angiography on day 1, then rest and regadenoson-stress SPECT on day 2. The prespecified primary analysis examines the agreement rate between CTP and SPECT for detecting or excluding ischemia (≥2 or 0-1 reversible defects, respectively), as assessed by 3 independent blinded readers for each modality. Non-inferiority will be indicated if the lower boundary of the 95% CI for the agreement rate is within 0.15 of 0.78 (the observed agreement rate in the regadenoson pivotal trials). The protocol described herein will support the first evaluation of regadenoson-stress CTP by using multiple scanner types compared with SPECT.
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Affiliation(s)
- Ricardo C Cury
- Baptist Hospital of Miami and Baptist Cardiac and Vascular Institute, 8900 North Kendall Dr, Miami, FL 33176, USA.
| | - Therese M Kitt
- Astellas Scientific and Medical Affairs, Inc., Northbrook, IL, USA
| | | | - Jamie Akin
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Richard T George
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Impact of iterative reconstruction on CT coronary calcium quantification. Eur Radiol 2013; 23:3246-52. [DOI: 10.1007/s00330-013-3022-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/31/2013] [Indexed: 01/07/2023]
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Heart rate control with oral ivabradine in computed tomography coronary angiography: A randomized comparison of 7.5mg vs 5mg regimen. Int J Cardiol 2013; 168:362-8. [DOI: 10.1016/j.ijcard.2012.09.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/06/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022]
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Srichai MB, Barreto M, Lim RP, Donnino R, Babb JS, Jacobs JE. Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: a feasibility study. J Cardiovasc Comput Tomogr 2013; 7:102-9. [PMID: 23545461 DOI: 10.1016/j.jcct.2013.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obtaining diagnostic coronary CT angiography with low radiation exposure in patients with irregular heart rhythms such as atrial fibrillation (AF) remains challenging. OBJECTIVE We evaluated image quality and inter-reader variability with the use of prospective electrocardiographic (ECG)-triggered sequential dual-source acquisition at end systole for coronary artery disease (CAD) evaluation in patients with AF. METHODS Thirty consecutive patients with AF who underwent prospective ECG-triggered sequential dual-source acquisition were evaluated. Images were reconstructed every 50 milliseconds from 250 to 400 milliseconds after the R wave. Two independent, blinded readers evaluated the coronaries for image quality on a 5-point scale (worst to best) and stenosis on 5-point semiquantitative (none to severe) and binary scales (>50% or <50%). Diagnostic image quality was graded for each reconstruction. RESULTS Eleven patients (37%) had significant (≥50% stenosis) CAD. Average heart rate was 82 ± 20 beats/min and variability range was 71 ± 22 beats/min. Mean effective radiation dose was 6.5 ± 2.4 mSv. Diagnostic image quality was noted in 97.9% of 304 coronary segments with median image quality of 3.0. The 300-millisecond reconstruction phase provided the highest image quality; 70% of patients showed diagnostic image quality. Combination of all phases (250-400 milliseconds) performed significantly better than single or other phase combinations (P < 0.0005 for all comparisons). Inter-reader variability for stenosis detection was excellent, with 98.4% concordance by using a binary scale (50% stenosis cutoff). CONCLUSIONS Prospective ECG-triggered sequential dual-source CT acquisition with the use of end-systolic acquisition provides diagnostic image quality with potentially low radiation doses for evaluation of CAD in patients with AF. Use of multiple end-systolic phases over a 150-millisecond window improves diagnostic image quality.
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Affiliation(s)
- Monvadi B Srichai
- Department of Medicine, Cardiology Division, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 5PHC, Washington, DC 20007, USA.
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Menke J, Unterberg-Buchwald C, Staab W, Sohns JM, Seif Amir Hosseini A, Schwarz A. Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: Meta-analysis of diagnostic accuracy, image quality, and radiation dose. Am Heart J 2013; 165:154-63.e3. [PMID: 23351817 DOI: 10.1016/j.ahj.2012.10.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/03/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND In coronary computed tomography (CT) angiography (CTA) prospective electrocardiography triggering requires less radiation dose than retrospective electrocardiography gating but provides less cardiac phases for interpretation. This meta-analysis presents a concise and comprehensive head-to-head comparison of image quality, diagnostic accuracy, and radiation dose of prospectively triggered coronary CTA vs retrospectively gated CTA in patients with suspected or known coronary artery disease (CAD). METHODS In patients with CAD and without tachyarrhythmia, eligible studies (selected from 4 databases) compared prospectively triggered vs retrospectively gated CTA (performed with ≥64-slice CT or dual-source CT) in 2 groups having approximately similar patient characteristics, scored CTA image quality, and/or assessed how accurately CTA diagnoses ≥50% coronary stenoses compared with catheter angiography and reported the radiation dose. The data were meta-analyzed by random-effects models, with CIs provided in the text. RESULTS Among 3,330 patients from 20 included studies, 91.3% of CTAs (segments: 97.8%) had diagnostic quality with prospective triggering and 93.3% of CTAs (segments: 98.4%) with retrospective gating (P > .05). Among 664 patients from 5 studies, the pooled sensitivity/specificity of diagnostic CTAs was 98.7%/91.3% (segment level: 91.3%/97.7%) with prospective triggering and 96.9%/95.8% (segment level: 93.1%/97.6%) with retrospective gating (P > .05). The pooled effective dose was 3.5 mSv with prospective triggering and thus, by a factor of 3.5, lower than the pooled effective dose of retrospective gating, which was 12.3 mSv (P < .01). CONCLUSIONS In patients with CAD and without tachyarrhythmia, prospectively triggered coronary CTA provides image quality and diagnostic accuracy comparable with retrospectively gated CTA, but at a much lower radiation dose.
