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Funama Y, Oda S, Teramoto F, Aoki Y, Takahashi I, Kojima S, Goto T, Tanaka K, Kidoh M, Nagayama Y, Nakaura T, Hirai T. Improving Visualization of In-stent Lumen Using Prototype Photon-counting Detector Computed Tomography with High-resolution Plaque Kernel. J Med Phys 2024; 49:127-132. [PMID: 38828063 PMCID: PMC11141743 DOI: 10.4103/jmp.jmp_163_23] [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: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 06/05/2024] Open
Abstract
The study aimed to compare the performance of photon-counting detector computed tomography (PCD CT) with high-resolution (HR)-plaque kernel with that of the energy-integrating detector CT (EID CT) in terms of the visualization of the lumen size and the in-stent stenotic portion at different coronary vessel angles. The lumen sizes in PCD CT and EID CT images were 2.13 and 1.80 mm at 0°, 2.20 and 1.77 mm at 45°, and 2.27 mm and 1.67 mm at 90°, respectively. The lumen sizes in PCD CT with HR-plaque kernel were wider than those in EID CT. The mean degree of the in-stent stenotic portion at 50% was 69.7% for PCD CT and 90.4% for EID CT. PCD CT images with HR-plaque kernel enable improved visualization of lumen size and accurate measurements of the in-stent stenotic portion compared to conventional EID CT images regardless of the stent direction.
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Affiliation(s)
- Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Fuyuhiko Teramoto
- Medical System Research and Development Center, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Yuko Aoki
- Medical System Research and Development Center, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Isao Takahashi
- Innovative Technology Laboratory, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Shinichi Kojima
- Innovative Technology Laboratory, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Taiga Goto
- Medical System Research and Development Center, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Kana Tanaka
- Medical System Research and Development Center, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Abdelkarim A, Roy SK, Kinninger A, Salek A, Baranski O, Andreini D, Pontone G, Conte E, O’Rourke R, Hamilton-Craig C, Budoff MJ. Evaluation of Image Quality for High Heart Rates for Coronary Computed Tomographic Angiography with Advancement in CT Technology: The CONVERGE Registry. J Cardiovasc Dev Dis 2023; 10:404. [PMID: 37754833 PMCID: PMC10532141 DOI: 10.3390/jcdd10090404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE This study aims to evaluate image quality in patients with heart rates above or equal to 70 beats per minute (bpm), performed on a 16 cm scanner (256-slice General Electric Revolution) in comparison to a CT scanner with only 4 cm of coverage (64 slice Volume CT). BACKGROUND Recent advancements in image acquisition, such as whole-heart coverage in a single rotation and post-processing methods in coronary computed tomographic angiography (CCTA), include motion-correction algorithms, such as SnapShot Freeze (SSF), which improve temporal resolution and allow for the assessment of coronary artery disease (CAD) with lower motion scores and better image qualities. Studies from the comprehensive evaluation of high temporal- and spatial-resolution cardiac CT using a wide coverage system (CONVERGE) registry (a multicenter registry at four centers) have shown the 16 cm CT scanner having a better image quality in comparison to the 4 cm scanner. However, these studies failed to include patients with undesirable or high heart rates due to well-documented poor image acquisition on prior generations of CCTA scanners. METHODS A prospective, observational, multicenter cohort study comparing image quality, quantitively and qualitatively, on scans performed on a 16 cm CCTA in comparison to a cohort of images captured on a 4 cm CCTA at four centers. Participants were recruited based on broad inclusion criteria, and each patient in the 16 cm CCTA arm of the study received a CCTA scan using a 256-slice, whole-heart, single-beat scanner. These patients were then matched by age, gender, and heart rate to patients who underwent CCTA scans on a 4 cm CT scanner. Image quality was graded based on the signal-to-noise ratio, contrast-to-noise ratio, and on a Likert scale of 0-4: 0, very poor-4, excellent. RESULTS 104 patients were evaluated for this study. The mean heart rate was 75 ± 7 in the 4 cm scanner and 75 ± 7 in the 16 cm one (p = 0.426). The signal-to-noise and contrast-to-noise ratios were higher in the 16 cm scanner (p = 0.0001). In addition, more scans were evaluated as having an excellent quality on the 16 cm scanner than on the 4 cm scanner (p < 0.0001) based on a 4-point Likert scale. CONCLUSIONS The 16 cm scanner has a superior image quality for fast heart rates compared to the 4 cm scanner. This study shows that there is a significantly higher frequency of excellent and good studies showing better contrast-to-noise and signal-to-noise ratios with the 16 cm scanner compared to the 4 cm scanner.
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Affiliation(s)
- Ayman Abdelkarim
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Sion K. Roy
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - April Kinninger
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Azadeh Salek
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Olivia Baranski
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy (G.P.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20126 Milan, Italy
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy (G.P.)
| | - Rachael O’Rourke
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, 4032 QLD, Australia (C.H.-C.)
| | - Christian Hamilton-Craig
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, 4032 QLD, Australia (C.H.-C.)
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
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Zhang Y, Zhang X, Jiang Y, Yang P, Hu X, Peng B, Yue X, Li Y, Ma P, Yuan Y, Yu Y, Liu B, Li X. 3D whole-heart noncontrast coronary MR angiography based on compressed SENSE technology: a comparative study of conventional SENSE sequence and coronary computed tomography angiography. Insights Imaging 2023; 14:35. [PMID: 36790611 PMCID: PMC9931966 DOI: 10.1186/s13244-023-01378-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE The relatively long scan time has hampered the clinical use of whole-heart noncontrast coronary magnetic resonance angiography (NCMRA). The compressed sensitivity encoding (SENSE) technique, also known as the CS technique, has been found to improve scan times. This study aimed to identify the optimal CS acceleration factor for NCMRA. METHODS Thirty-six participants underwent four NCMRA sequences: three sequences using the CS technique with acceleration factors of 4, 5, and 6, and one sequence using the conventional SENSE technique with the acceleration factor of 2. Coronary computed tomography angiography (CCTA) was considered as a reference sequence. The acquisition times of the four NCMRA sequences were assessed. The correlation and agreement between the visible vessel lengths obtained via CCTA and NCMRA were also assessed. The image quality scores and contrast ratio (CR) of eight coronary artery segments from the four NCMRA sequences were quantitatively evaluated. RESULTS The mean acquisition time of the conventional SENSE was 343 s, while that of CS4, CS5, and CS6 was 269, 215, and 190 s, respectively. The visible vessel length from the CS4 sequence showed good correlation and agreement with CCTA. The image quality score and CR from the CS4 sequence were not statistically significantly different from those in the other groups (p > 0.05). Moreover, the image score and CR showed a decreasing trend with the increase in the CS factor. CONCLUSIONS The CS technique could significantly shorten the acquisition time of NCMRA. The CS sequence with an acceleration factor of 4 was generally acceptable for NCMRA in clinical settings to balance the image quality and acquisition time.
