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Jelnin V, Kliger C, Zucchetta F, Ruiz CE. Use of Computed Tomography to Guide Mitral Interventions. Interv Cardiol Clin 2016; 5:33-43. [PMID: 27852480 DOI: 10.1016/j.iccl.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With increasing utilization of cardiac computed tomographic angiography (CTA) and widespread adoption of fusion imaging technology allowing the merger of pre-procedural CTA with fluoroscopy, the ability of CTA to guide structural heart interventions has evolved significantly. It has opened new possibilities in mitral valve (MV) interventions with improved pre-procedural planning and intra-procedural guidance. Given the lack of fluoroscopic landmarks of the mitral apparatus and continued growth of native MV device technologies, the value of CTA will continue to develop. The goal of this chapter is to detail the role of CTA in MV imaging and support for transcatheter therapies.
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Affiliation(s)
- Vladimir Jelnin
- Division of Structural and Congenital Heart Disease, Heart and Vascular Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Chad Kliger
- Department of Cardiothoracic Surgery, Division of Structural and Congenital Heart Disease, Hofstra University School of Medicine, Lenox Hill Hospital, North Shore LIJ Health System, 130 East 77th Street, 4th Floor Black Hall, New York, NY 10075, USA
| | - Fabio Zucchetta
- Department of Cardiology, Thoracic and Vascular Sciences, Division of Cardiac Surgery, University of Padua, Via Giustiniani 2, Padua 35128, Italy
| | - Carlos E Ruiz
- Division of Structural and Congenital Heart Disease, Heart and Vascular Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA
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Cardiac CT angiography beyond the coronary arteries: what radiologists need to know and why they need to know it. AJR Am J Roentgenol 2015; 203:W583-95. [PMID: 25415723 DOI: 10.2214/ajr.13.12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE With current state-of-the-art CT combining fast scanning times and high spatial resolution, anatomy beyond the coronary arteries is well visualized and may lead to discovery of abnormalities. The purpose of this article is to provide a strategy for radiologists to recognize important extracoronary cardiac CT angiography (CTA) findings. CONCLUSION A systemic approach to cardiac CTA by anatomic location and attention to key CT features are critical to identify and properly characterize important extracoronary cardiac abnormalities.
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Ghosh N, Al-Shehri H, Chan K, Mesana T, Chan V, Chen L, Yam Y, Chow BJW. Characterization of mitral valve prolapse with cardiac computed tomography: comparison to echocardiographic and intraoperative findings. Int J Cardiovasc Imaging 2011; 28:855-63. [PMID: 21604082 DOI: 10.1007/s10554-011-9888-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 05/09/2011] [Indexed: 01/27/2023]
Abstract
A single imaging modality that can accurately assess both coronary anatomy and mitral valve (MV) anatomy prior to surgery may be desirable. We sought to determine the diagnostic accuracy of cardiac computed tomography (CT) to detect and characterize mitral valve prolapse (MVP) compared to echocardiography. Consecutive patients referred for 'single-source' cardiac CT for investigation prior to non-coronary cardiac sugery were identified. MV anatomy was assessed for MVP and results were compared to echocardiography and to intra-operative visual assessment of the MV. Comparison between the three modalities was performed at the per-patient, per-leaflet and per-scallop levels. A total of 67 consecutive patients that were referred for Cardiac CT prior to non-coronary cardiac surgery and were prospectively recruited into a Cardiac CT registry. Of these, 65 patients underwent cardiac surgery. 63 patients had echocardiography and 32 patients had intra-operative visual assessment of the mitral valve. Compared to echocardiography, cardiac CT had excellent sensitivity (92.6%) and specificity (97.1%) for the detection of any MVP, but had poor sensitivity (68.5%) for the detection of individual prolapsing scallop. Compared to intra-operative visual assessment of the prolapsing scallop, both cardiac CT and echocardiography had low sensitivity (58.1 and 78.1%, respectively). Cardiac CT was able to identify patients with MVP but had difficulty identifying the prolapsed scallops compared to echocardiography. Single-source CT may not be ready for characterization of individual mitral valve scallops.
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Affiliation(s)
- Nina Ghosh
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
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Bogaert J, Centonze M, Vanneste R, Francone M. Cardiac and pericardial abnormalities on chest computed tomography: what can we see? Radiol Med 2010; 115:175-90. [DOI: 10.1007/s11547-010-0514-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/13/2009] [Indexed: 11/30/2022]
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Akhtar NJ, Markowitz AH, Gilkeson RC. Multidetector Computed Tomography in the Preoperative Assessment of Cardiac Surgery Patients. Radiol Clin North Am 2010; 48:117-39. [DOI: 10.1016/j.rcl.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gaztanaga J, Pizarro G, Sanz J. Evaluation of cardiac valves using multidetector CT. Cardiol Clin 2009; 27:633-44. [PMID: 19766920 DOI: 10.1016/j.ccl.2009.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac CT is an accurate and reasonable alternative modality for valvular imaging. It is used primarily for the evaluation of coronary artery disease; however, important information regarding valvular anatomy and function can be derived from CT. Calcification is a common CT finding in various valvular abnormalities and carries important diagnostic and prognostic value. In addition, valvular morphology, stenosis, and regurgitation also are detected on contrast enhanced scans, with good correlation with trans-thoracic echocardiography and other techniques.
