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Vogelgesang F, Coenen MH, Schueler S, Schlattmann P, Dewey M. An exemplary reanalysis of coronary computed tomography angiography diagnostic meta-analyses shows insufficient data sharing and incorrect sensitivity and specificity estimates. J Clin Epidemiol 2024; 170:111306. [PMID: 38428541 DOI: 10.1016/j.jclinepi.2024.111306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To systematically evaluate the reproducibility of primary data and, the reproducibility and correctness of pooled sensitivity and specificity estimates reported in a sample of diagnostic meta-analyses. STUDY DESIGN AND SETTING We conducted an exemplary systematic review of diagnostic meta-analyses comparing coronary computed tomography angiography to invasive coronary angiography in patients with suspected coronary artery disease. The objectives were to assess 1) the reproducibility of contingency tables, 2) the reproducibility of pooled sensitivity and specificity, and 3) differences to reported results when applying a recommended bivariate binomial model for pooling sensitivity and specificity. Therefore, we reproduced the contingency tables and recalculated sensitivity and specificity by utilizing both the pooling method of each meta-analysis and a bivariate binomial model. We used linear trends to assess the improvement of these objectives over time. RESULTS We identified 38 diagnostic meta-analyses, each including on average 19 primary studies (range: 3 to 89 studies; total: 715-including duplicates) with an average of approximately 1800 patients per meta-analysis (range: 118 to 7516 patients). For 31 meta-analyses (82%, 95% CI: 65%, 91%), the contingency tables were reproducible; however, only 15 published them. Using the pooling method of each meta-analysis, we obtained comparable recalculated sensitivities/specificities for 28 meta-analyses (74% [57%, 86%]). Only 11 meta-analyses pooled sensitivity/specificity using a bivariate binomial model (29% [16%, 46%]). When all meta-analyses were pooled with this model, published sensitivities/specificities were confirmed for 19 of 38 meta-analyses (50% [34%, 66%]). There was only marginal improvement in data availability and application of recommended pooling methods over time. CONCLUSION Data sharing should become standard practice along with the use of appropriate pooling methods. Journal publication requirements may play a key role in enhancing the quality of scientific reporting and methodological standards which may lead to more reliable and consistent outcomes. The ability to reproduce sensitivity and specificity estimates in diagnostic imaging meta-analyses is dependent on the availability of contingency tables and the explicit reporting of pooling methods and software used.
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Affiliation(s)
- Felicitas Vogelgesang
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maria H Coenen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Schueler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health and Berlin University Alliance, Berlin, Germany.
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Nishihara T, Miyoshi T, Nakashima M, Akagi N, Morimitsu Y, Inoue T, Miki T, Yoshida M, Toda H, Nakamura K, Yuasa S. Diagnostic improvements of calcium-removal image reconstruction algorithm using photon-counting detector CT for calcified coronary lesions. Eur J Radiol 2024; 172:111354. [PMID: 38309215 DOI: 10.1016/j.ejrad.2024.111354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To investigate the diagnostic performance of a calcium-removal image reconstruction algorithm with photon-counting detector-computed tomography (PCD-CT), a technology that hides only the calcified plaque from the spectral data in coronary calcified lesions. METHODS This retrospective study included 17 patients who underwent PCD-coronary CT angiography (CCTA) with at least one significant coronary stenosis (≥50 %) with calcified plaque by CCTA and invasive coronary angiography (ICA) performed within 60 days of CCTA. A total of 162 segments with calcified plaque were evaluated for subjective image quality using a 4-point scale. Their calcium-removal images were reconstructed from conventional images, and both images were compared with ICA images as the reference standard. The contrast-to noise ratios for both images were calculated. RESULTS Conventional and calcium-removal images had a subjective image quality of 2.7 ± 0.5 and 3.2 ± 0.9, respectively (p < 0.001). The percentage of segments with a non-diagnostic image quality was 32.7 % for conventional images and 28.3 % for calcium-removal images (p < 0.001). The segment-based diagnostic accuracy revealed an area under the receiver operating characteristic curve of 0.87 for calcium-removal images and 0.79 for conventional images (p = 0.006). Regarding accuracy, the specificity and positive predictive value of calcium-removal images were significantly improved compared with those of conventional images (80.5 % vs. 69.5 %, p = 0.002 and 64.1 % vs. 52.0 %, p < 0.001, respectively). The objective image quality of the mean contrast-to-noise ratio did not differ between the images (13.9 ± 3.6 vs 13.3 ± 3.4, p = 0.356) CONCLUSIONS: Calcium-removal images with PCD-CT can potentially be used to evaluate diagnostic performance for calcified coronary artery lesions.
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Affiliation(s)
- Takahiro Nishihara
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Mitsutaka Nakashima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriaki Akagi
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Morimitsu
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Inoue
- Division of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoki Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Qiao J, Li S, Yang H, Chen X, Zhu T, Li Q, Wan W, Xu Y, Ge B, Zhao Y, Tang Y, Li F, He Y, Xia L. Subtraction Improves the Accuracy of Coronary CT Angiography in Patients with Severe Calcifications in Identifying Moderate and Severe Stenosis: A Multicenter Study. Acad Radiol 2023; 30:2801-2810. [PMID: 36586762 DOI: 10.1016/j.acra.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the diagnostic accuracy of subtraction coronary computed tomographic angiography (CCTAsub) in identifying ≥ 50% and ≥ 70% coronary stenosis in patients with different degrees of calcification. MATERIALS AND METHODS In this study, 180 patients with coronary calcified plaques who underwent both coronary CT angiography and invasive coronary angiography (ICA) were prospectively enrolled at five centers. Patients were divided into three groups according to the Agatston score: group A (low to moderate, < 400), group B (high, 400-999), and group C (very high, ≥ 1000). Diagnostic accuracies estimated by area under the receiver operating characteristic curve (AUC) were compared between conventional CCTA (CCTAcon) and CCTAsub, with ICA as a reference standard. RESULTS There were 86 patients in group A, 44 in group B, and 50 in group C. In identifying ≥ 70% coronary stenosis, subtraction improved the diagnostic accuracies on a per-segment basis in group B (AUC: 0.80 vs 0.92, p = 0.001) and group C (AUC: 0.75 vs 0.84, p = 0.001) after subtraction. When identifying ≥ 50% coronary stenosis, the per-segment AUC of CCTAsub in group B and C were significantly higher than that in CCTAcon (group B: 0.81 vs 0.92, p < 0.001; group C: 0.77 vs 0.88, p < 0.001). However, no improvement was observed in group A. CONCLUSION Subtraction achieved better diagnostic accuracy in patients with Agatston score ≥ 400, both in identifying ≥ 50% and ≥ 70% coronary stenosis, which was instructive for the application of subtraction in clinical practice.
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Affiliation(s)
- Jinhan Qiao
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Li
- Department of Radiology, People's Hospital, Hubei University of Medicine, Shiyan, China
| | - Hongzhi Yang
- Department of Radiology, Xidian Group Hospital, Xi'an, China
| | - Xiaolong Chen
- Image Center Shaanxi Provincial People's Hospital, Xi'an, China
| | - Tingting Zhu
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Li
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Wan
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinghao Xu
- Canon Medical Systems (China) CO.,LTD., Building 205, Yard NO.A10, JiuXianQiao North Road, ChaoYang District, 100015, Beijing
| | - Bing Ge
- Canon Medical Systems (China) CO.,LTD., Building 205, Yard NO.A10, JiuXianQiao North Road, ChaoYang District, 100015, Beijing
| | - Yun Zhao
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Tang
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Bejing, China; Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Bejing, China.