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Affiliation(s)
- Yang Zhang
- grid.412679.f0000 0004 1771 3402Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, 230032 Anhui Province China ,Department of Radiology, Fuyang People’s Hospital, Fuyang, 236015 Anhui Province China
| | - Xinna Zhang
- grid.412679.f0000 0004 1771 3402Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, 230032 Anhui Province China
| | - Yuqi Jiang
- grid.186775.a0000 0000 9490 772XDepartment of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, 236000 Anhui China
| | - Panpan Yang
- grid.186775.a0000 0000 9490 772XDepartment of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, 236000 Anhui China
| | - Xiankuo Hu
- Department of Radiology, Fuyang People’s Hospital, Fuyang, 236015 Anhui Province China
| | - Bin Peng
- Department of Radiology, Fuyang People’s Hospital, Fuyang, 236015 Anhui Province China
| | | | - Yuanyuan Li
- Department of Radiology, Fuyang People’s Hospital, Fuyang, 236015 Anhui Province China
| | - Peiqi Ma
- Department of Radiology, Fuyang People’s Hospital, Fuyang, 236015 Anhui Province China
| | - Yushan Yuan
- Department of Radiology, Fuyang People’s Hospital, Fuyang, 236015 Anhui Province China
| | - Yongqiang Yu
- grid.412679.f0000 0004 1771 3402Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, 230032 Anhui Province China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China.
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China. .,Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, 236000, Anhui, China.
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Lu H, Zhao S, Tian D, Yang S, Ma J, Chen Y, Ge M, Zeng M, Jin H. Clinical Application of Non-Contrast-Enhanced Dixon Water-Fat Separation Compressed SENSE Whole-Heart Coronary MR Angiography at 3.0 T With and Without Nitroglycerin. J Magn Reson Imaging 2021; 55:579-591. [PMID: 34254384 DOI: 10.1002/jmri.27829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND 3.0 T non-contrast-enhanced nitroglycerin (NTG)-assisted whole-heart coronary magnetic resonance angiography (MRA) employing Dixon water-fat separation and compressed SENSE (CS-SENSE) acceleration is a promising method for diagnosing coronary artery disease (CAD). PURPOSE To evaluate the diagnostic performance of this technique for detecting clinically-relevant (≥50% diameter reducing) CAD and to evaluate the difference in NTG-induced coronary vasodilation between patients with and without clinically-relevant CAD. STUDY TYPE Prospective. POPULATION Sixty-six patients with suspected CAD. FIELD STRENGTH/SEQUENCE 3.0 T; CSSENSE, Dixon water-fat separation, three-dimensional segmented turbo field gradient-echo sequence for whole-heart coronary MRA. ASSESSMENT Overall image quality of coronary MRA was calculated on the basis of all visible coronary segments. The diagnostic performance of coronary MRA for detecting a ≥50% reduction in coronary artery diameter with and without NTG was compared using X-ray coronary angiography (CAG) as the reference. According to CAG, patients were divided into a non-clinically-relevant CAD group and clinically-relevant CAD group, and the difference in NTG-induced vasodilation between the groups was evaluated. STATISTICAL TESTS Unpaired/paired Student's t-test, Mann-Whitney U test, paired Wilcoxon signed-rank test, χ2 test, McNemar test. A two-tailed P value <0.05 was considered significant. RESULTS Overall image quality was increased significantly in the coronary MRA images after NTG. The diagnostic performance of the non-NTG vs. NTG-assisted coronary MRA was as follows on a per-patient basis: sensitivity 94.3% vs. 94.3%, specificity 64.5% vs. 83.9%, positive predictive value 75.0% vs. 86.8%, negative predictive value 90.9% vs. 92.9%, and accuracy 80.3% vs. 89.4%, respectively. NTG-induced vasodilation was significantly lower in the clinically-relevant CAD group than in the non-clinically-relevant CAD group (13.7 ± 8.1% vs. 24.1 ± 16.3%). DATA CONCLUSION Non-contrast Dixon water-fat separation CS-SENSE coronary MRA at 3.0 T can noninvasively detect clinically-relevant CAD and sublingual NTG improved performance. Combining pre- and post-NTG coronary MRA may provide a simple noninvasive and nonionizing test to evaluate coronary vasodilation function. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Hongfei Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Di Tian
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Meiying Ge
- Department of Radiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
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Koubaissi SA, Kamar Z, El Ankouni M, Degheili JA, Haddad A. Coronary Computed Tomographic Angiography Imaging as a Prognostic Indicator for Coronary Artery Disease: Data from a Lebanese Tertiary Center. Heart Views 2021; 21:239-244. [PMID: 33986921 PMCID: PMC8104316 DOI: 10.4103/heartviews.heartviews_87_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Coronary artery disease (CAD) is a major cause of death and disability worldwide. Coronary computed tomographic angiography (CCTA) is a noninvasive imaging technique with a high negative predictive value (NPV). Most studies were done in developed countries, where the prevalence of CAD does not reflect the actual disease burden in developing countries, such as Lebanon. Methods: We retrospectively evaluated the prognostic value of CCTA in predicting acute myocardial events (AMEs) in 200 Lebanese patients. We determined if specific medical and radiological characteristics are linked with AME and looked for any association between the patient's medical risk factors and the type/location of detected atheromatous plaques. Patients' records were reviewed, and the follow-up period of 5–8 years ensued. Chi-square/Fisher test and Student's t-test were used, in addition to multinomial logistic regression to adjust for the confounding variables. P <0.05 was considered statistically significant. Results: Our study showed that CCTA had a NPV that reaches 97.9% in asymptomatic patients, a positive predictive value (PPV) of 76.4% for symptomatic patients, a sensitivity of 88.9%, and a specificity of 52.5%. AMEs were significantly increased in patients with a mixed plaque type and/or a moderate-to-severe lumen reduction on CCTA. Conclusions: CCTA is a sensitive modality for plaque detection and is found to have a remarkably high NPV for asymptomatic patients. A CCTA, along with a low pretest clinical probability of CAD, can be sufficient to rule out an AME for up to 8 years.
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Affiliation(s)
- Salwa A Koubaissi
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Zeinab Kamar
- Department of Anaesthesiology, Lebanese University, Beirut, Lebanon
| | - Mahdi El Ankouni
- Department of Internal Medicine, Lebanese University, Beirut, Lebanon
| | - Jad A Degheili
- Department of Surgery, Division of Urology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Antoine Haddad
- Department of Radiology, Saint Joseph University, Beirut, Lebanon
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Sun B, Chen Z, Duan Q, Xue Y, Chen L, Zhang Z, An J. A direct comparison of 3 T contrast-enhanced whole-heart coronary cardiovascular magnetic resonance angiography to dual-source computed tomography angiography for detection of coronary artery stenosis: a single-center experience. J Cardiovasc Magn Reson 2020; 22:40. [PMID: 32475355 PMCID: PMC7262765 DOI: 10.1186/s12968-020-00630-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In recent years, substantial advances have been made in noninvasive cardiac imaging, including cardiac computed tomography (CT) and cardiovascular magnetic resonance (CMR). The purpose of this study was to prospectively compare the diagnostic performance of contrast-enhanced whole heart coronary CMR angiography (CCMRA) to dual-source coronary CT angiography (CCTA) for the diagnosis of significant coronary stenoses (≥50%) in patients with known or suspected coronary artery disease (CAD) referred for conventional x-ray coronary angiography. METHODS Our objective was to directly compare the diagnostic accuracy of contrast-enhanced whole-heart CCMRA (CE-CCMRA) to dual-source CCTA (DS-CCTA) for the detection of CAD. We prospectively studied 57 symptomatic patients with suspected or known CAD who were scheduled for conventional x-ray coronary angiography. Significant CAD was defined as an x-ray defined diameter reduction of ≥50% in a coronary artery with a reference diameter of ≥1.5 mm. RESULTS CE-CCMRA and DS-CCTA were completed in 51 (89%) of 57 patients without complications. The acquisition times of CE-CCMRA and DS-CCTA, respectively, were 9.5 ± 3.1 min and 8.3 ± 1.4 s. On patient-based analysis, the sensitivity, specificity, positive and negative predictive value of CE-CCMRA and DS-CCTA were 93.5% versus 93.5%(P > 0.05), 85% versus 90%(P > 0.05), 90.6% versus 93.5%(P > 0.05), and 89.4% versus 90%(P > 0.05), respectively. The area under the curve (AUC) was 0.89 (95% CI: 0.79 to 0.99) for CE-CCMRA and 0.92 (95% CI: 0.83 to 1.00) for DS-CCTA. CONCLUSIONS DS-CCTA was found to be superior to CE-CCMRA in the diagnosis of significant coronary stenoses (≥50%) in patients with suspected or known CAD scheduled for conventional x-ray coronary angiography, owing to shorter scanning times and higher spatial resolution. However, CE-CCMRA and DS-CCTA have similar diagnostic accuracies.