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Affiliation(s)
- Jan Menke
- Department of Diagnostic Radiology, University Hospital, Goettingen, Germany.
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Sabarudin A, Sun Z, Yusof AKM. Coronary CT angiography with single-source and dual-source CT: comparison of image quality and radiation dose between prospective ECG-triggered and retrospective ECG-gated protocols. Int J Cardiol 2012; 168:746-53. [PMID: 23098849 DOI: 10.1016/j.ijcard.2012.09.217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/22/2012] [Accepted: 09/29/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study is conducted to investigate and compare image quality and radiation dose between prospective ECG-triggered and retrospective ECG-gated coronary CT angiography (CCTA) with the use of single-source CT (SSCT) and dual-source CT (DSCT). METHODS A total of 209 patients who underwent CCTA with suspected coronary artery disease scanned with SSCT (n=95) and DSCT (n=114) scanners using prospective ECG-triggered and retrospective ECG-gated protocols were recruited from two institutions. The image was assessed by two experienced observers, while quantitative assessment was performed by measuring the image noise, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR). Effective dose was calculated using the latest published conversion coefficient factor. RESULTS A total of 2087 out of 2880 coronary artery segments were assessable, with 98.0% classified as of sufficient and 2.0% as of insufficient image quality for clinical diagnosis. There was no significant difference in overall image quality between prospective ECG-triggered and retrospective gated protocols, whether it was performed with DSCT or SSCT scanners. Prospective ECG-triggered protocol was compared in terms of radiation dose calculation between DSCT (6.5 ± 2.9 mSv) and SSCT (6.2 ± 1.0 mSv) scanners and no significant difference was noted (p=0.99). However, the effective dose was significantly lower with DSCT (18.2 ± 8.3 mSv) than with SSCT (28.3 ± 7.0 mSv) in the retrospective gated protocol. CONCLUSIONS Prospective ECG-triggered CCTA reduces radiation dose significantly compared to retrospective ECG-gated CCTA, while maintaining good image quality.
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Affiliation(s)
- Akmal Sabarudin
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia; Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Paul JF, Amato A, Rohnean A. Low-dose coronary-CT angiography using step and shoot at any heart rate: comparison of image quality at systole for high heart rate and diastole for low heart rate with a 128-slice dual-source machine. Int J Cardiovasc Imaging 2012; 29:651-7. [PMID: 22918571 DOI: 10.1007/s10554-012-0110-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/30/2012] [Indexed: 01/03/2023]
Abstract
To compare image quality of coronary CT angiography in step-and-shoot mode at the diastolic phase at low heart rates (<70 bpm) and systolic phase at high heart rates (≥70 bpm). We prospectively included 96 consecutive patients then excluded 5 patients with arrhythmia. Coronary CT-angiography was performed using a dual-source 128-slice CT machine, at the diastolic phase in the 55 patients with heart rates <70 bpm (group D) and at the systolic phase in the 36 patients with heart rates ≥70 (group S). Image quality was scored on a 5 point-scale (1, not interpretable; 2, insufficient for diagnosis; 3, fair, sufficient for diagnosis; 4, good; 5, excellent). In addition, we compared the number of stair-step artifacts in the two groups. Mean image quality score was 4 (0.78) in group D and 4.1 (0.34) in group S (NS), with an unequal distribution (p = 0.01). Step artifacts were seen in 44 % of group D and 18 % of group S patients (p = 0.02). In 3 group D patients and no group S patients, the image score was <3 due to artifacts, requiring repeat CT-angiography. When performing dual-source 128-slice CT-angiography, step-and-shoot acquisition provides comparable mean image quality in systole, with less variability and fewer stair-step artifacts, compared to diastole. This method may be feasible at any heart rate in most patients in sinus rhythm, allowing low-dose prospective acquisition without beta-blocker premedication.
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Affiliation(s)
- Jean-François Paul
- Department of Radiology, Centre Chirurgical Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France.
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Kalia N, Budoff M. CTA in the evaluation of acute chest pain syndromes. Should more widespread use be advocated? EXPERT OPINION ON MEDICAL DIAGNOSTICS 2012; 6:275-280. [PMID: 23480739 DOI: 10.1517/17530059.2012.676041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION With the advent of CT more than 3 decades ago, we have seen rapid evolution of this technology, so that we are now able to noninvasively accurately image the coronary arterial tree. This has opened up a debate as to the role of this imaging modality in our day-to-day evaluation of acute coronary syndromes. Much recent literature has focused on whether in the acute setting this modality should be incorporated into current evaluation and treatment guidelines. AREAS COVERED A comprehensive review of a literature illustrating the utility of CTA in the acute care setting is presented. The paper goes on to address the benefits and challenges of implementation of CTA in the evaluation of acute chest pain syndromes. Alternative guidelines and insights on future directions are presented. EXPERT OPINION In this current era where CAD, and more specifically acute chest pain syndromes, remains as a large part of ED visits and also healthcare costs, CTA will play an important role in the diagnosis and treatment of individuals. It remains only a matter of time when this will be implemented in our guidelines, in light of the recent literature and ever improving CTA protocols.