| | - Liming Xia
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Boccalini S, Dessouky R, Rodesch PA, Lacombe H, Yagil Y, Lahoud E, Erhard K, Brendel B, Coulon P, Langlois JB, Chaput F, Parola S, Boussel L, Lerouge F, Si-Mohamed S, Douek PC. Gadolinium K-edge angiography with a spectral photon counting CT in atherosclerotic rabbits. Diagn Interv Imaging 2023; 104:490-499. [PMID: 37248095 DOI: 10.1016/j.diii.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to investigate the feasibility of gadolinium-K-edge-angiography (angio-Gd-K-edge) with gadolinium-based contrast agents (GBCAs) as obtained with spectral photon counting CT (SPCCT) in atherosclerotic rabbits. MATERIALS AND METHODS Seven atherosclerotic rabbits underwent angio-SPCCT acquisitions with two GBCAs, with similar intravenous injection protocol. Conventional and angio-Gd-K-edge images were reconstructed with the same parameters. Regions of interest were traced in different locations of the aorta and its branches. Hounsfield unit values, Gd concentrations, signal-to-noise (SNR) and contrast-to-noise (CNR) were calculated and compared. The maximum diameter and the diameter of the aorta in regard to atherosclerotic plaques were measured by two observers. Images were subjectively evaluated regarding vessels' enhancement, artefacts, border sharpness and overall image quality. RESULTS In the analyzable six rabbits, Gd-K-edge allowed visualization of target vessels and no other structures. HU values and Gd concentrations were greatest in the largest artery (descending aorta, 5.6 ± 0.8 [SD] mm), and lowest in the smallest (renal arteries, 2.1 ± 0.3 mm). While greater for conventional images, CNR and SNR were satisfactory for both images (all P < 0.001). For one observer there were no statistically significant differences in either maximum or plaque-diameters (P = 0.45 and all P > 0.05 in post-hoc analysis, respectively). For the second observer, there were no significant differences for images reconstructed with the same parameters (all P < 0.05). All subjective criteria scored higher for conventional images compared to K-edge (all P < 0.01), with the highest scores for enhancement (4.3-4.4 vs. 3.1-3.4). CONCLUSION With SPCCT, angio-Gd-K-edge after injection of GBCAs in atherosclerotic rabbits is feasible and allows for angiography-like visualization of small arteries and for the reliable measurement of their diameters.
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Affiliation(s)
- Sara Boccalini
- Lyon University, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; Department of Cardiovascular and Thoracic Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron, France.
| | - Riham Dessouky
- Lyon University, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France; Department of Radiology, Faculty of Medicine, Zagazig University, 44519, Zagazig, Egypt
| | - Pierre-Antoine Rodesch
- Lyon University, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France
| | - Hugo Lacombe
- Lyon University, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France
| | - Yoad Yagil
- Philips Medical Systems, 31004 Haifa, Israel
| | | | | | | | | | | | - Frederic Chaput
- Laboratoire de Chimie, Université de Lyon, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5182, 69364 Lyon, France
| | - Stephane Parola
- Laboratoire de Chimie, Université de Lyon, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5182, 69364 Lyon, France
| | - Loic Boussel
- Department of Cardiovascular and Thoracic Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron, France; Lyon University, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France
| | - Frederic Lerouge
- Laboratoire de Chimie, Université de Lyon, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, CNRS UMR 5182, 69364 Lyon, France
| | - Salim Si-Mohamed
- Department of Cardiovascular and Thoracic Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron, France; Lyon University, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France
| | - Philippe C Douek
- Department of Cardiovascular and Thoracic Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron, France; Lyon University, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Rohold A, Bøtker HE, Leipsic J, Sand NPR. Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina. Radiology 2023; 308:e230524. [PMID: 37698477 DOI: 10.1148/radiol.230524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Kristian T Madsen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Bjarne L Nørgaard
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Kristian A Øvrehus
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jesper M Jensen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik Parner
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik L Grove
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Timothy A Fairbairn
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Koen Nieman
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Manesh R Patel
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Campbell Rogers
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Sarah Mullen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Mickley
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Allan Rohold
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jonathon Leipsic
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Niels Peter R Sand
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
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Hakimjavadi R, Lu J, Yam Y, Dwivedi G, Small GR, Chow BJW. Pre-screening for non-diagnostic coronary computed tomography angiography. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad026. [PMID: 39045062 PMCID: PMC11195707 DOI: 10.1093/ehjimp/qyad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/07/2023] [Indexed: 07/25/2024]
Abstract
Aims Indiscriminate coronary computed tomography angiography (CCTA) referrals for suspected coronary artery disease could result in a higher rate of equivocal and non-diagnostic studies, leading to inappropriate downstream resource utilization or delayed time to diagnosis. We sought to develop a simple clinical tool for predicting the likelihood of a non-diagnostic CCTA to help identify patients who might be better served with a different test. Methods and results We developed a clinical scoring system from a cohort of 21 492 consecutive patients who underwent CCTA between February 2006 and May 2021. Coronary computed tomography angiography study results were categorized as normal, abnormal, or non-diagnostic. Multivariable logistic regression analysis was conducted to produce a model that predicted the likelihood of a non-diagnostic test. Machine learning (ML) models were utilized to validate the predictor selection and prediction performance. Both logistic regression and ML models achieved fair discriminate ability with an area under the curve of 0.630 [95% confidence interval (CI) 0.618-0.641] and 0.634 (95% CI 0.612-0.656), respectively. The presence of a cardiac implant and weight >100 kg were among the most influential predictors of a non-diagnostic study. Conclusion We developed a model that could be implemented at the 'point-of-scheduling' to identify patients who would be best served by another non-invasive diagnostic test.
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Affiliation(s)
- Ramtin Hakimjavadi
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Juan Lu
- Department of Medicine, The University of Western Australia, 35 Stirling Highway, CRAWLEY Western Australia 6009, Australia
- Department of Computer Science and Software Engineering, The University of Western Australia, 35 Stirling Highway, CRAWLEY Western Australia 6009, Australia
- Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia 6009, Australia
| | - Yeung Yam
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Girish Dwivedi
- Department of Medicine, The University of Western Australia, 35 Stirling Highway, CRAWLEY Western Australia 6009, Australia
- Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia 6009, Australia
- Department of Medicine, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch Western Australia 6150, Australia
| | - Gary R Small
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Benjamin J W Chow
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- Department of Radiology, University of Ottawa, 451 Smyth Rd, Ottawa ON K1H 8M5, Canada
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Kaolawanich Y, Prapan N, Phoopattana S, Boonyasirinant T. The novel H 2VK-65 clinical risk assessment tool predicts high coronary artery calcium score in symptomatic patients referred for coronary computed tomography angiography. Front Cardiovasc Med 2023; 10:1096036. [PMID: 37465454 PMCID: PMC10351923 DOI: 10.3389/fcvm.2023.1096036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Background Coronary computed tomographic angiography (CCTA) has emerged as a powerful imaging modality for the detection and prognostication of individuals with suspected coronary artery disease (CAD). High amounts of coronary artery calcium (CAC) significantly obscure the interpretation of CCTA. Clinical risk assessment tools and data specific to predictors of high CAC in symptomatic patients are limited. Methods Consecutive patients who underwent CAC scan and CCTA to diagnose CAD during 2016-2020 were included. A high CAC score was defined as >400 by Agatston method. Univariate and multivariate analyses were performed to determine the predictors of high CAC. The clinical risk score was derived from factors independently associated with high CAC. The derivation cohort was composed of 465 patients; this score was validated in 98 patients. Results The mean age was 63 ± 11 years, 53% were female, and 15.9% had high CAC scores. The independent predictors of high CAC scores were age >65 years (odds ratio [OR] 3.02, 95% confidence interval (95%CI) 1.56-5.85, p = 0.001), chronic kidney disease (CKD) (OR 11.09, 95%CI 3.38-36.38, p < 0.001), heart failure (OR 6.52, 95%CI 2.23-19.09, p = 0.001), hypertension (OR 26.44, 95%CI 9.02-77.44, p < 0.001), and vascular diseases, including ischemic stroke/transient ischemic attack and peripheral arterial disease (OR 20.96, 95%CI 4.19-104.86, p < 0.001). The H2VK-65 (Hypertension, Heart failure, Vascular diseases, CKD, and Age > 65) score allocates 1 point for age >65, 2 points for CKD or heart failure, and 3 points for hypertension or vascular diseases. Using a threshold of ≥4 points, the sensitivity and specificity to detect high CAC was 81% and 80%, respectively. The area under the curve was 0.88 and 0.85 in the derivation and validation cohorts, respectively. Conclusion The novel H2VK-65 score demonstrated good performance for predicting high CAC scores in symptomatic patients referred for CCTA.