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Affiliation(s)
- Bin Sun
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China
| | - Zhiyong Chen
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China.
| | - Qing Duan
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China
| | - Yunjing Xue
- Department of Radiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, People's Republic of China
| | - Lianglong Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China
| | | | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
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Madaj P, Li D, Nakanishi R, Andreini D, Pontone G, Conte E, O’Rourke Franzcr R, Hamilton-Craig C, Nimmagadda M, Kim N, Fatima B, Dailing C, Budoff MJ. Lower Radiation Dosing in Cardiac CT Angiography: The CONVERGE Registry. J Nucl Med Technol 2020; 48:58-62. [DOI: 10.2967/jnmt.119.229500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
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8
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Huang X, Gao S, Ma Y, Lu X, Jia Z, Hou Y. The optimal monoenergetic spectral image level of coronary computed tomography (CT) angiography on a dual-layer spectral detector CT with half-dose contrast media. Quant Imaging Med Surg 2020; 10:592-603. [PMID: 32269920 DOI: 10.21037/qims.2020.02.17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background To investigate the optimal monoenergetic level of spectral reconstructions in coronary computed tomography angiography (coronary CTA) on a dual-layer spectral detector computed tomography (SDCT) with half-dose contrast media. Methods Two hundred patients with suspected coronary artery disease (CAD) were enrolled in this prospective coronary CTA study and randomly divided into a routine-dose contrast media group and a half-dose contrast media group (each n=100). Coronary CTA was performed using SDCT with prospective electrocardiogram (ECG)-gated mode. A tube voltage of 120 kVp was used, along with an automated tube current modulation. A dose of iodixanol 270 mgI/mL of 0.8 and 0.4 mL/kg was administered to the routine and half-dose groups, respectively. For the routine-dose group, 120 kVp polychromatic images with a model-based iterative reconstruction (IMR) (Group A) were reconstructed. For the half-dose group, three monoenergetic levels of images were reconstructed (Group B, 45 keV; Group C, 50 keV; and Group D, 55 keV). Objective indicators [mean CT values; noise; signal-to-noise ratio (SNR); and contrast-to-noise ratio (CNR)] and subjective indicators (contrast, sharpness, subjective noise, and acceptability) in each group were compared. Results There were no significant differences in demographics or radiation dose (1.83±0.51 vs. 1.80±0.53 mSv, P=0.78) between the routine- and half-dose groups. The average iodine loads were 15.33±2.26 and 7.48±1.14 g, respectively. Mean CT values, SNR, CNR, and subjective contrast in Group C were higher than those in Group A (P<0.05), and there were no significant differences in other indicators between Group C and Group A (P>0.05). The objective and subjective noise in Group B were worse than those in Group A (P<0.05). The contrast, sharpness, and acceptability of Group D were all worse than those of Group A (P<0.05). Conclusions Compared to routine polychromatic images, 50 keV monoenergetic images can provide equivalent or improved coronary image quality in coronary CTA performed on SDCT with half the amount of contrast media.
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Affiliation(s)
- Xin Huang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Sizhe Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang 110016, China
| | - Zheng Jia
- CT Clinical Science, Philips Healthcare, Shenyang 110016, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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9
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Li JJ, Zeng M. Clinical impact of low-radiation computed tomography coronary angiography diagnosis for coronary artery stenosis: Study Protocol. Medicine (Baltimore) 2019; 98:e17474. [PMID: 31725604 PMCID: PMC6867739 DOI: 10.1097/md.0000000000017474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this study aims to assess the clinic impact of low-radiation computed tomography coronary angiography (LR-CTCA) diagnosis for coronary artery stenosis (CAS). METHODS This study will comprehensively search the following electronic databases from inception to the present: PUBMED, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, VIP database, WANGFANG, and China National Knowledge Infrastructure. All these electronic databases will be searched without language restrictions. All case-controlled studies on assessing the clinical impact of LR-CTCA diagnosis for patients with CAS will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be utilized to evaluate the methodological quality for each qualified studies. RESULTS We will assess the clinic impact of LR-CTCA diagnosis for CAS by measuring sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION The results of this study will summarize the latest evidence of LR-CTCA diagnosis for CAS. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139336.
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Affiliation(s)
- Jian-Jun Li
- Department of CT Diagnosis, Yan’an People's Hospital, Yan’an, China
| | - Ming Zeng
- Department of Radiology, Yan’an Hospital of Traditional Chinese Medicine, Yan’an, China
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10
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Albrecht MH, Varga-Szemes A, Schoepf UJ, Nance JW, De Cecco CN, De Santis D, Tesche C, Eid MH, Penmetsa M, Lesslie VW, Piccini D, Goeller M, Wichmann JL, Vogl TJ, Chowdhury SM, Nutting A, Hlavacek AM. Diagnostic Accuracy of Noncontrast Self-navigated Free-breathing MR Angiography versus CT Angiography: A Prospective Study in Pediatric Patients with Suspected Anomalous Coronary Arteries. Acad Radiol 2019; 26:1309-1317. [PMID: 30655052 DOI: 10.1016/j.acra.2018.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic accuracy of a prototype noncontrast, free-breathing, self-navigated 3D (SN3D) MR angiography (MRA) technique for the assessment of coronary artery anatomy in children with known or suspected coronary anomalies, using CT angiography (CTA) as the reference standard. MATERIALS AND METHODS Twenty-one children (15 male, 12.3 ± 2.6 years) were prospectively enrolled between July 2014 and August 2016 in this IRB-approved, HIPAA-compliant study. Patients underwent same-day unenhanced SN3D-MRA and contrast-enhanced CTA. Two observers rated the visualization of coronary artery segments and diagnostic confidence on a 3-point scale and assessed coronary arteries for anomalous origin, as well as interarterial and intramural course. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of SN3D-MRA for the detection of coronary artery abnormalities were calculated. Interobserver agreement was assessed using Intraclass Correlation Coefficients (ICC). RESULTS Fourteen children showed coronary artery abnormalities on CTA. The visualization of coronary segments was rated significantly higher for CTA compared to MRA (p <0.015), except for the left main coronary artery (p = 0.301), with good to excellent interobserver agreement (ICC = 0.62-0.94). Diagnostic confidence was higher for CTA (p = 0.046). Sensitivity, specificity, PPV, and NPV of MRA were 92%, 92%, 96%, and 87% for the detection of coronary artery anomalies, 85%, 85%, 74%, and 92% for high origin, 71%, 92%, 82%, and 87% for interarterial, and 41%, 96%, 87%, and 80% for intramural course. CONCLUSIONS Noncontrast SN3D-MRA is highly accurate for the detection of coronary artery anomalies in pediatric patients while diagnostic confidence and coronary artery visualization remain superior with CTA.