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Affiliation(s)
- Nove Kalia
- Biomedical Research Institute at Harbor-UCLA - Cardiology , Torrance CA , USA
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Sun Z, Ng KH. Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy. Eur J Radiol 2012; 81:e94-100. [DOI: 10.1016/j.ejrad.2011.01.070] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 12/28/2022]
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Sun Z, Ng KH. Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2012; 28:2109-19. [PMID: 22212661 DOI: 10.1007/s10554-011-0006-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 12/21/2011] [Indexed: 02/06/2023]
Abstract
To perform a systematic review and meta-analysis of the diagnostic value of prospective ECG-gating coronary CT angiography in the diagnosis of coronary artery disease. A search of biomedical databases for English literature was performed to identify studies investigating the diagnostic value of 64- or more slice CT angiography with use of prospective ECG-gating in the diagnosis of coronary artery disease. Sensitivity, specificity, positive and negative predictive value estimates pooled across studies were tested using a fixed effects model. Fourteen studies met selection criteria for inclusion in the analysis. Pooled estimates and 95% confidence interval (CI) of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography for diagnosis of significant coronary stenosis were 99% (95% CI: 98, 100%), 91% (95% CI: 88, 94%), 94% (95% CI: 91, 96%) and 99% (95% CI: 97, 100%), according to the patient-based assessment. The mean values of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography were 95% (95% CI: 93, 96%), 95% (95% CI: 93, 95%), 88% (95% CI: 86, 90%), and 98% (95% CI: 97, 98%), according to vessel-based assessment; 92% (95% CI: 90, 93%), 97% (95% CI: 97, 98%), 84% (95% CI: 82, 86%), 99% (95% CI: 99, 99%), according to segment-based assessment, respectively. The mean effective dose was 3.3 mSv (95% CI: 2.3, 4.1 mSv) for the prospective ECG-gating coronary CT angiography. This analysis shows that for a predominantly male population with a high disease prevalence the use of coronary CT angiography with prospective ECG gating allows for a reduced radiation exposure without a sacrifice in diagnostic efficacy.
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Pauwels EKJ, Bourguignon MH. Radiation dose features and solid cancer induction in pediatric computed tomography. Med Princ Pract 2012; 21:508-15. [PMID: 22472997 DOI: 10.1159/000337404] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 01/24/2012] [Indexed: 12/17/2022] Open
Abstract
Over the past two decades technical advances and improvements have made computed tomography (CT) a valuable and essential tool in the array of diagnostic imaging modalities. CT uses ionizing radiation (X-rays) which may damage DNA and increase the risk of carcinogenesis. This is especially pertinent in pediatric CT as children are more radiosensitive and have a longer life expectancy than adults. The purpose of this paper is to review and elucidate the potential harmful effects of ionizing radiation in terms of solid cancer induction from pediatric CT scanning. In the light of scientific and technical developments, we will also discuss the possible strategies and ongoing efforts to reduce CT radiation exposure in pediatric patients. In this context, we will not ignore the fact that a well-justified CT scan may exceed its risk and have a favorable impact.
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Affiliation(s)
- Ernest K J Pauwels
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. ernestpauwels @ gmail.com
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Halliburton SS, Abbara S, Chen MY, Gentry R, Mahesh M, Raff GL, Shaw LJ, Hausleiter J. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 2011; 5:198-224. [PMID: 21723512 DOI: 10.1016/j.jcct.2011.06.001] [Citation(s) in RCA: 360] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 02/08/2023]
Abstract
Over the last few years, computed tomography (CT) has developed into a standard clinical test for a variety of cardiovascular conditions. The emergence of cardiovascular CT during a period of dramatic increase in radiation exposure to the population from medical procedures and heightened concern about the subsequent potential cancer risk has led to intense scrutiny of the radiation burden of this new technique. This has hastened the development and implementation of dose reduction tools and prompted closer monitoring of patient dose. In an effort to aid the cardiovascular CT community in incorporating patient-centered radiation dose optimization and monitoring strategies into standard practice, the Society of Cardiovascular Computed Tomography has produced a guideline document to review available data and provide recommendations regarding interpretation of radiation dose indices and predictors of risk, appropriate use of scanner acquisition modes and settings, development of algorithms for dose optimization, and establishment of procedures for dose monitoring.
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Affiliation(s)
- Sandra S Halliburton
- Imaging Institute, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J1-4, Cleveland, OH 44195, USA.