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Marsh JF, VanMeter PD, Rajendran K, Leng S, McCollough CH. Ex vivo coronary calcium volume quantification using a high-spatial-resolution clinical photon-counting-detector computed tomography. J Med Imaging (Bellingham) 2023; 10:043501. [PMID: 37408984 PMCID: PMC10319293 DOI: 10.1117/1.jmi.10.4.043501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Coronary artery calcification (CAC) is an important indicator of coronary disease. Accurate volume quantification of CAC is challenging using computed tomography (CT) due to calcium blooming, which is a consequence of limited spatial resolution. Ex vivo coronary specimens were scanned on an ultra-high-resolution (UHR) clinical photon-counting detector (PCD) CT scanner, and the accuracy of CAC volume estimation was compared with a state-of-the-art conventional energy-integrating detector (EID) CT, a previous-generation investigational PCD-CT, and micro-CT. Approach CAC specimens (n = 13 ) were scanned on EID-CT and PCD-CT using matched parameters (120 kV, 9.3 mGy CTDI vol ). EID-CT images were reconstructed using our institutional routine clinical protocol for CAC quantification. UHR PCD-CT data were reconstructed using a sharper kernel. An image-based denoising algorithm was applied to the PCD-CT images to achieve similar noise levels as EID-CT. Micro-CT images served as the volume reference standard. Calcification images were segmented, and their volume estimates were compared. The CT data were further compared with previous work using an investigational PCD-CT. Results Compared with micro-CT, CT volume estimates had a mean absolute percent error of 24.1 % ± 25.6 % for clinical PCD-CT, 60.1 % ± 48.2 % for EID-CT, and 51.1 % ± 41.7 % for previous-generation PCD-CT. Clinical PCD-CT absolute percent error was significantly (p < 0.01 ) lower than both EID-CT and previous generation PCD-CT. The mean calcification CT number and contrast-to-noise ratio were both significantly (p < 0.01 ) higher in clinical PCD-CT relative to EID-CT. Conclusions UHR clinical PCD-CT showed reduced calcium blooming artifacts and further enabled improved accuracy of CAC quantification beyond that of conventional EID-CT and previous generation PCD-CT systems.
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Affiliation(s)
- Jeffrey F. Marsh
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | | | - Kishore Rajendran
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
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Shan D, Ding Y, Wang X, Liu Z, Dou G, Wang K, Zhang W, Jing J, He B, Li Y, Yang J, Chen Y. Incremental diagnostic value of perivascular fat attenuation index for identifying hemodynamically significant ischemia with severe calcification. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-02831-z. [PMID: 36961598 DOI: 10.1007/s10554-023-02831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/03/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To explore the incremental value of perivascular fat attenuation index (FAI) to identify hemodynamically significant ischemia in severe calcified vessels. METHODS Patients who underwent coronary computed tomographic angiography (CCTA) examination at Chinese PLA General Hospital from 2017 to 2020 and subsequently underwent fractional flow reserve (FFR) examination within 1 month were consecutively included. Several CCTA-derived indices were measured, including the coronary artery calcification score (CACS), lesion length, ≥CAD-RADS 4 proportion, perivascular FAI and CT-FFR. The included vessels were divided into a nonsevere calcification group and a severe calcification group according to the quartile of CACS. FFR ≤ 0.80 represents the presence of hemodynamically significant ischemia. RESULTS A total of 124 patients with 152 vessels were included (age: 61.1 ± 9.2 years; male 64.5%). Significant differences in lesion length (28.4 ± 14.2 vs. 23.1 ± 12.3 mm, P = 0.021), perivascular FAI (-73.0 ± 7.5 vs. -79.0 ± 7.4 HU, P < 0.001) and CT-FFR (0.78 ± 0.06 vs. 0.86 ± 0.04, P < 0.001) were noted between the FFR ≤ 0.80 group (47 vessels) and the FFR > 0.80 group (105 vessels). Furthermore, the perivascular FAI in the FFR ≤ 0.80 group was significantly greater than that in the FFR > 0.80 group (nonsevere calcification: -73.2 ± 7.5 vs. -78.2 ± 7.4 HU, P = 0.002; severe calcification: -72.8 ± 7.7 vs. -82.7 ± 6.3 HU, P < 0.001). In discriminating hemodynamically significant ischemia, the specificity and accuracy of CT-FFR were significantly affected by severe calcification, which demonstrated a significantly declining trend (P = 0.033 and P = 0.010, respectively). The diagnostic performance of CT-FFR in the severe calcification group was lower than that in the nonsevere calcified group. However, perivascular FAI showed good discriminative performance in the severe calcification group. In combination with perivascular FAI, the predictive value of CT-FFR in identifying hemodynamically significant ischemia with severe calcification increased from an AUC of 0.740 to 0.919. CONCLUSION For coronary artery with severe calcification, the diagnostic performance of CT-FFR in discriminating flow-limiting lesions could be greatly impaired. Perivascular FAI represents a potential reliable imaging marker to provide incremental diagnostic value over CT-FFR for identifying hemodynamically significant ischemia with severe calcification.
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Affiliation(s)
- Dongkai Shan
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Yipu Ding
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xi Wang
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Zinuan Liu
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Guanhua Dou
- Department of Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Kai Wang
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Wei Zhang
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Jing Jing
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Bai He
- Department of Cardiology, the First Medical Center of PLA General Hospital, Beijing, China
| | - Yang Li
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Junjie Yang
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China.
| | - Yundai Chen
- Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China.
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Zhou B, Tang Z, Huang X, Zhu H, Li X, Xiong H, Yu J, Liao R, Zhang D. Subtraction coronary CT angiography in patients with high heart rate. Acta Cardiol 2023; 78:99-108. [PMID: 35384795 DOI: 10.1080/00015385.2022.2061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
All the previous subtraction coronary CT angiography (CCTA) had strict heart rate (HR) inclusion criteria. In this study, a new subtraction method was applied to patients with various HR. The post-contrast scan time was respectively 3.5 s after ascending aorta peak enhancement while HR >80 bpm, 4 s while 65≤ HR ≤80 bpm and 4.5 s while HR <65 bpm. Forty-six patients who underwent the new subtraction protocol were enrolled and patients were stratified into the high HR group (≥70 bpm) and low HR group (<70 bpm). Eighteen patients with 15 severe calcification segments and 25 stent segments further received invasive coronary angiography (ICA). In all included patients, the coronary artery enhancement was compared between the high and low HR groups. In patients with ICA performed, the image quality improvement and diagnostic effectiveness for detection of significant coronary segments stenosis (>50%) were compared between the conventional CCTA and subtraction CCTA and between the high HR group and low HR group, respectively. All enrolled patients got sufficient coronary artery enhancement. In patients with ICA performed, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the diagnosis of significant stenosis was 0.93 in subtraction CCTA and 0.73 in conventional CCTA (p < 0.05). Furthermore, there were no significant differences in image quality improvement, specificity, positive predictive value and accuracy between the high HR group and low HR group. The new subtraction CCTA method broadened the clinical availability for patients with high HR.
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Affiliation(s)
- Bi Zhou
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hongzhang Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Ruikun Liao
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
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11
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Duerden L, O’Brien H, Doshi S, Charters P, King L, Hudson BJ, Rodrigues JCL. Impact of an ultra-low dose unenhanced planning scan on CT coronary angiography scan length and effective radiation dose. BJR Open 2023; 4:20210056. [PMID: 36105418 PMCID: PMC9459860 DOI: 10.1259/bjro.20210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/25/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Imaged scan length (z-axis coverage) is a simple parameter that can reduce CT dose without compromising image quality. In CT coronary angiography (CTCA), z-axis coverage may be planned using non-contrast calcium score scan (CaCS) to identify the relevant coronary anatomy. However, standardised Agatston CaCS is acquired at 120 kV which adds a relatively high contribution to total study dose and CaCS is no longer routinely recommended in UK guidelines. We evaluate an ultra-low dose unenhanced planning scan on CTCA scan length and effective radiation dose. Methods An ultra-low dose tin filter (Sn-filter) planning scan (100 kVp, maximum iterative reconstruction) was performed and used to plan the z-axis coverage on 48 consecutive CTCAs (62% men, 62 ± 13 years) compared with 47 CTCA planned using a localiser alone (46% men, 59 ± 12 years) between May and June 2019. Excess scanning beyond the ideal scan length was calculated for both groups. Estimations of radiation dose were also compared between the two groups. Results Addition of an ultra-low dose unenhanced planning scan to CTCA protocol was associated with reduction in overscanning with no impact on image quality. There was no significant difference in total study effective dose with the addition of the planning scan, which had an average dose-length product of 3 mGy.cm. (total study dose: Protocol A 2.1 mSv vs Protocol B 2.2 mSv, p = 0.92). Conclusion An ultra-low dose unenhanced planning scan facilitates optimal scan length for the diagnostic CTCA, reducing overscanning and preventing incomplete cardiac imaging with no significant dose penalty or impact on image quality. Advances in knowledge An ultra-low dose CTCA planning is feasible and effective at optimising scan length.