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Gosling RC, Morris PD, Silva Soto DA, Lawford PV, Hose DR, Gunn JP. Virtual Coronary Intervention: A Treatment Planning Tool Based Upon the Angiogram. JACC Cardiovasc Imaging 2019; 12:865-872. [PMID: 29550308 PMCID: PMC6503181 DOI: 10.1016/j.jcmg.2018.01.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study sought to assess the ability of a novel virtual coronary intervention (VCI) tool based on invasive angiography to predict the patient's physiological response to stenting. BACKGROUND Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with improved clinical and economic outcomes compared with angiographic guidance alone. Virtual (v)FFR can be calculated based upon a 3-dimensional (3D) reconstruction of the coronary anatomy from the angiogram, using computational fluid dynamics (CFD) modeling. This technology can be used to perform virtual stenting, with a predicted post-PCI FFR, and the prospect of optimized treatment planning. METHODS Patients undergoing elective PCI had pressure-wire-based FFR measurements pre- and post-PCI. A 3D reconstruction of the diseased artery was generated from the angiogram and imported into the VIRTUheart workflow, without the need for any invasive physiological measurements. VCI was performed using a radius correction tool replicating the dimensions of the stent deployed during PCI. Virtual FFR (vFFR) was calculated pre- and post-VCI, using CFD analysis. vFFR pre- and post-VCI were compared with measured (m)FFR pre- and post-PCI, respectively. RESULTS Fifty-four patients and 59 vessels underwent PCI. The mFFR and vFFR pre-PCI were 0.66 ± 0.14 and 0.68 ± 0.13, respectively. Pre-PCI vFFR deviated from mFFR by ±0.05 (mean Δ = -0.02; SD = 0.07). The mean mFFR and vFFR post-PCI/VCI were 0.90 ± 0.05 and 0.92 ± 0.05, respectively. Post-VCI vFFR deviated from post-PCI mFFR by ±0.02 (mean Δ = -0.01; SD = 0.03). Mean CFD processing time was 95 s per case. CONCLUSIONS The authors have developed a novel VCI tool, based upon the angiogram, that predicts the physiological response to stenting with a high degree of accuracy.
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Affiliation(s)
- Rebecca C Gosling
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom.
| | - Paul D Morris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom; Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
| | - Daniel A Silva Soto
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Patricia V Lawford
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
| | - D Rodney Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Julian P Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom; Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
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Zhang W, Ba Z, Wang Z, Lv H, Zhao J, Zhang Y, Zhang F, Song L. Diagnostic performance of low-radiation-dose and low-contrast-dose (double low-dose) coronary CT angiography for coronary artery stenosis. Medicine (Baltimore) 2018; 97:e11798. [PMID: 30142766 PMCID: PMC6113019 DOI: 10.1097/md.0000000000011798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic accuracy of low-radiation-dose and low-contrast-dose (double low-dose) coronary computed tomography angiography (CTA) for coronary artery stenosis in patients with suspected coronary artery disease (CAD).Totally 88 patients with suspected CAD were divided in the routine and double low-dose groups. Subjective image quality (IQ) was scored and diagnostic performance for detecting ≥50% stenosis was determined with the invasive coronary angiography. IQ and diagnostic performance were analyzed and compared between the 2 groups.There was no significant difference in the IQ of coronary artery between the routine and double low-dose groups, with good inter-observer agreement for the IQ. There were no significant differences in the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy on the per-patient, per-vessel, or per-segment level between the routine and double low-dose groups. The contrast medium injection volume in the double low-dose group was reduced by 37.1% compared with the routine-dose group. The effective dose in the double low dose was reduced by 44.5% compared with the routine-dose group.Double low-dose coronary CTA with IR can acquire satisfactory IQ and have high diagnostic sensitivity, specificity, and accuracy for the detection of coronary artery stenosis.
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Affiliation(s)
- Wei Zhang
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
| | - Zhaogui Ba
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong
| | - Zhenqiang Wang
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong
| | - Huaying Lv
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong
| | - Jun Zhao
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
| | - Yonghua Zhang
- Department of Radiology, People's Hospital of Yutian County, Yutian, Hebei, China
| | - Feixue Zhang
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
| | - Lei Song
- Department of Radiology, The Second Hospital of Shandong University, Shandong University, Jinan
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Abstract
Resting regional wall motion abnormality (RWMA) has significant prognostic value beyond the findings of computed tomography (CT) coronary angiography. Stretch quantification of endocardial engraved zones (SQUEEZ) has been proposed as a measure of regional cardiac function. The purpose of the work reported here was to determine the effect of lowering the radiation dose on the precision of automatic SQUEEZ assessments of RWMA. Chronic myocardial infarction was created by a 2-h occlusion of the left anterior descending coronary artery in 10 swine (heart rates 80-100, ejection fraction 25-57%). CT was performed 5-11 months post infarct using first-pass contrast enhanced segmented cardiac function scans on a 320-detector row scanner at 80 kVp/500 mA. Images were reconstructed at end diastole and end systole with both filtered back projection and using the "standard" adaptive iterative dose reduction (AIDR) algorithm. For each acquisition, 9 lower dose acquisitions were created. End systolic myocardial function maps were calculated using SQUEEZ for all noise levels and contrast-to-noise ratio (CNR) between the left ventricle blood and myocardium was calculated as a measure of image quality. For acquisitions with CNR > 4, SQUEEZ could be estimated with a precision of ± 0.04 (p < 0.001) or 5.7% of its dynamic range. The difference between SQUEEZ values calculated from AIDR and FBP images was not statistically significant. Regional wall motion abnormality can be quantified with good precision from low dose acquisitions, using SQUEEZ, as long as the blood-myocardium CNR stays above 4.
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Zhang H, Ma Y, Lyu J, Yang Y, Yuan W, Song Z. Low kV and Low Concentration Contrast Agent with Iterative Reconstruction of Computed Tomography (CT) Coronary Angiography: A Preliminary Study. Med Sci Monit 2017; 23:5005-5010. [PMID: 29051477 PMCID: PMC5661743 DOI: 10.12659/msm.904251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to evaluate the image quality and radiation dose of CT coronary angiography (CTCA) with low kV, low concentration contrast agent, and iterative reconstruction. Material/Methods Ninety cases were randomly divided into 3 groups according to contrast agent concentration: group A 270 mg/ml (100 kV), group B 350 mg/ml (120 kV), and group C 370 mg/ml (120 kV), with 30 cases per group. Tube current was 200–250 mAs. Collimator width was 128×0.6 mm. Rotation speed was 0.27 s. The CT value of the left and right coronary arteries and the ascending aortic root was measured. The SNR and CNR of the images were calculated to evaluate the image quality objectively. The CTDI, DLP, and contrast injection were recorded. Results There were no significant differences in sex, age, weight, height, and BMI among the 3 groups. There was no statistically significant difference between left and right coronary artery and ascending aortic root CT value, background noise, SNR, and CNR. Compared to B and C, the ED in group A decreased by about 27.58% and 28.21%, respectively. The total amount of iodine in group A was decreased by about 21.27% and 24.83%, respectively compared with groups B and C. Conclusions Low kV and low concentration contrast agent combined with iterative reconstruction for CTCA imaging produced image quality consistent with that of conventional CTCA and significantly reduced the dosage of the radiation and injected iodine.