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Neefjes LA, Dharampal AS, Rossi A, Nieman K, Weustink AC, Dijkshoorn ML, Ten Kate GJR, Dedic A, Papadopoulou SL, van Straten M, Cademartiri F, Krestin GP, de Feyter PJ, Mollet NR. Image quality and radiation exposure using different low-dose scan protocols in dual-source CT coronary angiography: randomized study. Radiology 2011; 261:779-86. [PMID: 21969666 DOI: 10.1148/radiol.11110606] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare image quality, radiation dose, and their relationship with heart rate of computed tomographic (CT) coronary angiographic scan protocols by using a 128-section dual-source CT scanner. MATERIALS AND METHODS Institutional review board approved the study; all patients gave informed consent. Two hundred seventy-two patients (175 men, 97 women; mean ages, 58 and 59 years, respectively) referred for CT coronary angiography were categorized according to heart rate: less than 65 beats per minute (group A) and 65 beats per minute or greater (group B). Patients were randomized to undergo prospective high-pitch spiral scanning and narrow-window prospective sequential scanning in group A (n = 160) or wide-window prospective sequential scanning and retrospective spiral scanning in group B (n = 112). Image quality was graded (1 = nondiagnostic; 2 = artifacts present, diagnostic; 3 = no artifacts) and compared (Mann-Whitney and Student t tests). RESULTS In group A, mean image quality grade was significantly lower with high-pitch spiral versus sequential scanning (2.67 ± 0.38 [standard deviation] vs 2.86 ± 0.21; P < .001). In a subpopulation (heart rate, <55 beats per minute), mean image quality grade was similar (2.81 ± 0.30 vs 2.94 ± 0.08; P = .35). In group B, image quality grade was comparable between sequential and retrospective spiral scanning (2.81 ± 0.28 vs 2.80 ± 0.38; P = .54). Mean estimated radiation dose was significantly lower (high-pitch spiral vs sequential scanning) in group A (for 100 kV, 0.81 mSv ± 0.30 vs 2.74 mSv ± 1.14 [P < .001]; for 120 kV, 1.65 mSv ± 0.69 vs 4.21 mSv ± 1.20 [P < .001]) and in group B (sequential vs retrospective spiral scanning) (for 100 kV, 4.07 mSv ± 1.07 vs 5.54 mSv ± 1.76 [P = .02]; for 120 kV, 7.50 mSv ± 1.79 vs 9.83 mSv ± 3.49 [P = .1]). CONCLUSION A high-pitch spiral CT coronary angiographic protocol should be applied in patients with regular and low (<55 beats per minute) heart rates; a sequential protocol is preferred in all others.
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Affiliation(s)
- Lisan A Neefjes
- Department of Radiology, Erasmus Medical Center, Dr Molewaterplein 40, Room Hs 207, PO Box 2040, 3000 CA Rotterdam, the Netherlands
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Kim JS, Choo KS, Jeong DW, Chun KJ, Park YH, Song SG, Park JH, Kim JH, Kim J, Han D, Lim SJ. Step-and-shoot prospectively ECG-gated vs. retrospectively ECG-gated with tube current modulation coronary CT angiography using 128-slice MDCT patients with chest pain: diagnostic performance and radiation dose. Acta Radiol 2011; 52:860-5. [PMID: 21873509 DOI: 10.1258/ar.2011.110006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND With increasing awareness for radiation exposure, the study of diagnostic accuracy of coronary CT angiography (CCTA) with low radiation dose techniques is mandatory to both radiologist and clinician. PURPOSE To compare diagnostic performance and effective radiation dose between step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with tube current modulation (TCM) CCTA using 128-slice multidetector computed tomography (MDCT). MATERIAL AND METHODS We retrospectively evaluated 60 patients who underwent CCTA with either of two different low-dose techniques using 128-slice MDCT (23 patients for step-and shoot-prospectively ECG-gated and 37 patients for retrospectively ECG-gated with TCM CCTA) followed by conventional coronary angiography. All coronary arteries and all segments thereof, except anatomical variants or small size (< 1.5 mm) ones, were included in analysis. RESULTS In per-segment analysis, sensitivity, specificity, positive predictive value, and negative predictive value were 91/96%, 95/94%, 75/73%, and 98/99% for step-and-shoot prospectively ECG-gated and retrospectively ECG gated with TCM CCTA, respectively, relative to conventional coronary angiography. Effective radiation dose were 1.75 ± 0.83 mSv, 4.91 ± 1.71 mSv in the step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with TCM CCTA groups, respectively. CONCLUSION The two low-radiation dose CCTA techniques using 128-slice MDCT yields comparable diagnostic performance for coronary artery disease in symptomatic patients with low heart rates.
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Affiliation(s)
- Jeong Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Ki Seok Choo
- Department of Diagnostic Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Dong Wook Jeong
- Department of Family Medicine, Pusan National University School of Medicine and Pusan National University Yangsan Hospital
| | - Kook Jin Chun
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Yong Hyun Park
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Sung Gook Song
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Ju Hyun Park
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - June Hong Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Jun Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Dongcheul Han
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital
| | - Soo Jin Lim
- Department of Cardiology, Gimhae Jung-Ang Hospital, Korea
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Sun G, Li M, Jiang XS, Li L, Peng ZH, Mu NN. Transthoracic Doppler echocardiography to predict optimal tube pulsing window for coronary artery CT angiography. Eur J Radiol 2011; 81:2215-20. [PMID: 21930357 DOI: 10.1016/j.ejrad.2011.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/24/2011] [Accepted: 08/28/2011] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVE To evaluate the feasibility of transthoracic Doppler echocardiography to determine the optimal pulsing windows for CT coronary angiography to narrow the pulsing windows further, especially in higher heart rate. MATERIALS AND METHODS Doppler was performed on 135 patients before CT scanning. For Doppler, the intervals with minimal motion were evaluated during both systole and diastole integrating electrocardiogram (ECG) intervals. For CT scanning, the retrospective ECG-gating was applied and the optimal reconstruction intervals were determined. The accuracy of Doppler analysis to predict the optimal reconstruction intervals was tested. The predicted length of pulsing windows was compared between Doppler analysis and traditional prospective ECG-gating protocol (heart rate≦65 bpm, 60-76%; 66-79 bpm, 30-77%; ≧80 bpm, 31-47%). RESULTS According to Doppler analysis, the mean length of intervals with minimal motion in systole was 106.4±39.2 ms and 125.2±92.0 ms in diastole. When the intervals with minimal motion during diastole>90 ms, the optimal reconstruction intervals were located at diastole; otherwise, at systole (P<0.001). The optimal reconstruction intervals in 93.8% (132/135) patients could be predicted accurately by Doppler analysis. If the optimal reconstruction intervals predicted by Doppler were applied as the exposure windows, the mean length of pulsing windows should has been 105.2±69.4 ms (range: 26.9-510.3 ms), which was significantly shorter than that of traditional prospective ECG-gating protocol (232.0±120.2 ms, range: 93.2-427.3 ms, P<0.001). CONCLUSION Doppler can help detecting the optimal pulsing windows accurately. Prospective ECG-gating incorporating Doppler analysis may narrow pulsing windows significantly while maintaining image quality.