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Affiliation(s)
- Laura Duerden
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
| | - Helen O’Brien
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
| | - Susan Doshi
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, United Kingdom
| | - Pia Charters
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
| | - Laurence King
- Royal United Hospitals Bath NHS Foundation Trust, Avon, United Kingdom
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Pack JD, Xu M, Wang G, Baskaran L, Min J, De Man B. Cardiac CT blooming artifacts: clinical significance, root causes and potential solutions. Vis Comput Ind Biomed Art 2022; 5:29. [PMID: 36484886 PMCID: PMC9733770 DOI: 10.1186/s42492-022-00125-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
This review paper aims to summarize cardiac CT blooming artifacts, how they present clinically and what their root causes and potential solutions are. A literature survey was performed covering any publications with a specific interest in calcium blooming and stent blooming in cardiac CT. The claims from literature are compared and interpreted, aiming at narrowing down the root causes and most promising solutions for blooming artifacts. More than 30 journal publications were identified with specific relevance to blooming artifacts. The main reported causes of blooming artifacts are the partial volume effect, motion artifacts and beam hardening. The proposed solutions are classified as high-resolution CT hardware, high-resolution CT reconstruction, subtraction techniques and post-processing techniques, with a special emphasis on deep learning (DL) techniques. The partial volume effect is the leading cause of blooming artifacts. The partial volume effect can be minimized by increasing the CT spatial resolution through higher-resolution CT hardware or advanced high-resolution CT reconstruction. In addition, DL techniques have shown great promise to correct for blooming artifacts. A combination of these techniques could avoid repeat scans for subtraction techniques.
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Affiliation(s)
- Jed D. Pack
- grid.418143.b0000 0001 0943 0267GE Research, Niskayuna, NY 12309 USA
| | - Mufeng Xu
- grid.33647.350000 0001 2160 9198Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Ge Wang
- grid.33647.350000 0001 2160 9198Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Lohendran Baskaran
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY 10065 USA ,grid.419385.20000 0004 0620 9905National Heart Centre, Singapore, 169609 Singapore
| | - James Min
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY 10065 USA ,Cleerly, New York, NY 10065 USA
| | - Bruno De Man
- grid.418143.b0000 0001 0943 0267GE Research, Niskayuna, NY 12309 USA
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13
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Limpijankit T, Jongjirasiri S, Meemook K, Unwanatham N, Thakkinstian A, Laothamatas J. Predictive values of coronary artery calcium and arterial stiffness for long-term cardiovascular events in patients with stable coronary artery disease. Clin Cardiol 2022; 46:171-183. [PMID: 36448219 PMCID: PMC9933115 DOI: 10.1002/clc.23955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subclinical atherosclerosis detected by increased coronary artery calcium (CAC) or arterial stiffness as reflected by cardio-ankle vascular index (CAVI) has been associated with major adverse cardiovascular events (MACEs). However, comparative data from these two assessments in the same population are still limited. METHODS From 2005 to 2013, patients with stable coronary artery disease (CAD), both asymptomatic and symptomatic who underwent both coronary computed tomography and CAVI were enrolled and followed for occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke) until December 2019. A cause-specific hazard model was applied to assess the associations of CAC score, and CAVI with long-term MACEs. RESULTS A total of 8687 patients participated. Of them, CAC scores were 0, 1-99, 100-399, and ≥400 in 49.7%, 31.9%, 12.3%, and 6.1%, respectively. Arterial stiffness (CAVI ≥ 9.0) was associated with the magnitude of CAC in 23.8%, 36.3%, 44.5%, and 56.2%, respectively. During an average of 9.9 ± 2.4 years follow-up, MACEs occurred in 8.0% (95% CI: 7.4%, 8.6%) of subjects. After adjusting for covariables, CAC scores of 100-399 and ≥400, and CAVIs of ≥9.0 were found to independently predict the occurrence of MACEs with the hazard ratios (95% CI) of 1.70 (1.13, 1.98), 1.87 (1.33, 2.63), and 1.27 (1.06, 1.52), respectively. Other risk predictors were hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), aspirin, and statin therapy. CONCLUSIONS A CAC score ≥100 or a CAVI ≥ 9.0 predicts the long-term occurrence of MACEs in both asymptomatic and symptomatic patients with stable CAD. These two noninvasive tests can be used as screening tools to guide treatment for the prevention of future CV events.
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Affiliation(s)
- Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Sutipong Jongjirasiri
- Department of Radiology, Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Krissada Meemook
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Nattawut Unwanatham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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14
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Brandt V, Schoepf UJ, Aquino GJ, Bekeredjian R, Varga-Szemes A, Emrich T, Bayer RR, Schwarz F, Kroencke TJ, Tesche C, Decker JA. Impact of machine-learning-based coronary computed tomography angiography-derived fractional flow reserve on decision-making in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Radiol 2022; 32:6008-6016. [PMID: 35359166 DOI: 10.1007/s00330-022-08758-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate feasibility and diagnostic performance of coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) for detection of significant coronary artery disease (CAD) and decision-making in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to potentially avoid additional pre-TAVR invasive coronary angiography (ICA). METHODS Consecutive patients with severe AS (n = 95, 78.6 ± 8.8 years, 53% female) undergoing pre-procedural TAVR-CT followed by ICA with quantitative coronary angiography were retrospectively analyzed. CCTA datasets were evaluated using CAD Reporting and Data System (CAD-RADS) classification. CT-FFR measurements were computed using an on-site machine-learning algorithm. A combined algorithm was developed for decision-making to determine if ICA is needed based on pre-TAVR CCTA: [1] all patients with CAD-RADS ≥ 4 are referred for ICA; [2] patients with CAD-RADS 2 and 3 are evaluated utilizing CT-FFR and sent to ICA if CT-FFR ≤ 0.80; [3] patients with CAD-RADS < 2 or CAD-RADS 2-3 and normal CT-FFR are not referred for ICA. RESULTS Twelve patients (13%) had significant CAD (≥ 70% stenosis) on ICA and were treated with PCI. Twenty-eight patients (30%) showed CT-FFR ≤ 0.80 and 24 (86%) of those were reported to have a maximum stenosis ≥ 50% during ICA. Using the proposed algorithm, significant CAD could be identified with a sensitivity, specificity, and positive and negative predictive value of 100%, 78%, 40%, and 100%, respectively, potentially decreasing the number of necessary ICAs by 65 (68%). CONCLUSION Combination of CT-FFR and CAD-RADS is able to identify significant CAD pre-TAVR and bears potential to significantly reduce the number of needed ICAs. KEY POINTS • Coronary CT angiography-derived fractional flow reserve (CT-FFR) using machine learning together with the CAD Reporting and Data System (CAD-RADS) classification safely identifies significant coronary artery disease based on quantitative coronary angiography in patients prior to transcatheter aortic valve replacement. • The combination of CT-FFR and CAD-RADS enables decision-making and bears the potential to significantly reduce the number of needed invasive coronary angiographies.
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Affiliation(s)
- Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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15
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Functional Evaluation of Intermediate Coronary Lesions with Integrated Computed Tomography Angiography and Invasive Angiography in Patients with Stable Coronary Artery Disease. J Transl Int Med 2022; 10:255-263. [PMID: 36776233 PMCID: PMC9901557 DOI: 10.2478/jtim-2022-0018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and objectives The hemodynamic evaluation of coronary stenoses undergoes a transition from wire-based invasive measurements to image-based computational assessments. However, fractional flow reserve (FFR) values derived from coronary CT angiography (CCTA) and angiography-based quantitative flow ratio have certain limitations in accuracy and efficiency, preventing their widespread use in routine practice. Hence, we aimed to investigate the diagnostic performance of FFR derived from the integration of CCTA and invasive angiography (FFRCT-angio) with artificial intelligence assistance in patients with stable coronary artery disease (CAD). Methods Forty stable CAD patients with 67 target vessels (50%-90% diameter stenosis) were included in this single-center retrospective study. All patients underwent CCTA followed by coronary angiography with FFR measurement within 30 days. Both CCTA and angiographic images were combined to generate a three-dimensional reconstruction of the coronary arteries using artificial intelligence. Subsequently, functional assessment was performed through a deep learning algorithm. FFR was used as the reference. Results FFRCT-angio values were significantly correlated with FFR values (r = 0.81, P < 0.001, Spearman analysis). Per-vessel diagnostic accuracy of FFRCT-angio was 92.54%. Sensitivity and specificity in identifying ischemic lesions were 100% and 88.10%, respectively. Positive predictive value and negative predictive value were 83.33% and 100%, respectively. Moreover, the diagnostic performance of FFRCT-angio was satisfactory in different target vessels and different segment lesions. Conclusions FFRCT-angio exhibits excellent diagnostic performance of identifying ischemic lesions in patients with stable CAD. Combining CCTA and angiographic imaging, FFRCT-angio may represent an effective and practical alternative to invasive FFR in selected patients.