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Affiliation(s)
- Hong Zhang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Yanhe Ma
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Jun Lyu
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Yapeng Yang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Wei Yuan
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (mainland)
| | - Zhenchun Song
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (mainland)
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Halliburton SS, Tanabe Y, Partovi S, Rajiah P. The role of advanced reconstruction algorithms in cardiac CT. Cardiovasc Diagn Ther 2017; 7:527-538. [PMID: 29255694 DOI: 10.21037/cdt.2017.08.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-linear iterative reconstruction (IR) algorithms have been increasingly incorporated into clinical cardiac CT protocols at institutions around the world. Multiple IR algorithms are available commercially from various vendors. IR algorithms decrease image noise and are primarily used to enable lower radiation dose protocols. IR can also be used to improve image quality for imaging of obese patients, coronary atherosclerotic plaques, coronary stents, and myocardial perfusion. In this article, we will review the various applications of IR algorithms in cardiac imaging and evaluate how they have changed practice.
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Affiliation(s)
| | - Yuki Tanabe
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sasan Partovi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX, USA
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Submillisievert imaging protocol using full reconstruction and advanced patient motion correction in 320-row area detector coronary CT angiography. Int J Cardiovasc Imaging 2017; 34:465-474. [PMID: 28900781 DOI: 10.1007/s10554-017-1237-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/20/2017] [Indexed: 12/29/2022]
Abstract
Radiation exposure remains a concern in the use of coronary CT angiography (CCTA). Full reconstruction (Full) and reconstruction using advanced patient motion correction (APMC) could obtain a lower radiation dose using low tube current scanning in a 320-row Area Detector CT (320-ADCT). The radiation dose for an imaging protocol using Full and APMC in daily practice was estimated. A total of 209 patients who underwent CCTA in 1 rotation scanning with 100 kv and adaptive iterative dose reduction 3D in 320-ADCT were enrolled. Imaging protocols were classified into 3 groups based on estimated slow filling time: (1) slow filling time ≥ 275 msec, Full with 30% of usual tube current (N = 43)(Full30%mA) (2) 206.3 msec ≤ slow filling time < 275 msec, APMC with 50% of usual tube current (N = 48)(APMC50%mA); and (3) 137.5 msec ≤ slow filling time < 206.3 msec, Half reconstruction with usual tube current (N = 118)(Half100%mA). Radiation dose was estimated by the effective dose. The diagnostic accuracy of CCTA was compared with that of invasive coronary angiography in 28 patients. The effective doses of Full30%mA, APMC50%mA, and Half100%mA were 0.77 ± 0.31, 1.30 ± 0.85, and 1.98 ± 0.68, respectively. Of 28 patients, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in vessel-based analyses were: Full30%mA, 66.7, 82.4, 80.0, 40.0, and 93.3%; APMC50%mA, 100.0, 80.0, 83.3, 50.05, and 100.0%; and Half100%mA, 90.9, 83.0, 86.3, 78.95, and 92.9%, respectively. An imaging protocol using Full30%mA and APMC50%mA was one of the methods how radiation dose could be reduced radiation dose maintained diagnostic accuracy compared to imaging using conventional Half100%mA.
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Ghekiere O, Salgado R, Buls N, Leiner T, Mancini I, Vanhoenacker P, Dendale P, Nchimi A. Image quality in coronary CT angiography: challenges and technical solutions. Br J Radiol 2017; 90:20160567. [PMID: 28055253 PMCID: PMC5605061 DOI: 10.1259/bjr.20160567] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 11/05/2022] Open
Abstract
Multidetector CT angiography (CTA) has become a widely accepted examination for non-invasive evaluation of the heart and coronary arteries. Despite its ongoing success and worldwide clinical implementation, it remains an often-challenging procedure in which image quality, and hence diagnostic value, is determined by both technical and patient-related factors. Thorough knowledge of these factors is important to obtain high-quality examinations. In this review, we discuss several key elements that may adversely affect coronary CTA image quality as well as potential measures that can be taken to mitigate their impact. In addition, several recent vendor-specific advances and future directions to improve image quality are discussed.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
- Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Nico Buls
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
| | | | - Paul Dendale
- Heart Center Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Alain Nchimi
- GIGA Cardiovascular Sciences, Liège University (ULg), Domaine Universitaire du Sart Tilman, Rue de l'hôpital, Liège, Belgium
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Prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp with 30mL contrast agent: An intraindividual comparison with sequential scanning at 120 kVp with 60mL contrast agent. Eur J Radiol 2017; 90:97-105. [PMID: 28583653 DOI: 10.1016/j.ejrad.2017.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/03/2017] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate image quality, radiation dose, and diagnostic efficiency of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp with 30mL contrast agent intra-individually compared with routine CCTA protocol. MATERIALS AND METHODS One hundred and thirty eight patients with suspected coronary artery disease, body mass index (BMI)≤25kg/m2 and heart rate (HR)≤70 beats per minute (bpm) underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp and 30mL contrast agent (protocol A) and prospectively ECG-triggered sequential scanning at 120 kVp and 60mL contrast medium (protocol B). Objective and subjective image quality, radiation doses, and diagnostic accuracy were evaluated and compared between the two protocols. RESULTS Higher CT attenuation, higher noise, lower signal-to-noise ratios (SNRs) and lower contrast-to-noise ratios (CNRs) were found in protocol A than in protocol B (P<0.001). However, image quality of protocol A were diagnostic. In patients with BMI<23kg/m2 or HR<60bpm, subjective image quality scores of some coronary arteries in protocol A were not significantly different from protocol B (P>0.05). Effective dose in protocol A has reduced by 96.7% compared with protocol B (P<0.001). No significant differences were found for diagnostic accuracy between the two protocols on a per-segment (P=0.513), per-vessel (P=0.317) and per-patient (P=0.125) basis. CONCLUSIONS Prospectively ECG-triggered high-pitch CCTA at 70kVp with 30mL contrast agent can reduce radiation dose but maintain image quality and high diagnostic accuracy in a selected, non-obese population.
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Ma Y, Liu H, Hou Y, Qiao A, Hou Y, Yang Q, Guo Q. Instantaneous wave-free ratio derived from coronary computed tomography angiography in evaluation of ischemia-causing coronary stenosis: Feasibility and initial clinical research. Medicine (Baltimore) 2017; 96:e5979. [PMID: 28121952 PMCID: PMC5287976 DOI: 10.1097/md.0000000000005979] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/31/2016] [Accepted: 01/06/2017] [Indexed: 01/10/2023] Open
Abstract
The instantaneous wave-free ratio (iFR) closely related to fractional flow reserve (FFR) is a adenosine-independent physiologic index of coronary stenosis severity. We sought to evaluate whether iFR derived from coronary computed tomographic angiography (iFRCT) can be used as a novel noninvasive method for diagnosis of ischemia-causing coronary stenosis.We retrospectively enrolled 33 patients (47 lesions) with coronary artery disease (CAD) and examined with coronary computed tomographic angiography (CTA), invasive coronary angiography (ICA), and FFR. Patient-specific anatomical model of the coronary artery was built by original resting end-diastolic CTA images. Based on the model and computational fluid dynamics, individual boundary conditions were set to calculate iFRCT as the mean pressure distal to the stenosis divided by the mean aortic pressure during the diastolic wave-free period of rest state. Ischemia was assessed by an FFR of up to 0.8, while anatomically obstructive CAD was defined by a stenosis of at least 50% by ICA. The correlation between iFRCT and FFR was evaluated. The receiver operating characteristic (ROC) curve was used to select the cut-off value of iFRCT for diagnosis of ischemia-causing stenosis. The diagnostic performances of iFRCT, coronary CTA, and iFRCT plus CTA for ischemia-causing stenosis were compared with ROC curve and Delong method.On a per-vessel basis, iFRCT and FFR had linear correlation (r = 0.75, p < 0.01). ROC analysis identified an optimal iFRCT cut-off value of 0.82 for categorization based on an FFR cut-off value 0.8, and the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of iFRCT were 78.72%,70.59%, 83.33%,70.59%, and 83.33%, respectively. Compared with obstructive CAD diagnosed by coronary CTA (AUC = 0.60), iFRCT yielded diagnostic improvement over stenosis assessment with AUC increasing from 0.6 by CTA to 0.87 (P < 0.01) and 0.90 (P < 0.01) when iFRCT plus CTA.In conclusion, iFRCT is a promising index improving diagnostic performance over coronary CTA for detection of ischemia-causing coronary stenosis.