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Affiliation(s)
- Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, No. 25, Shifan Road, Jinan, Shandong Province 250031, China.
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Maffei E, Palumbo AA, Martini C, Tedeschi C, Tarantini G, Seitun S, Ruffini L, Aldrovandi A, Weustink AC, Meijboom WB, Mollet NR, Krestin GP, de Feyter PJ, Cademartiri F. "In-house" pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation. Eur Radiol 2011; 19:2931-40. [PMID: 19597820 DOI: 10.1007/s00330-009-1509-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/22/2009] [Indexed: 11/26/2022]
Abstract
We retrospectively evaluated the effect, timing and safety of different pharmacological strategies during 64-slice CT coronary angiography (CT-CA). From the institutional database of CT-CAwe enrolled 560 consecutive patients with suspected coronary artery disease. The type of drug preparation (group 1 = no treatment; group 2 = oral metoprolol; group 3 = other; group 4 = intravenous (IV) atenolol; group 5 = IV atenolol + nitrates; NR = non-responders), timing, and adverse effects were recorded. Heart rate (HR) during different preparation phases was recorded. Four adverse effects were recorded, none of which was attributable to pharmacological treatment. In all groups, except group 1, the HR on arrival was significantly reduced by the pharmacological treatment (p<0.01). Group 4 showed the best (-16±8 bpm) HR reduction. There was no significant effect on HR due to nitrates (p = 0.49), while a slight increase due to contrast material was noted (p<0.05). Average time required for preparation was 44±25min. Groups 4 and 5 showed the most effective timing (8±9 min and 8±8 min, respectively; p<0.01). Pharmacological preparation in patients undergoing CT-CA is safe and effective. Best results in terms of HR reduction and fast preparation are obtained with IV administration of beta-blockers.
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Affiliation(s)
- Erica Maffei
- Department of Radiology and Cardiology, Azienda Ospedaliero - Universitaria di Parma, Italy
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Thilo C, Gebregziabher M, Mayer FB, Berghaus TM, Zwerner PL, Schoepf UJ. Can non-calcified coronary artery plaques be detected on non-contrast CT calcium scoring studies? Acad Radiol 2011; 18:858-65. [PMID: 21669351 DOI: 10.1016/j.acra.2011.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/07/2011] [Accepted: 02/14/2011] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Coronary computed tomographic (CT) angiography has been shown to detect noncalcified coronary artery plaque. Depending on tissue composition, noncalcified plaque differs in CT attenuation from blood and epicardial fat. The aim of this study was to determine whether noncalcified plaque can be visually detected on non-contrast-enhanced CT calcium scoring studies. MATERIALS AND METHODS A total of 106 patients (40 women; mean age, 59 years) who underwent coronary calcium scoring, coronary CT angiography, and quantitative catheter angiography were prospectively investigated. Two blinded observers independently reviewed calcium scoring studies for positive vascular remodeling and hypoattenuation within the vessel wall, suggestive of noncalcified plaque. Findings on calcium scoring studies were compared with those on coronary CT angiography and quantitative catheter angiography. RESULTS The mean Agatston score was 515.8 ± 826.8. Overall interobserver agreement for the identification of noncalcified lesions was substantial (κ = 0.69). Observer 1 and observer 2 identified 21 and 17 patients, respectively, with 38 and 35 lesions suggestive of noncalcified plaque. Coronary CT angiography confirmed noncalcified plaque in 33 of 38 (86.8%; observer 1) and 31 of 35 (88.6%; observer 2) lesions. Thus, the overall positive predictive value for correct identification of noncalcified plaque on calcium scoring studies was 0.88, although overall sensitivity was low at 0.39. CONCLUSIONS Noncalcified plaque can be visually detected on calcium scoring studies. Review of calcium scoring studies for features of noncalcified plaque may enhance the identification of patients with more active disease and higher cardiovascular risk.
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Affiliation(s)
- Christian Thilo
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29401, USA.