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16
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Ties D, van Dorp P, Pundziute G, van der Aalst CM, Gratama JWC, Braam RL, Kuijpers D, Lubbers DD, van der Bilt IA, Westenbrink BD, Wolcherink MJO, Doggen CJ, Išgum I, Nijveldt R, de Koning HJ, Vliegenthart R, Oudkerk M, van der Harst P. Early detection of obstructive coronary artery disease in the asymptomatic high-risk population: objectives and study design of the EARLY-SYNERGY trial. Am Heart J 2022; 246:166-177. [PMID: 35038412 DOI: 10.1016/j.ahj.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/11/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) burden for society is expected to steeply increase over the next decade. Improved feasibility and efficiency of preventive strategies is necessary to flatten the curve. Acute myocardial infarction (AMI) is the main determinant of CAD-related mortality and morbidity, and predominantly occurs in individuals with more advanced stages of CAD causing subclinical myocardial ischemia (obstructive CAD; OCAD). Unfortunately, OCAD can remain subclinical until its destructive presentation with AMI or sudden death. Current primary preventive strategies are not designed to differentiate between non-OCAD and OCAD and the opportunity is missed to treat individuals with OCAD more aggressively. METHODS EARLY-SYNERGY is a multicenter, randomized-controlled clinical trial in individuals with coronary artery calcium (CAC) presence to study (1.) the yield of cardiac magnetic resonance stress myocardial perfusion imaging (CMR-MPI) for early OCAD diagnosis and (2) whether early OCAD diagnosis improves outcomes. Individuals with CAC score ≥300 objectified in 2 population-based trials (ROBINSCA; ImaLife) are recruited for study participation. Eligible candidates are randomized 1:1 to cardiac magnetic resonance stress myocardial perfusion imaging (CMR-MPI) or no additional functional imaging. In the CMR-MPI arm, feedback on imaging results is provided to primary care provider and participant in case of guideline-based actionable findings. Participants are followed-up for clinical events, healthcare utilization and quality of life. CONCLUSIONS EARLY-SYNERGY is the first randomized-controlled clinical trial designed to test the hypothesis that subclinical OCAD is widely present in the general at-risk population and that early differentiation of OCAD from non-OCAD followed by guideline-recommended treatment improves outcomes.
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17
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Antonopoulos AS, Angelopoulos A, Tsioufis K, Antoniades C, Tousoulis D. Cardiovascular risk stratification by coronary computed tomography angiography imaging: current state-of-the-art. Eur J Prev Cardiol 2022; 29:608-624. [PMID: 33930129 DOI: 10.1093/eurjpc/zwab067] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022]
Abstract
Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. The current CT armamentum is also further enhanced by perivascular Fat Attenuation Index (FAI), a non-invasive metric of coronary inflammation, which allows for the first time the direct quantification of the residual vascular inflammatory burden. Machine learning and radiomic features' extraction and spectral CT for tissue characterization are also expected to maximize the diagnostic and prognostic yield of CCTA. The combination of anatomical, functional, and biological information on coronary circulation by CCTA offers a unique toolkit for the risk stratification of patients, and patient selection for targeted aggressive prevention strategies. We hereby provide a review of the current state-of-the art in the field and discuss how integrating the full capacities of CCTA into clinical care pathways opens new opportunities for the tailored management of coronary artery disease.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Andreas Angelopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Charalambos Antoniades
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
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18
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Li F, He Q, Xu L, Zhou Y, Sun Y, Wang Z, Xu Y, Yang Z, He Y. Diagnostic Accuracy of Subtraction Coronary CT Angiography in Severely Calcified Segments: Comparison Between Readers With Different Levels of Experience. Front Cardiovasc Med 2022; 9:828751. [PMID: 35387432 PMCID: PMC8977640 DOI: 10.3389/fcvm.2022.828751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSubtraction coronary CT angiography (CCTA) may reduce blooming and beam-hardening artifacts. This study aimed to assess its value in improving the diagnostic accuracy of readers with different experience levels.MethodWe prospectively enrolled patients with target segment who underwent CCTA and invasive coronary angiography (ICA). Target segment images were independently evaluated by three groups of radiologists with different experience levels with CCTA using ICA as the standard reference. Diagnostic accuracy was measured by the area under the curve (AUC), using ≥50% stenosis as the cut-off value.ResultsIn total, 134 target segments with severe calcification from 47 patients were analyzed. The mean specificity of conventional CCTA for each group ranged from 22.4 to 42.2%, which significantly improved with subtraction CCTA, ranging from 81.3 to 85.7% (all p < 0.001). The mean sensitivity of conventional CCTA for each group ranged from 83.3 to 88.0%. Following calcification subtraction, the mean sensitivity decreased for the novice (p < 0.001) and junior (p = 0.017) radiologists but was unchanged for the senior radiologists (p = 0.690). With subtraction CCTA, the mean AUCs of CCTA significantly increased: values ranged from 0.53, 0.54, and 0.61 to 0.70, 0.74, and 0.85 for the novice, junior, and senior groups (all p < 0.001).ConclusionSubtraction CCTA could improve the diagnostic accuracy of radiologists at all experience levels of CCTA interpretation.
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Affiliation(s)
- Fang Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Qing He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lixue Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Zhou
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yufei Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yinghao Xu
- Canon Medical Systems (China) Co. Ltd., Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Zhenghan Yang
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yi He
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19
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Gohmann RF, Seitz P, Pawelka K, Majunke N, Schug A, Heiser L, Renatus K, Desch S, Lauten P, Holzhey D, Noack T, Wilde J, Kiefer P, Krieghoff C, Lücke C, Ebel S, Gottschling S, Borger MA, Thiele H, Panknin C, Abdel-Wahab M, Horn M, Gutberlet M. Combined Coronary CT-Angiography and TAVI Planning: Utility of CT-FFR in Patients with Morphologically Ruled-Out Obstructive Coronary Artery Disease. J Clin Med 2022; 11:jcm11051331. [PMID: 35268422 PMCID: PMC8910873 DOI: 10.3390/jcm11051331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Coronary artery disease (CAD) is a frequent comorbidity in patients undergoing transcatheter aortic valve implantation (TAVI). If significant CAD can be excluded on coronary CT-angiography (cCTA), invasive coronary angiography (ICA) may be avoided. However, a high plaque burden may make the exclusion of CAD challenging, particularly for less experienced readers. The objective was to analyze the ability of machine learning (ML)-based CT-derived fractional flow reserve (CT-FFR) to correctly categorize cCTA studies without obstructive CAD acquired during pre-TAVI evaluation and to correlate recategorization to image quality and coronary artery calcium score (CAC). Methods: In total, 116 patients without significant stenosis (≥50% diameter) on cCTA as part of pre-TAVI CT were included. Patients were examined with an electrocardiogram-gated CT scan of the heart and high-pitch scan of the torso. Patients were re-evaluated with ML-based CT-FFR (threshold = 0.80). The standard of reference was ICA. Image quality was assessed quantitatively and qualitatively. Results: ML-based CT-FFR was successfully performed in 94.0% (109/116) of patients, including 436 vessels. With CT-FFR, 76/109 patients and 126/436 vessels were falsely categorized as having significant CAD. With CT-FFR 2/2 patients but no vessels initially falsely classified by cCTA were correctly recategorized as having significant CAD. Reclassification occurred predominantly in distal segments. Virtually no correlation was found between image quality or CAC. Conclusions: Unselectively applied, CT-FFR may vastly increase the number of false positive ratings of CAD compared to morphological scoring. Recategorization was virtually independently from image quality or CAC and occurred predominantly in distal segments. It is unclear whether or not the reduced CT-FFR represent true pressure ratios and potentially signifies pathophysiology in patients with severe aortic stenosis.