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Affiliation(s)
- Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang
| | - Hui Liu
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang
| | - Aike Qiao
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Yingying Hou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Qingqing Yang
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang
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Wang L, Liu G, Liu J, Zheng M, Li L. Effects of no-reflow phenomenon on ventricular systolic synchrony in patients with acute anterior myocardial infarction after percutaneous coronary intervention. Ther Clin Risk Manag 2016; 12:1017-22. [PMID: 27445480 PMCID: PMC4928622 DOI: 10.2147/tcrm.s107808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of no-reflow phenomenon on ventricular systolic synchrony via myocardial blush grades (MBGs) in patients with acute anterior myocardial infarction after percutaneous coronary intervention (PCI). PATIENTS AND METHODS All patients were divided into two groups and assessed by MBGs. To observe the parameters of the left ventricular function and left ventricular systolic synchrony, equilibrium radionuclide angiography was performed 1 week after PCI and repeated 6 months after acute myocardial infarction (AMI). Measurement data were compared and analyzed by the Student's t-test, and the count data were evaluated by the χ (2) test. A multivariate regression analysis was performed to assess the contribution of confounding factors. RESULTS A total of 100 patients were enrolled in this study: 26 in the no-reflow and 74 in the reflow group. There was no significant difference in terms of age, sex, hypertension history, diabetes history, hyperlipidemia history, and smoking history between the two groups. However, the incidence rate of heart failure with Killip's grade ≥2 in the no-reflow group was significantly higher than that in the reflow group (38.46% vs 18.92%, P<0.05). Six months after the AMI-PCI, the left ventricular ejection fraction, peak ejection rate, and peak filling rate in the no-reflow group were significantly lower than those in the reflow group (t=2.21, 2.29, and 2.03, P<0.05 for all comparisons), but the values of the time to peak ejection rate, time to peak filling rate, phase shift, full width at half maximum, and peak phase standard deviation were all higher (t=2.41, 2.46, 2.00, 2.55, and 2.49, P<0.05 for all comparisons), and the incidence rate of major adverse cardiac events in the no-reflow group was also more elevated than that in the reflow group (53.85% vs 8.11%, χ (2)=34.49, P<0.001). CONCLUSION The no-reflow phenomenon identified by MBGs reflects the no-reperfusion status in the myocardium in the infarction-related zone after AMI. The directly caused reduction in the left ventricular systolic synchrony performance leads to adverse long-term outcomes in patients with AMI.
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Affiliation(s)
- Le Wang
- Department of Cardiology, The First Hospital of Hebei Medical University
| | - Gang Liu
- Department of Cardiology, The First Hospital of Hebei Medical University
| | - Jun Liu
- Department of Cardiology, The First Hospital of Hebei Medical University
| | - Mingqi Zheng
- Department of Cardiology, The First Hospital of Hebei Medical University
| | - Liang Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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He Y, Pang J, Dai Q, Fan Z, An J, Li D. Diagnostic Performance of Self-navigated Whole-Heart Contrast-enhanced Coronary 3-T MR Angiography. Radiology 2016; 281:401-408. [PMID: 27192461 DOI: 10.1148/radiol.2016152514] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the diagnostic performance of self-navigated whole-heart coronary 3-T magnetic resonance (MR) angiography by using conventional invasive coronary angiography (ICA) as the reference gold standard. Materials and Methods This study was approved by the local ethics committee. Written informed consent was obtained from each patient before the study. Thirty-nine consecutive patients underwent coronary MR angiography and later underwent ICA. Coronary MR angiography was performed with a 3-T imager with contrast agent enhancement during free breathing with self-navigated affine motion correction reconstruction. Coronary segments with reference diameters larger than 1.5 mm were included in the comparison between coronary MR angiography and ICA. The coronary MR angiography images were evaluated by two experienced readers blinded to the ICA results to identify significant luminal narrowing (>50% diameter reduction in reference ICA). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were performed to detect significant coronary artery stenosis. Results Coronary MR angiography examinations were successfully performed in all 39 patients. A total of 327 coronary segments had reference luminal diameter larger than 1.5 mm. Of these 327 coronary segments, 303 (92.7%) segments had a quality score greater than 1 at coronary MR angiography and were included in the analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.2%, 75.0%, 81.8%, 70.6%, and 76.9%, respectively, on a per-patient basis. Conclusion Contrast-enhanced self-navigated coronary 3-T MR angiography is a promising technique for the noninvasive detection of clinically significant coronary stenosis. © RSNA, 2016.
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Affiliation(s)
- Yi He
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Jianing Pang
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Qinyi Dai
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Zhanming Fan
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Jing An
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
| | - Debiao Li
- From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, China 100029 (Y.H., Q.D., Z.F.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (J.P., D.L.); and MR Collaboration NE Asia, Siemens Shenzhen Magnetic Resonance, Shanghai, China (J.A.)
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Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis. Eur Radiol 2016; 26:3781-3789. [PMID: 26863897 PMCID: PMC5052288 DOI: 10.1007/s00330-016-4229-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/18/2016] [Indexed: 02/08/2023]
Abstract
Objective To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization. Methods 160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8). Results 210 coronary segments were included (59 % positive). MLA of ≤1.8 mm2 was identified as the optimal cut-off (c = 0.97, p < 0.001; 95 % CI 0.94–0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm2 sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c = 0.92; p < 0.001; 95 % CI 0.88–95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95 % CI 0.84–93, c = 0.87; 95 % CI 0.82–92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c = 0.74 (95 % CI 0.67–81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84. Conclusions MLA ≤1.8 mm2 and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis. Key Points • Quantitative coronary CT-angiography is accurate for prediction of functional relevant stenosis. • Absolute lumen area and diameter rather than %stenosis predict functional relevance. • Lumen area <1.8 mm2and diameter <1.2 mm are the most accurate cut-offs. • Quantitative parameters are helpful for decision-making in terms of patient management.