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Huang MP, Liang CH, Zhao ZJ, Liu H, Li JL, Zhang JE, Cui YH, Yang L, Liu QS, Ivanc TB, Vembar M. Evaluation of image quality and radiation dose at prospective ECG-triggered axial 256-slice multi-detector CT in infants with congenital heart disease. Pediatr Radiol 2011; 41:858-66. [PMID: 21534003 DOI: 10.1007/s00247-011-2079-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/11/2010] [Accepted: 12/11/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are a limited number of reports on the technical and clinical feasibility of prospective electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) in infants with congenital heart disease (CHD). OBJECTIVE To evaluate image quality and radiation dose at weight-based low-dose prospectively gated 256-slice MDCT angiography in infants with CHD. MATERIALS AND METHODS From November 2009 to February 2010, 64 consecutive infants with CHD referred for pre-operative or post-operative CT were included. All were scanned on a 256-slice MDCT system utilizing a low-dose protocol (80 kVp and 60-120 mAs depending on weight: 60 mAs for ≤ 3 kg, 80 mAs for 3.1-6 kg, 100 mAs for 6.1-10 kg, 120 mAs for 10.1-15 kg). RESULTS No serious adverse events were recorded. A total of 174 cardiac deformities, confirmed by surgery or heart catheterization, were studied. The sensitivity of MDCT for cardiac deformities was 97.1%; specificity, 99.4%; accuracy, 95.9%. The mean heart rate during scan was 136.7 ± 14.9/min (range, 91-160) with a corresponding heart rate variability of 2.8 ± 2.2/min (range, 0-8). Mean scan length was 115.3 ± 11.7 mm (range, 93.6-143.3). Mean volume CT dose index, mean dose-length product and effective dose were 2.1 ± 0.4 mGy (range, 1.5-2.8), 24.7 ± 5.9 mGy·cm (range, 14.7-35.8) and 1.6 ± 0.3 mSv (range, 1.1-2.5), respectively. Diagnostic-quality images were achieved in all cases. Satisfactory diagnostic quality for visualization of all/proximal/distal coronary artery segments was achieved in 88.4/98.8/80.0% of the scans. CONCLUSION Low-dose prospectively gated axial 256-slice CT angiography is a valuable tool in the routine clinical evaluation of infants with CHD, providing a comprehensive three-dimensional evaluation of the cardiac anatomy, including the coronary arteries.
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Affiliation(s)
- Mei-ping Huang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, 106 Zhongshan Er Road, Guangzhou, People's Republic of China
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Liew GYH, Feneley M, Worthley SG. Noninvasive Coronary Artery Imaging: Current Clinical Applications. Heart Lung Circ 2011; 20:425-37. [PMID: 21530393 DOI: 10.1016/j.hlc.2010.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/13/2010] [Indexed: 01/01/2023]
Affiliation(s)
- Gary Y H Liew
- Cardiovascular Investigation Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
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31
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Systolic prospectively ECG-triggered dual-source CT angiography for evaluation of the coronary arteries in heart transplant recipients. Eur Radiol 2011; 21:1887-94. [DOI: 10.1007/s00330-011-2126-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 01/17/2011] [Accepted: 02/21/2011] [Indexed: 02/02/2023]
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Radiation doses from phantom measurements at high-pitch dual-source computed tomography coronary angiography. Eur J Radiol 2011; 81:773-9. [PMID: 21310565 DOI: 10.1016/j.ejrad.2011.01.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/06/2011] [Accepted: 01/17/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare radiation doses delivered at prospectively ECG-triggered sequential- (SEQ), retrospectively ECG-gated spiral- (RETRO) and prospectively ECG-triggered high-pitch spiral- (HP) computed tomography coronary angiography (CTCA) protocols, as well as catheter coronary angiography (CCA) using an anthropomorphic phantom. MATERIALS AND METHODS An anthropomorphic Alderson phantom equipped with 50 thermoluminescent dosimeters (TLDs) was scanned using different CTCA protocols and an uncomplicated diagnostic CCA examination was simulated. Absorbed doses were experimentally determined and effective doses calculated using the dose-length product (DLP) for CTCA and the dose-area product (DAP) for CCA, as well as according to International Commission on Radiation Protection (ICRP) publications 60 and 103. RESULTS Effective organ doses were significantly lower for HP protocols (100kV: 0.17±0.26mSv; 120kV: 0.26±0.39mSv) compared to SEQ protocols (100kV: 0.50±0.79mSv; 120kV: 0.90±1.41mSv; each p<0.05) and compared to RETRO protocols (100kV: 1.59±2.12mSv; 120kV: 2.75±3.50mSv; each p<0.05). Effective organ doses at HP-CTCA tended to be lower than at CCA (0.37±0.40mSv), however this was not statistically significant (p=0.13). Effective doses calculated according to ICRP guidelines could be estimated using the DLP and a conversion coefficient of k=0.034mSv/[mGycm] (ICRP103) or k=0.028mSv/[mGycm] (ICRP60), respectively. HP-CTCA led to a dose reduction of 89% compared to RETRO-CTCA, regardless of the calculation method used. CONCLUSIONS Radiation doses as determined by phantom measurements are significantly lower at HP-CTCA compared to SEQ-CTCA and RETRO-CTCA and comparable to uncomplicated diagnostic CCA.