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Affiliation(s)
- Robin Fabian Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-865-255-024
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
| | - Konrad Pawelka
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (N.M.); (S.D.); (P.L.); (J.W.); (H.T.); (M.A.-W.)
| | - Adrian Schug
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Linda Heiser
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
| | - Katharina Renatus
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (N.M.); (S.D.); (P.L.); (J.W.); (H.T.); (M.A.-W.)
| | - Philipp Lauten
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (N.M.); (S.D.); (P.L.); (J.W.); (H.T.); (M.A.-W.)
| | - David Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (D.H.); (T.N.); (P.K.); (M.A.B.)
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (D.H.); (T.N.); (P.K.); (M.A.B.)
| | - Johannes Wilde
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (N.M.); (S.D.); (P.L.); (J.W.); (H.T.); (M.A.-W.)
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (D.H.); (T.N.); (P.K.); (M.A.B.)
| | - Christian Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Sebastian Gottschling
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
| | - Michael A. Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (D.H.); (T.N.); (P.K.); (M.A.B.)
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (N.M.); (S.D.); (P.L.); (J.W.); (H.T.); (M.A.-W.)
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany
| | | | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (N.M.); (S.D.); (P.L.); (J.W.); (H.T.); (M.A.-W.)
| | - Matthias Horn
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstr. 16-18, 04107 Leipzig, Germany;
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (K.P.); (A.S.); (L.H.); (K.R.); (C.K.); (C.L.); (S.E.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany
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20
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VanMeter P, Marsh J, Rajendran K, Leng S, McCollough C. Quantification of Coronary Calcification using High-Resolution Photon-Counting-Detector CT and an Image Domain Denoising Algorithm. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12031:120311R. [PMID: 35677470 PMCID: PMC9172081 DOI: 10.1117/12.2612999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Coronary artery calcification (CAC) is an important indicator of coronary disease. Accurate volume quantification of coronary calcification, especially calcifications smaller than a few mm, using computed tomography (CT) is challenging due to calcium blooming, which is a consequence of limited spatial resolution. In this study, ex-vivo coronary specimens were scanned on a clinical photon-counting detector (PCD) CT scanner and the estimated coronary calcification volume were compared with a conventional energy-integrating detector (EID) CT. Scans were performed using the same tube potential and radiation dose (120 kV, 9.3 mGy CTDIvol). EID-CT images were reconstructed using our routine clinical protocol for CAC quantification. PCD-CT images were reconstructed using a sharper reconstruction kernel than that was supported by the EID-CT scanner, resulting in improved resolution but higher image noise levels. An image-based denoising algorithm was applied to the PCD-CT images to achieve similar noise levels as the EID-CT images. Calcifications were segmented to estimate the volume. Micro-CT images of the same calcifications were acquired and served as the reference standard. PCD-CT images showed reduced calcium blooming artifacts compared to EID-CT. Calcification volume estimates were found to overestimate the micro-CT volumes by 9 ± 12% for PCD-CT data, and 24 ± 18% for the EID-CT data. Volume quantification accuracy of the current PCD-CT system was also found to be superior to a previous-generation investigational PCD-CT scanner with larger detector pixels.
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Affiliation(s)
| | - Jeffrey Marsh
- Department of Radiology, Mayo Clinic, Rochester, MN, USA, 55905
| | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA, 55905
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21
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Li J, Guo MT, Yang X, Gao F, Li N, Huang MG. The usefulness of subtraction coronary computed tomography angiography for in-stent restenosis assessment of patients with CoCr stent using 320-row area detector CT. Medicine (Baltimore) 2021; 100:e28345. [PMID: 34941141 PMCID: PMC8701865 DOI: 10.1097/md.0000000000028345] [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] [Received: 08/16/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to assess in-stent restenosis (ISR) of coronary artery for patients with CoCr stent using subtraction coronary computed tomography angiography (CCTA) with one-breath-hold scan on 320-row area detector CT, invasive coronary angiography (ICA) as clinical standard.Patients who were referred for CCTA from January 2020 to May 2021 were retrospectively analyzed. Pre-contrast and CCTA was performed with dedicated one-breath-hold subtraction scan protocol and post processing to get subtracted-CCTA image without stent. Subjective image qualities and diagnosable rate were analyzed for CCTA and subtracted-CCTA respectively. The ISR degree of each stent was evaluated both on CCTA and subtracted-CCTA images. The receiver-operating characteristic curve with sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA in the diagnosis of ISR were calculated with ICA as reference.Forty patients with 85 CoCr coronary stents of 3 to 3.5 mm diameter with ICA confirmation within 1 month were finally included. Subtracted-CCTA showed more diagnosable segments of stent (91.76% [78/85]) than those of CCTA (50.59% [43/85]) (P < .001). The subjective image quality score of CCTA was 2.23 ± 1.32 while 3.41 ± 0.90 on subtracted-CCTA (P < .001). Both subtracted-CCTA and CCTA showed high consistency with ICA (Kappa = 0.795 and 0.918 respectively). The area under the curve was 0.607 for CCTA and 0.757 for subtracted-CCTA (P < .001) for stent based diagnose, respectively. The sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA were 90.0%, 97.0%, 95.3%, and 87.5%, 100.0%, 97.43%, respectively.Subtracted-CCTA showed improved diagnose performance for ISR, which potentially reduce further follow-up ICA procedures for patients with CoCr stents.
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Affiliation(s)
- Jian Li
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Man-Tao Guo
- Department of Radiology, Xianyang Hospital of Yan’an University, Xianyang, Shaanxi, China
| | - Xiao Yang
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Fang Gao
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Na Li
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
| | - Ming-Gang Huang
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China
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22
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Nørgaard BL, Mortensen MB, Parner E, Leipsic J, Steffensen FH, Grove EL, Mathiassen ON, Sand NP, Pedersen K, Riedl KA, Engholm M, Bøtker HE, Jensen JM. Clinical outcomes following real-world computed tomography angiography-derived fractional flow reserve testing in chronic coronary syndrome patients with calcification. Eur Heart J Cardiovasc Imaging 2021; 22:1182-1189. [PMID: 32793947 DOI: 10.1093/ehjci/jeaa173] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/23/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS This study sought to investigate outcomes following a normal CT-derived fractional flow reserve (FFRCT) result in patients with moderate stenosis and coronary artery calcification, and to describe the relationship between the extent of calcification, stenosis, and FFRCT. METHODS AND RESULTS Data from 975 consecutive patients suspected of chronic coronary syndrome with stenosis (30-70%) determined by computed CT angiography and FFRCT to guide downstream management decisions were reviewed. Median (range) follow-up time was 2.2 (0.5-4.2) years. Coronary artery calcium (CAC) scores were ≥400 in 25%, stenosis ≥50% in 83%, and FFRCT >0.80 in 51% of the patients. There was a lower incidence of the composite endpoint (death, myocardial infarction, hospitalization for unstable angina, and unplanned coronary revascularization) at 4.2 years in patients with any CAC and FFRCT > 0.80 vs. FFRCT ≤ 0.80 (3.9% and 8.7%, P = 0.04), however, in patients with CAC scores ≥400 the risk difference between groups did not reach statistical significance, 4.2% vs. 9.7% (P = 0.24). A negative relationship between CAC scores and FFRCT irrespective of stenosis severity was demonstrated. CONCLUSION FFRCT shows promise in identifying patients with stenosis and calcification who can be managed without further downstream testing. Moreover, an inverse relationship between CAC levels and FFRCT was demonstrated. Studies are needed to further assess the clinical utility of FFRCT in patients with extensive coronary calcification.