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Halliburton SS, Rajiah P. Cardiac CT Scanner Technology: What Is New and What Is Next? CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9370-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Coronary CT angiography in obese patients using 3rd generation dual-source CT: effect of body mass index on image quality. Eur Radiol 2015; 26:2937-46. [DOI: 10.1007/s00330-015-4161-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/23/2015] [Accepted: 12/07/2015] [Indexed: 01/20/2023]
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Zhang F, Yang L, Song X, Li YN, Jiang Y, Zhang XH, Ju HY, Wu J, Chang RP. Feasibility study of low tube voltage (80 kVp) coronary CT angiography combined with contrast medium reduction using iterative model reconstruction (IMR) on standard BMI patients. Br J Radiol 2015; 89:20150766. [PMID: 26607646 DOI: 10.1259/bjr.20150766] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of low-tube-voltage (80 kVp) coronary CT angiography (CCTA) combined with contrast medium (CM) reduction and iterative model reconstruction (IMR) on patients with standard body mass index compared with clinical routine protocol. METHODS Retrospectively gated helical CCTA scans were acquired using a 256-slice multi-slice CT (Brilliance iCT; Philips Healthcare, Cleveland, OH) on 94 patients with standard body mass index (20-25 kg m(-2)) who were randomly assigned into 2 groups. The scan protocol for Group 1 was 100 kVp and 600 mAs with 70 ml CM at an injection rate of 4.5-5.5 ml s(-1); images were reconstructed by a hybrid iterative reconstruction technique (iDose(4); Philips Healthcare). Group 2 was scanned at 80 kVp and 600 mAs with 35 ml CM at an injection rate of 3.5-4.5 ml s(-1); images were reconstructed with IMR. Objective measurements such as the mean image noise and contrast-to-noise ratio of the two groups were measured on CT images and compared using the paired t-test. In addition, a subjective image quality evaluation was performed by two radiologists who were blinded to the scan protocol, using a 5-point scale [1 (poor) to 5 (excellent)]. The results of the two groups were compared using Mann-Whitney U test. RESULTS The iodine delivery rate of Group 2 was 1.0 ± 0.5 gI s(-1) compared with 2.1 ± 0.5 gI s(-1) in Group 1 resulting in a reduction of 52.4%. In addition, an effective radiation dose reduction of 56.4% was achieved in Group 2 (2.4 ± 1.2 mSv) compared with Group 1 (5.5 ± 1.4 mSv). The mean CT attenuation, contrast-to-noise ratio and image quality of all segments in Group 2 were significantly improved compared with those in Group 1 (all, p < 0.01). CONCLUSION The use of IMR along with a low tube voltage (80 kVp) combined with a low CM protocol for CCTA can reduce both radiation and CM dose with improved image quality. ADVANCES IN KNOWLEDGE In this study, we used a novel knowledge-based IMR which remarkably reduced the image noise. We compared the quality of the images obtained when the tube voltage was reduced to 80 kVp and that of those obtained according to the clinical routine protocols to determine whether ultra-low-dose imaging plus IMR is feasible in CCTA scans. We found that a low dose protocol combined with 80 kVp and reduced CM for CCTA can reduce both radiation dose and CM dose with improved image quality by the use of IMR in non-obese patients.
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Affiliation(s)
- Fan Zhang
- 1 Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Li Yang
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiang Song
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ying-Na Li
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yan Jiang
- 3 Clinical Science Imaging System, Philips Healthcare, Shanghai, China
| | - Xing-Hua Zhang
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hai-Yue Ju
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jian Wu
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Rui-Ping Chang
- 2 Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
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Ulimoen GR, Ofstad AP, Endresen K, Gullestad L, Johansen OE, Borthne A. Low-dose CT coronary angiography for assessment of coronary artery disease in patients with type 2 diabetes--a cross-sectional study. BMC Cardiovasc Disord 2015; 15:147. [PMID: 26573616 PMCID: PMC4647633 DOI: 10.1186/s12872-015-0143-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/06/2015] [Indexed: 11/22/2022] Open
Abstract
Background Silent coronary artery disease (CAD) is prevalent in type 2 diabetes mellitus (T2DM). Although coronary computed tomography angiography (CCTA) over recent years has emerged a useful tool for assessing and diagnosing CAD it’s role and applicability for patients with T2DM is still unclarified, in particular in asymptomatic patients. We aimed to assess the role of CCTA in detecting and characterizing CAD in patients with T2DM without cardiac symptoms when compared to gold standard invasive coronary angiography (ICA). Methods This was a cross-sectional analysis of patients with T2DM without symptomatic CAD enrolled in the Asker and Baerum Cardiovascular Diabetes Study who, following clinical examination and laboratory assessment, underwent subsequently CCTA and ICA. Results In total 48 Caucasian patients with T2DM (36 men, age 64.0 ± 7.3 years, diabetes duration 14.6 ± 6.4 years, HbA1c 7.4 ± 1.1 %, BMI 29.6 ± 4.3 kg/m2) consented to, and underwent, both procedures (CCTA and ICA). The population was at intermediate cardiovascular risk (mean coronary artery calcium score 269, 75 % treated with antihypertensive therapy). ICA identified a prevalence of silent CAD at 17 % whereas CCTA 35 %. CCTA had a high sensitivity (100 %) and a high negative predictive value (100 %) for detection of patients with CAD when compared to ICA, but the positive predictive value was low (47 %). Conclusions Low-dose CCTA is a reliable method for detection and exclusion of significant CAD in T2DM and thus may be a useful tool for the clinicians. However, a low positive predictive value may limit its usefulness as a screening tool for all CAD asymptomatic patients with T2DM. Further studies should assess the applicability for risk assessment beyond the evaluation of the vascular bed.
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Affiliation(s)
- Geir Reinvik Ulimoen
- Department of Radiology, Akershus University Hospital, PB 1000, 1478, Lorenskog, Norway.
| | - Anne Pernille Ofstad
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Knut Endresen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372, Oslo, Norway.
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372, Oslo, Norway. .,University of Oslo, Oslo, Norway.
| | - Odd Erik Johansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Arne Borthne
- Department of Radiology, Akershus University Hospital, PB 1000, 1478, Lorenskog, Norway. .,University of Oslo, Oslo, Norway.
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Marano R, Pitocco D, Di Stasio E, Savino G, Merlino B, Trani C, Pirro F, Rutigliano C, Santangelo C, Minoiu AC, Natale L, Bonomo L. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy. Eur Radiol 2015; 26:788-96. [PMID: 26139314 DOI: 10.1007/s00330-015-3864-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). METHODS Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. RESULTS CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87%. CONCLUSIONS These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. KEY POINTS Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.
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Affiliation(s)
- Riccardo Marano
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy.
| | - Dario Pitocco
- Department of Internal Medicine, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Enrico Di Stasio
- Department of Clinical Biochemistry, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine - Institute of Cardiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Federica Pirro
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudia Rutigliano
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Carolina Santangelo
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Aurelian Costin Minoiu
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
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Li J, Wu L, Tian X, Zhang J, Shi Y. Intravascular ultrasound observation of the mechanism of no-reflow phenomenon in acute myocardial infarction. PLoS One 2015; 10:e0119223. [PMID: 26035818 PMCID: PMC4452793 DOI: 10.1371/journal.pone.0119223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 01/23/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To study the mechanism of the no-reflow phenomenon using coronary angiography (CAG) and intravascular ultrasound (IVUS). Methods A total of 120 patients with acute myocardial infarction (AMI) who successfully underwent indwelling intracoronary stent placement by percutaneous coronary intervention (PCI). All patients underwent pre- and post-PCI CAG and pre-IVUS. No-reflow was defined as post-PCI thrombolysis in myocardial infarction (TIMI) grade 0, 1, or 2 flow in the absence of mechanical obstruction. Normal reflow was defined as TIMI grade 3 flow. The pre-operation reference vascular area, minimal luminal cross-sectional area, plaque cross-sectional area, lesion length, plaque volume and plaque traits were measured by IVUS. Results The no-reflow group was observed in 14 cases (11.6%) and normal blood-flow group in 106 cases (89.4%) based on CAG results. There was no statistically significant difference in the patients’ medical history, reference vascular area (no-flow vs. normal-flow; 15.5 ± 3.2 vs. 16.2 ± 3.3, p> 0.05) and lesion length (21.9 ± 5.1 vs. 19.5 ± 4.8, p> 0.05) between the two groups. No-reflow patients had a longer symptom onset to reperfusion time compared to normal blood-flow group [(6.6 ± 3.1) h vs (4.3 ± 2.7) h; p< 0.05] and higher incidence of TIMI flow grade< 3 (71.4% vs 49.0%, p< 0.05). By IVUS examination, the no-reflow group had a significantly increased coronary plaque area and plaque volume compared to normal blood-flow group [(13.7 ± 3.0) mm2 vs (10.2 ± 2.9) mm2; (285.4 ± 99.8) mm3 vs (189.7 ± 86.4) mm3; p< 0.01]. The presence of IVUS-detected soft plaque (57.1% vs. 24.0%, p< 0.01), eccentric plaque (64.2% vs. 33.7%, p< 0.05), plaque rupture (50.0% vs. 21.2%, p< 0.01), and thrombosis (42.8% vs. 15.3%) were significantly more common in no-reflow group. Conclusion There was no obvious relationship between the coronary risk factors and no-reflow phenomenon. The symptom onset to reperfusion time, TIMI flow grade before stent deployment, plaque area, soft plaques, eccentric plaques, plaque rupture and thrombosis may be risk factors for the no-reflow phenomenon after PCI.