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Duarte R, Fernandez G, Castellon D, Costa JC. Prospective Coronary CT Angiography 128-MDCT Versus Retrospective 64-MDCT: Improved Image Quality and Reduced Radiation Dose. Heart Lung Circ 2011; 20:119-25. [DOI: 10.1016/j.hlc.2010.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 08/31/2010] [Accepted: 09/06/2010] [Indexed: 10/24/2022]
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Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have coronary heart disease? Intern Med J 2011; 41:5-13. [DOI: 10.1111/j.1445-5994.2009.02066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Young C, Taylor AM, Owens CM. Paediatric cardiac computed tomography: a review of imaging techniques and radiation dose consideration. Eur Radiol 2010; 21:518-29. [PMID: 21188593 DOI: 10.1007/s00330-010-2036-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 12/06/2010] [Accepted: 12/08/2010] [Indexed: 01/10/2023]
Abstract
The significant challenges involved in imaging the heart in small children (<15 kg) have been addressed by, and partially resolved with improvement in temporal and spatial resolution secondary to the advent of new multi-detector CT technology. This has enabled both retrospective and prospective ECG-gated imaging in children even at high heart rates (over 100 bpm) without the need for beta blockers. Recent studies have highlighted that the radiation burden associated with cardiac CT can be reduced using prospective ECG-gating. Our experience shows that the resultant dose reduction can be optimised to a level equivalent to that of a non-gated study. This article reviews the different aspects of ECG-gating and the preferred technique for cardiac imaging in the young child (<15 kg). We summarize our evidenced based recommendations for readers, referencing recent articles and using our in house data, protocols and dose measurements discussing the various methods available for dose calculations and their inherent bias.
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Affiliation(s)
- Carolyn Young
- Cardiorespiratory Unit, UCL Institute of Child Health, London, UK.
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Guaricci AI, Schuijf JD, Cademartiri F, Brunetti ND, Montrone D, Maffei E, Tedeschi C, Ieva R, Di Biase L, Midiri M, Macarini L, Di Biase M. Incremental value and safety of oral ivabradine for heart rate reduction in computed tomography coronary angiography. Int J Cardiol 2010; 156:28-33. [PMID: 21095627 DOI: 10.1016/j.ijcard.2010.10.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/13/2010] [Accepted: 10/23/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart rate (HR) reduction is essential to achieve optimal image quality and diagnostic accuracy with computed tomography coronary angiography (CTCA). Administration of ivabradine could be an attractive alternative to beta-blockade to reduce HR. METHODS One-hundred-twenty-three patients referred for CTCA were prospectively enrolled. Patients were divided in two groups depending on the absence or presence of chronic beta-blockade treatment. Within the two groups patients were randomized to either no additional premedication or oral ivabradine for 5 days prior to CTCA. In presence of chronic beta-blockade therapy it was shifted to atenolol 50mg twice a day for 5 days prior to CTCA. HR and blood pressure were assessed at admission (T0), immediately before CTCA (T1) and during CTCA (T2). The target HR was <65 bpm. RESULTS Ivabradine significantly reduced HR during CTCA. Mean relative HR reduction was 15% for controls, 12% for chronic beta-blockade, 19% for ivabradine and 24% for both chronic beta-blockade and ivabradine at T2 (p for trend <0.001). The rate of patients who reached the target HR at T2 was 83% in controls, 71% with chronic beta-blockade, 97% with ivabradine and 97% with both (p for trend <0.05). The percentage of patients that needed additional IV beta-blockade at T1 decreased from 69% to 40% with ivabradine and 30% with both (p for trend <0.05). CONCLUSIONS Ivabradine is safe and effective in increasing the rate of patients at target HR and in reducing the need for additional IV beta-blockade in patients referred for CTCA.
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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.
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Willoteaux S, Sibileau E, Caroff J, Nedelcu C, Abi Kalil W, Delepine S, Thouveny F. [Dose reduction during CT coronary angiography]. JOURNAL DE RADIOLOGIE 2010; 91:1220-1224. [PMID: 21178895 DOI: 10.1016/s0221-0363(10)70177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Dose delivery during CT coronary angiography with retrospective ECG gating is high especially due to the important slice overlapping. Optimization of the acquisition parameters is necessary to reduce patient exposure. First, the height of the scan field should be limited to the heart. Both kV and mA should be adjusted based on patient morphology. ECG gated exposure modulation with mA reduction during systole, a technique most applicable for patients with slow and regular heart rate, can result in a dose reduction up to 50%. The use of prospective ECG gating can also reduce patient dose. This technique also requires patients with slow and regular heart rate.
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Affiliation(s)
- S Willoteaux
- Service de Radiologie, Hôpital Larrey, CHU d'Angers, Angers, France.
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Radiation dose from coronary CT angiography: Five years of progress. J Cardiovasc Comput Tomogr 2010; 4:365-74. [DOI: 10.1016/j.jcct.2010.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/04/2010] [Indexed: 11/17/2022]
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Johnson PT, Horton KM, Fishman EK. Volume Visualization of the Ascending Thoracic Aorta Using Isotropic MDCT Data: Protocol Optimization. AJR Am J Roentgenol 2010; 195:1082-1087. [DOI: 10.2214/ajr.09.2667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pamela T. Johnson
- All authors: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St., Room 3140D, Baltimore, MD 21287
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Heyer CM, Lemburg SP, Peters SA. Paediatric radiology and scientific contributions to radiation dose at the meeting of the German Radiological Society—An analysis of an 11-year period. Eur J Radiol 2010; 75:e135-40. [DOI: 10.1016/j.ejrad.2010.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 02/17/2010] [Indexed: 11/28/2022]
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Kumamaru KK, Hoppel BE, Mather RT, Rybicki FJ. CT angiography: current technology and clinical use. Radiol Clin North Am 2010; 48:213-35, vii. [PMID: 20609871 DOI: 10.1016/j.rcl.2010.02.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Since 1958, catheter angiography has assumed the role of gold standard for vascular imaging, despite the invasive nature of the procedure. Less invasive techniques for vascular imaging, such as computed tomographic angiography (CTA), have been developed and have matured in conjunction with developments in catheter arteriography. In a few cases, such as imaging, the aorta and the pulmonary arteries, CTA has supplanted catheter angiography as the gold standard. The expanding role of CTA emphasizes the need for deep, broad-based understanding of physical principles. This review describes CT hardware and associated software for angiography. The fundamentals of CTA physics are complemented with several clinical examples.