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Affiliation(s)
- Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Martin B Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Erik Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
| | - Jonathon Leipsic
- Department of Radiology, St. Pauls Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | | | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Ole N Mathiassen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Niels Peter Sand
- Department of Cardiology, Hospital of Southwest Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Kamilla Pedersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Katharina A Riedl
- Department of Cardiology, University Heart and vascular Center, Martinistrase 52, 20246 Hamburg, Germany
| | - Morten Engholm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensen Blv 99, 8200 Aarhus N, Denmark
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Feasibility of Subtraction Coronary Computed Tomographic Angiography and Influencing Factor Analysis: a Retrospective Study. Curr Med Sci 2021; 41:821-826. [PMID: 34403108 DOI: 10.1007/s11596-021-2413-3] [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: 04/23/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the feasibility of subtraction coronary computed tomographic (CT) angiography (SubCCTA) to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and analyze the factors that influence SubCCTA. METHODS A total of 294 patients suspected of having coronary artery diseases underwent coronary computed tomographic angiography (CCTA) and SubCCTA. Coronary stenoses were blindly evaluated by two experienced radiologists, which were compared with invasive coronary angiography (ICA). Multiple statistical indexes were adopted to analyze the value of SubCCTA for the diagnosis of calcium stenoses. RESULTS The diagnosable rate of SubCCTA was 67.2% (n=197), and the non-diagnosable rate was 32.8% (n=97). Using SubCCTA, the false positive rate decreased from 56.5% to 17.4%, and the corresponding diagnostic accuracy was increased from 83.6% to 92.9%. Univariate logistic regression analysis showed that height (OR=1.029, 95% CI=1.001-1.058), weight (OR=1.025, 95% CI=1.004-1.046), left ventricular size (OR=1.018, 95% CI=1.007-1.030), cardiothoracic ratio (OR=39.917, 95% CI=1.244-1281.098), the average heart rate (OR=0.866, 95% CI=0.836-0.896) and heart rate range (OR=0.882, 95% CI=0.853-0.912) might be the factors influencing SubCCTA. CONCLUSION This study suggested that SubCCTA could help improve diagnostic accuracy in the presence of calcium plaques. Moreover, several factors were discovered for the first time to possibly influence SubCCTA, which will be helpful in improving the subtracted image quality.
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24
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Coronary artery calcium score above 250 confirms the presence of significant stenosis in coronary CT angiography of symptomatic patients. Coron Artery Dis 2021; 33:189-195. [PMID: 34148974 DOI: 10.1097/mca.0000000000001082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Evaluation of coronary artery calcium score (CACS) at multiple low and high cutoff values for the detection of significant coronary stenosis at two different cutoffs (50 and 70%) in a large number of symptomatic patients was not investigated previously in one study. This study aims to investigate if there are a correlation and statistical significance between different CACS cutoffs and the severity of coronary artery stenosis by coronary CT angiography (CCTA) in symptomatic patients. METHODS This is a retrospective study that included all symptomatic patients who had CCTA in a tertiary care hospital over a period of 7 years. RESULTS CCTA of 502 patients was evaluated (406 included, mean age 56.2 years); 230 were males (56.7%). The prevalence of stenosis at any percentage was 53.7%, ≥50% was 26.6% and ≥70% was 12.3%. The mean CACS was 84.5 (range 0-1860), for males was 124.5 and for females was 32.1. Patients with CACS of zero (59%) and CACS of ≥1 (41%) had a mean stenosis of 8.9% (range 0-75%) and 52.6% (range 0-100%), respectively. All patients with a CACS of ≥250 were found to have ≥50% stenosis (100% specificity and positive predictive value, 35.2% sensitivity, 81% negative predictive value and 82.6% accuracy). The percentage of stenosis increased as CACS increased with strong statistical significance (P value < 0.0001) and a positive correlation (r = 0.58). CONCLUSIONS CACS is a valuable diagnostic tool to predict the severity of coronary artery stenosis. A cutoff value of 250 confirmed the presence of at least 50% stenosis in symptomatic patients.
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Sandstedt M, Marsh J, Rajendran K, Gong H, Tao S, Persson A, Leng S, McCollough C. Improved coronary calcification quantification using photon-counting-detector CT: an ex vivo study in cadaveric specimens. Eur Radiol 2021; 31:6621-6630. [PMID: 33713174 DOI: 10.1007/s00330-021-07780-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the accuracy of coronary calcium quantification of cadaveric specimens imaged from a photon-counting detector (PCD)-CT and an energy-integrating detector (EID)-CT. METHODS Excised coronary specimens were scanned on a PCD-CT scanner, using both the PCD and EID subsystems. The scanning and reconstruction parameters for EID-CT and PCD-CT were matched: 120 kV, 9.3-9.4 mGy CTDIvol, and a quantitative kernel (D50). PCD-CT images were also reconstructed using a sharper kernel (D60). Scanning the same specimens using micro-CT served as a reference standard for calcified volumes. Calcifications were segmented with a half-maximum thresholding technique. Segmented calcified volume differences were analyzed using the Friedman test and post hoc pairwise Wilcoxon signed rank test with the Bonferroni correction. Image noise measurements were compared between EID-CT and PCD-CT with a repeated-measures ANOVA test and post hoc pairwise comparison with the Bonferroni correction. A p < 0.05 was considered statistically significant. RESULTS The volume measurements in 12/13 calcifications followed a similar trend: EID-D50 > PCD-D50 > PCD-D60 > micro-CT. The median calcified volumes in EID-D50, PCD-D50, PCD-D60, and micro-CT were 22.1 (IQR 10.2-64.8), 21.0 (IQR 9.0-56.5), 18.2 (IQR 8.3-49.3), and 14.6 (IQR 5.1-42.4) mm3, respectively (p < 0.05 for all pairwise comparisons). The average image noise in EID-D50, PCD-D50, and PCD-D60 was 60.4 (± 3.5), 56.0 (± 4.2), and 113.6 (± 8.5) HU, respectively (p < 0.01 for all pairwise comparisons). CONCLUSION The PCT-CT system quantified coronary calcifications more accurately than EID-CT, and a sharp PCD-CT kernel further improved the accuracy. The PCD-CT images exhibited lower noise than the EID-CT images. KEY POINTS • High spatial resolution offered by PCD-CT reduces partial volume averaging and consequently leads to better morphological depiction of coronary calcifications. • Improved quantitative accuracy for coronary calcification volumes could be achieved using high-resolution PCD-CT compared to conventional EID-CT. • PCD-CT images exhibit lower image noise than conventional EID-CT at matched radiation dose and reconstruction kernel.
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Affiliation(s)
- Mårten Sandstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jeffrey Marsh
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Young CR, Reynolds DA, Gambill N, Brooks DI, Villines TC. Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography. Tomography 2020; 6:356-361. [PMID: 33364425 PMCID: PMC7744187 DOI: 10.18383/j.tom.2020.00041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Extensive coronary artery calcium (CAC) diminishes the accuracy of coronary computed tomography angiography (CCTA). Many imagers adjust CCTA acquisition parameters depending on a preCCTA Agatston CAC score to optimize diagnostic accuracy. Typical preCCTA CAC imaging adds considerably to radiation exposure, partially attributable to imaging beyond the area known for highest CAC, the proximal coronary arteries. We aimed to determine whether a z-axis reduced scan length (RSL) would identify the majority of CAC and provide adequate information to computed tomography angiography providers relative to a standard full-scan length (FSL) preCCTA noncontrast CT. We retrospectively examined 200 subjects. The mean CAC scores detected in RSL and FSL were 77.4 (95% CI 50.6 to 104.3) and 93.9 (95% CI 57.3 to 130.5), respectively. RSL detected 81% of the FSL CAC. Among false negatives, with no CAC detected in RSL, FSL CAC severity was minimal (mean score 2.8). There was high concordance, averaging 88%, between CCTA imaging parameter adjustment decisions made by 2 experienced imagers based on either RSL or FSL. CAC detected and decision concordance decreased with increasing CAC burden. CAC detected was lower, and false negatives were more common in the right coronary artery owing to its anatomic course, placing larger segments outside RSL. Axial scan length and effective dose decreased 59% from FSL (∼14.5 cm/∼1.1 mSv) to RSL (∼5.9 cm/∼0.45 mSv). This retrospective study suggests that RSL identifies most CAC, results in similar CCTA acquisition parameter modifications, and reduces radiation exposure. Our colleagues corroborated these results in a recently published prospective study.