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Affiliation(s)
- Juan Gaztanaga
- Division of Cardiology, Department of Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA
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Francone M, Carbone I, Napoli A, Algeri E, Grazhdani H, Lezoche R, Mirabelli F, Gaudio C, Calabrese FA, Catalano C, Passariello R. Imaging of myocardial infarction using a 64-slice MDCT scanner: correlation between infarcted region and status of territory-dependent coronary artery. Radiol Med 2007; 112:1100-16. [PMID: 18080098 DOI: 10.1007/s11547-007-0209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 04/26/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was performed to evaluate the ability of 64-slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territory-dependent coronary vessel status was examined. MATERIALS AND METHODS We retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. RESULTS After clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5+/-19 HU vs. 56.1+/-23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI. CONCLUSIONS The presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.
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Affiliation(s)
- M Francone
- Dipartimento di Scienze Radiologiche, Università degli Studi di Roma La Sapienza, Viale Regina Elena 324, Rome, Italy.
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Piers LH, Dikkers R, Tio RA, van den Berg MP, Willems TP, Zijlstra F, Oudkerk M. A comparison of echocardiographic and electron beam computed tomographic assessment of aortic valve area in patients with valvular aortic stenosis. Int J Cardiovasc Imaging 2007; 23:781-8. [PMID: 17285263 PMCID: PMC2048829 DOI: 10.1007/s10554-007-9208-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 01/17/2007] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to compare electron beam computed tomography (EBT) with transthoracic echocardiography (TTE) in determining aortic valve area (AVA). Thirty patients (9 females, 21 males) underwent a contrast-enhanced EBT scan (e-Speed, GE, San Francisco, CA, USA) and TTE within 17 +/- 12 days. In end-inspiratory breath hold, a prospectively ecg-triggered scan was acquired with a beam speed of 50-100 ms, a collimation of 2 x 1.5 mm and an increment of 3.0 mm. The AVA was measured with planimetry. A complete TTE study was performed in all patients, and the AVA was computed using the continuity equation. There was close correlation between AVA measured with EBT and AVA assessed with TTE (r = 0.60, P < 0.01). The AVA measured with EBT was 0.51 +/- 0.46 cm(2 )larger than the AVA calculated with TTE measurements. EBT appeared to be a valuable non-invasive method to measure the AVA. EBT measures the anatomical AVA, while with TTE the functional AVA is calculated, which explains the difference in results between the methods.
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Affiliation(s)
- Lieuwe H Piers
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, Groningen, 9700 RB, The Netherlands.
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Kido T, Kurata A, Higashino H, Sugawara Y, Okayama H, Higaki J, Anno H, Katada K, Mori S, Tanada S, Endo M, Mochizuki T. Cardiac imaging using 256-detector row four-dimensional CT: preliminary clinical report. ACTA ACUST UNITED AC 2007; 25:38-44. [PMID: 17225052 DOI: 10.1007/s11604-006-0097-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 10/07/2006] [Indexed: 12/14/2022]
Abstract
PURPOSE Along with the increase of detector rows on the z-axis and a faster gantry rotation speed, the spatial and temporal resolutions of the multislice computed tomography (CT) have been improved for noninvasive coronary artery imaging. We investigated the feasibility of the second specification prototype 256-detector row four-dimensional CT for assessing coronary artery and cardiac function. MATERIALS AND METHODS The subjects were five patients with coronary artery disease. Contrast medium (40-60 ml) was intravenously administered at the rate of 3-4 ml/s. The patient's whole heart was scanned for 1.5 s to cover at least one cardiac cycle during breathholding without electrocardiographic gating. Parameters used were 0.5 mm slice thickness, 0.5 s/rotation, 120 Kv, and 350 mA, with a half-scan reconstruction algorithm (temporal resolution 250 ms). Twenty-six transaxial datasets were reconstructed at intervals of 50 ms. RESULTS The assessability of the coronary arteries in AHA segments 1, 2, 3, 5, 6, 7, 9, and 11 was visually evaluated, resulting in 29 of 32 (90.9%) segments being assessable. Functional assessment was also performed using animated movies without banding artifacts in all cases. CONCLUSIONS The 256-detector row four-dimensional CT can assess the coronary artery and cardiac function using data during 1.5 s without banding artifacts.
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Affiliation(s)
- Teruhito Kido
- Department of Radiology, Ehime University School of Medicine, Shitsukawa, Toon 794-0295, Japan
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Vogel-Claussen J, Pannu H, Spevak PJ, Fishman EK, Bluemke DA. Cardiac Valve Assessment with MR Imaging and 64-Section Multi–Detector Row CT. Radiographics 2006; 26:1769-84. [PMID: 17102049 DOI: 10.1148/rg.266065035] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of noninvasive techniques are available to assess cardiac valve morphologic features and function, with echocardiography currently being the most widely used modality for this purpose. Technical advances in electrocardiographically gated multi-detector row computed tomography (CT) and magnetic resonance (MR) imaging allow the noninvasive visualization of the cardiac valves. At present, 64-section multi-detector row CT and MR imaging are commonly being used for comprehensive examination of the heart. Information about the cardiac valves is routinely provided by MR imaging of cardiac function or coronary CT angiography. Thus, the interpreting physician may have additional information available that can aid in making the diagnosis. Supplemental movie clips are available at http://radiographics.rsnajnls.org/cgi/content/full/26/6/1769/DC1.
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Affiliation(s)
- Jens Vogel-Claussen
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, MRI, Room 143, 600 N Wolfe St, Baltimore, MD 21287, USA
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