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Earls JP, Leipsic J. Cardiac Computed Tomography Technology and Dose-reduction Strategies. Radiol Clin North Am 2010; 48:657-74. [PMID: 20705164 DOI: 10.1016/j.rcl.2010.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dual-step prospective ECG-triggered 128-slice dual-source CT for evaluation of coronary arteries and cardiac function without heart rate control: a technical note. Eur Radiol 2010; 20:2092-9. [DOI: 10.1007/s00330-010-1794-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/21/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
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Wolf F, Leschka S, Loewe C, Homolka P, Plank C, Schernthaner R, Bercaczy D, Goetti R, Lammer J, Friedrich G, Marincek B, Alkadhi H, Feuchtner G. Coronary artery stent imaging with 128-slice dual-source CT using high-pitch spiral acquisition in a cardiac phantom: comparison with the sequential and low-pitch spiral mode. Eur Radiol 2010; 20:2084-91. [PMID: 20397019 DOI: 10.1007/s00330-010-1792-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 02/20/2010] [Accepted: 02/20/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate coronary stents in vitro using 128-slice-dual-source computed tomography (CT). METHODS Twelve different coronary stents placed in a non-moving cardiac/chest phantom were examined by 128-slice dual-source CT using three CT protocols [high-pitch spiral (HPS), sequential (SEQ) and conventional spiral (SPIR)]. Artificial in-stent lumen narrowing (ALN), visible inner stent area (VIA), artificial in-stent lumen attenuation (ALA) in percent, image noise inside/outside the stent and CTDIvol were measured. RESULTS Mean ALN was 46% for HPS, 44% for SEQ and 47% for SPIR without significant difference. Mean VIA was similar with 31% for HPS, 30% for SEQ and 33% for SPIR. Mean ALA was, at 5% for HPS, significantly lower compared with -11% for SPIR (p = 0.024), but not different from SEQ with -1%. Mean image noise was significantly higher for HPS compared with SEQ and SPIR inside and outside the stent (p < 0.001). CTDIvol was lower for HPS (5.17 mGy), compared with SEQ (9.02 mGy) and SPIR (55.97 mGy), respectively. CONCLUSION The HPS mode of 128-slice dual-source CT yields fewer artefacts inside the stent lumen compared with SPIR and SEQ, but image noise is higher. ALN is still too high for routine stent evaluation in clinical practice. Radiation dose of the HPS mode is markedly (less than about tenfold) reduced.
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Affiliation(s)
- Florian Wolf
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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[Cardiac SPECT/CT: correlation between atherosclerosis, significant coronary artery stenoses and myocardial perfusion parameters in patients with known coronary artery disease]. Radiologe 2010; 50:366-71. [PMID: 20333503 DOI: 10.1007/s00117-009-1970-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Invasive coronary angiography (ICA) and CT angiography (CTA) both enable significant coronary artery stenoses to be detected, but they are not suitable for assessing their hemodynamic relevance. This can be accomplished using myocardial perfusion scintigraphy (MPS) which, however, has limited specificity and spatial resolution. Regarding patients with known coronary artery disease (CAD) it is furthermore important to stratify patient's individual risk for severe cardiac events to guide therapy management.The results of our investigations in 158 patients with CAD indicate that global and regional calcium scores (CAC) do not correlate with the presence of myocardial perfusion defects and significant coronary artery stenoses, respectively. However, published literature has reported CAC as being an independent predictor of long-time survival.For clinical purposes it seems that non-invasive diagnostics with CTA, MPS and CAC screening can be useful even in patients with known CAD. CAC and global scar burden enable long-term risk-stratification, whereas fusion of CTA and MPS is useful to detect the culprit lesion of relevant perfusion defects and to select options for revascularization.
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President's page: One of 600,000. J Cardiovasc Comput Tomogr 2010; 4:77-9. [PMID: 20159636 DOI: 10.1016/j.jcct.2010.01.014] [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: 01/15/2010] [Accepted: 01/15/2010] [Indexed: 11/22/2022]
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Jin KN, Park EA, Shin CI, Lee W, Chung JW, Park JH. Retrospective versus prospective ECG-gated dual-source CT in pediatric patients with congenital heart diseases: comparison of image quality and radiation dose. Int J Cardiovasc Imaging 2010; 26 Suppl 1:63-73. [DOI: 10.1007/s10554-009-9579-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/22/2009] [Indexed: 12/01/2022]
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Bamberg F, Sommer WH, Schenzle JC, Becker CR, Nikolaou K, Reiser MF, Johnson TRC. Systolic acquisition of coronary dual-source computed tomography angiography: feasibility in an unselected patient population. Eur Radiol 2009; 20:1331-6. [DOI: 10.1007/s00330-009-1680-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 10/11/2009] [Accepted: 10/17/2009] [Indexed: 10/20/2022]
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