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Affiliation(s)
- Junxia Li
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
- * E-mail:
| | - Longmei Wu
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
| | - Xinli Tian
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
| | - Jian Zhang
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
| | - Yujie Shi
- Department of Cardiology, Military General Hospital of Beijing People’s Liberation Army Hospital, Beijing, 100700, China
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Iterative reconstruction in cardiac CT. J Cardiovasc Comput Tomogr 2015; 9:255-63. [PMID: 26088375 DOI: 10.1016/j.jcct.2015.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/29/2022]
Abstract
Iterative reconstruction (IR) has the ability to reduce image noise in CT without compromising diagnostic quality, which permits a significant reduction in effective radiation dose. This been increasingly integrated into clinical CT practice over the past 7 years and has been particularly important in the field of cardiac CT with multiple vendors introducing cardiac CT-compatible IR algorithms. The following review will summarize the principles of IR algorithms, studies validating their noise- and dose-reducing abilities, and the specific applications of IR in cardiac CT.
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Accuracy of coronary CT angiography using a submillisievert fraction of radiation exposure: comparison with invasive coronary angiography. J Am Coll Cardiol 2014; 64:772-80. [PMID: 25145520 DOI: 10.1016/j.jacc.2014.04.079] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) is increasingly being used for evaluation of coronary artery disease (CAD). As a result of the widely reported potential of carcinogenic risk from x-ray based examinations, many strategies have been developed for dose reduction with CTA. OBJECTIVES The purpose of this study was to assess the diagnostic accuracy of CTA acquired with a submillisievert fraction of effective radiation dose reconstructed with a model-based iterative reconstruction (MBIR) using invasive coronary angiography (ICA) as a standard of reference. METHODS In 36 patients (body mass index range 17 to 39 kg/m(2)) undergoing ICA for CAD evaluation, a CTA was acquired using very low tube voltage (80 to 100 kV) and current (150 to 210 mA) and was reconstructed with MBIR. CAD (defined as ≥50% luminal narrowing) was assessed on CTA and on ICA. RESULTS CTA resulted in an estimated radiation dose exposure of 0.29 ± 0.12 mSv (range 0.16 to 0.53 mSv), yielding 96.9% (436 of 450) interpretable segments. On an intention-to-diagnose basis, no segment was excluded, and vessels with at least 1 nonevaluable segment and no further finding were classified as false positive. This resulted in a sensitivity, specificity, positive, and negative predictive value and accuracy of 100%, 74%, 77%, 100%, and 86% per patient and 85%, 86%, 56%, 96%, and 85% per vessel, respectively. CONCLUSIONS The use of MBIR reconstruction allows accurate noninvasive diagnosis of CAD with CTA at a submillisievert fraction of effective radiation dose comparable with a chest x-ray in 2 views.
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Effect of iDose4 iterative reconstruction algorithm on image quality and radiation exposure in prospective and retrospective electrocardiographically gated coronary computed tomographic angiography. J Comput Assist Tomogr 2014; 38:956-62. [PMID: 25119063 DOI: 10.1097/rct.0000000000000137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to compare a commercially available reconstruction algorithm (iDose4) with filtered back projection (FBP) in terms of image quality (IQ) for both retrospective electrocardiographically gated and prospective electrocardiographically triggered cardiac computed tomographic angiography (CCTA) protocols and to evaluate the achievable radiation dose reduction. METHODS A total cohort of 58 patients underwent either prospective CTCA or retrospective CTCA with full or reduced tube current-time product (in milliampere-second) protocol on a 64-slice multidetector computed tomographic scanner. All images were reconstructed with FBP, whereas the reduced milliampere-second images were also reconstructed using 2 levels (levels 4 and 6) of iDose4. Subjective and objective IQ was evaluated. RESULTS Dose reductions of 43% in the retrospective CCTA protocol and 27% in the prospective CCTA protocol were achieved without compromising IQ. In the prospective CCTA protocol, the reduced-dose images were highly scored; thus, additional reduction of exposure settings is feasible. In the retrospective acquisition, dose reduction has led to similar IQ scores between the reduced-dose iDose4 images and the full-dose FBP images. Considering different reconstructions (FBP, iDose-L4 and -L6) of the same acquisition data, increase in iDose4 level resulted in less noisy images. A slight improvement was also noticed in all IQ indices; however, this improvement was not statistically significant for both acquisition protocols. CONCLUSIONS This study demonstrated that the application of iDose at CCTA facilitates significant radiation dose reduction by maintaining diagnostic quality. The combination of iDose4 with prospective acquisition is able to significantly reduce effective dose associated with CTCA at values of approximately 2 mSv and even lower.
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Abstract
As laparoscopic surgery is replacing open surgery, similarly computed tomography angiography is replacing invasive conventional cardiac angiography. In the last century, marvelous efforts in research have improved strategies for cure, diagnosis and prevention of fatal human diseases; however, coronary artery disease, as the most prevalent cause of mortality and morbidity in the world, has remained a great challenge. Due to advancements in technology and research, it has become more simple and robust to diagnose and treat coronary artery disease (CAD) with minimal or no intervention, promising to not only diagnosis at an early stage but potential prevention altogether. While most with obvious CAD can be diagnosed easily and quickly with ECG, those identified as 'low risk' require more extensive testing to diagnose or rule out CAD. For example in emergency departments, low-risk patients with chest pain are diagnosed solely depending on history, ECG and blood testing for biomarkers. This approach has resulted in either delayed or miss-diagnosis of Acute coronary syndrome. To prevent this, many emergency departments now use protocols for low-risk heart patients that include cardiac stress tests and/or CT heart imaging. This review provides an overview of the current literature on the value of Computed tomography angiography and discusses how prognostic information obtained with Computed tomography angiography can be used to further integrate the technique into clinical practice.
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Affiliation(s)
- Muhammad A Latif
- St. John Cardiovascular Research Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Sabarudin A, Sun Z. Coronary CT angiography: Diagnostic value and clinical challenges. World J Cardiol 2013; 5:473-483. [PMID: 24392192 PMCID: PMC3879693 DOI: 10.4330/wjc.v5.i12.473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/06/2013] [Accepted: 10/12/2013] [Indexed: 02/06/2023] Open
Abstract
Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.
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