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Affiliation(s)
- Colin R. Young
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Radiology, Yale New Haven Hospital, New Haven, CT
| | - David A. Reynolds
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Brooke Army Medical Center, Fort Sam Houston, TX; and
| | - Neil Gambill
- Walter Reed National Military Medical Center, Bethesda, MD
| | | | - Todd C. Villines
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- University of Virginia Health Center, Charlottesville, VA
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Gohmann RF, Lauten P, Seitz P, Krieghoff C, Lücke C, Gottschling S, Mende M, Weiß S, Wilde J, Kiefer P, Noack T, Desch S, Holzhey D, Borger MA, Thiele H, Abdel-Wahab M, Gutberlet M. Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-out Significant Coronary Artery Disease. J Clin Med 2020; 9:jcm9061623. [PMID: 32471233 PMCID: PMC7356559 DOI: 10.3390/jcm9061623] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Significant coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). Assessment of CAD prior to TAVI is recommended by current guidelines and is mainly performed via invasive coronary angiography (ICA). In this study we analyzed the ability of coronary CT-angiography (cCTA) to rule out significant CAD (stenosis ≥ 50%) during routine pre-TAVI evaluation in patients with high pre-test probability for CAD. Methods: In total, 460 consecutive patients undergoing pre-TAVI CT (mean age 79.6 ± 7.4 years) were included. All patients were examined with a retrospectively ECG-gated CT-scan of the heart, followed by a high-pitch-scan of the vascular access route utilizing a single intravenous bolus of 70 mL iodinated contrast medium. Images were evaluated for image quality, calcifications, and significant CAD; CT-examinations in which CAD could not be ruled out were defined as positive (CAD+). Routinely, patients received ICA (388/460; 84.3%; Group A), which was omitted if renal function was impaired and CAD was ruled out on cCTA (Group B). Following TAVI, clinical events were documented during the hospital stay. Results: cCTA was negative for CAD in 40.2% (188/460). Sensitivity, specificity, PPV, and NPV in Group A were 97.8%, 45.2%, 49.6%, and 97.4%, respectively. Median coronary artery calcium score (CAC) was higher in CAD+-patients but did not have predictive value for correct classification of patients with cCTA. There were no significant differences in clinical events between Group A and B. Conclusion: cCTA can be incorporated into pre-TAVI CT-evaluation with no need for additional contrast medium. cCTA may exclude significant CAD in a relatively high percentage of these high-risk patients. Thereby, cCTA may have the potential to reduce the need for ICA and total amount of contrast medium applied, possibly making pre-procedural evaluation for TAVI safer and faster.
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Affiliation(s)
- Robin F. Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (C.K.); (C.L.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-865-255-024
| | - Philipp Lauten
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.L.); (J.W.); (S.D.); (H.T.); (M.A.-W.)
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (C.K.); (C.L.); (S.G.); (M.G.)
| | - Christian Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (C.K.); (C.L.); (S.G.); (M.G.)
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (C.K.); (C.L.); (S.G.); (M.G.)
| | - Sebastian Gottschling
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (C.K.); (C.L.); (S.G.); (M.G.)
| | - Meinhard Mende
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstr. 16-18, 04107 Leipzig, Germany;
| | - Stefan Weiß
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany; (S.W.); (M.A.B.)
| | - Johannes Wilde
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.L.); (J.W.); (S.D.); (H.T.); (M.A.-W.)
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.K.); (T.N.); (D.H.)
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.K.); (T.N.); (D.H.)
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.L.); (J.W.); (S.D.); (H.T.); (M.A.-W.)
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany; (S.W.); (M.A.B.)
| | - David Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.K.); (T.N.); (D.H.)
| | - Michael A. Borger
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany; (S.W.); (M.A.B.)
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.K.); (T.N.); (D.H.)
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.L.); (J.W.); (S.D.); (H.T.); (M.A.-W.)
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany; (S.W.); (M.A.B.)
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.L.); (J.W.); (S.D.); (H.T.); (M.A.-W.)
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany; (S.W.); (M.A.B.)
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany; (P.S.); (C.K.); (C.L.); (S.G.); (M.G.)
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany; (S.W.); (M.A.B.)
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28
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Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in Patients with Severe Calcification. J Cardiovasc Transl Res 2020; 14:131-139. [PMID: 32239435 DOI: 10.1007/s12265-020-09977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Our aim was to analyze its diagnostic and prognostic value in patients with high coronary calcium score (CCS). A total of 113 patients with CCS > 400 were included. Significant coronary artery disease (CAD) was defined as stenosis ≥ 50%. Invasive coronary angiography and major cardiovascular events were recorded. The CCS and heart rate during the acquisition were significantly lower in the diagnostic coronary computed tomography angiography (CCTA) group. The cut-off value of CCS to establish the diagnostic utility of CCTA was 878. The rate of cardiovascular events was 9.3%. The positive predictive value of CCTA to detect significant CAD was 73.5% and the negative predictive value for predicting cardiovascular events was 96%. In patients with high CCS, CCTA is useful to evaluate CAD, especially when the CCS is lower or equal to 878; moreover, the prognostic value of CCTA is better in patients where significant CAD has been ruled out.
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Chen CC, Wu PW, Tsay PK, Wang CC, Toh CH, Wan YL. Subtracted Computed Tomography Angiography in the Evaluation of Coronary Arteries With Severe Calcification or Stents Using a 320-Row Computed Tomography Scanner. J Thorac Imaging 2020; 35:317-325. [PMID: 32073538 DOI: 10.1097/rti.0000000000000480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Coronary computed tomography angiography (CCTA) has its limitations in evaluating arteries with stents or heavy calcification. This study compares the diagnostic performance of subtracted coronary computed tomography angiography (SCCTA) and nonsubtracted coronary computed tomography angiography (NSCCTA) in evaluating coronary artery disease (CAD) and in-stent restenosis (ISR). MATERIALS AND METHODS Twelve patients with stents and 20 patients with heavy coronary calcifications (total Agatston's score >400) underwent both SCCTA and invasive coronary angiography (ICA) with an interval of <3 months. Four subjects in the stented group also had heavy calcifications. Overall, 30 stented segments and 202 calcified segments were assessed to compare the diagnostic performance of SCCTA and NSCCTA in detecting ISR and CAD. RESULTS For the 30 stented segments, SCCTA/NSCCTA had a sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) (shown in %) of 66.7/100, 100/55.6, 96.7/60, 100/20, and 96.4/100 in diagnosing ISR, respectively. For the 202 calcified segments, SCCTA/NSCCTA had a sensitivity, specificity, accuracy, PPV, and NPV of 68.8/84.4, 97.6/76.5, 93.1/77.7, 84.6/40.3, and 94.3/96.3 in diagnosing CAD, respectively. For both stented and calcified segments, SCCTA was significantly superior to NSCCTA in specificity and accuracy. For the calcified segments, SCCTA was significantly superior to NSCCTA in PPV. There was no significant difference in the diagnostic performance of SCCTA between the stented and calcified segments. CONCLUSIONS The diagnostic accuracy and specificity of SCCTA are significantly superior to those of NSCCTA in evaluating CAD and ISR. SCCTA shows no statistical difference in its diagnostic performance between the stented and calcified segments.
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Affiliation(s)
- Chun-Chi Chen
- Section of Cardiology, Department of Internal Medicine
| | - Patricia Wanping Wu
- Department of Medical Imaging and Intervention, Linkou and Taoyuan Chang Gung Memorial Hospital
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Linkou and Taoyuan Chang Gung Memorial Hospital
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou and Taoyuan Chang Gung Memorial Hospital
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de Thurah A, Andersen IT, Tinggaard AB, Riis AH, Therkildsen J, Bøtker HE, Bøttcher M, Hauge EM. Risk of major adverse cardiovascular events among patients with rheumatoid arthritis after initial CT-based diagnosis and treatment. RMD Open 2020; 6:e001113. [PMID: 31958282 PMCID: PMC6999677 DOI: 10.1136/rmdopen-2019-001113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a known risk factor for developing coronary artery disease (CAD). The influence of RA on the prognosis after initial CAD diagnosis and treatment is however largely unknown. We examined the risk of major cardiovascular events among RA and non-RA patients with chest pain referred to cardiac CT. METHODS This was a follow-up study, using data from the Western Denmark Heart Registry, containing data on CT angiography examinations (Cardiac CT). Information on RA diagnosis and covariates were identified through nationwide administrative registers. The primary outcome was a combined outcome including, myocardial infarction, ischaemic or unspecified stroke, coronary artery bypass grafting, percutaneous coronary intervention, and all-cause mortality. Median time until events or censoring was 3.5 years (min/max: 0.0: 9.2). Cox proportional hazard models were used to examine the association between RA/non-RA patients and outcomes. RESULTS Among 42 257 patients, referred between 2008 and 2016, we identified 358 (0.8%) with RA. An increased risk was seen in RA compared with non-RA (adjusted HR 1.35, 95% CI 0.93 to 1.96). Among patients who had received flare treatment more than once prior to cardiac CT the adjusted HR 1.80 (95% CI 1.08 to 3.00), and among patients with seropositive RA the adjusted HR 1.42 (95% CI 0.93 to 2.16). CONCLUSION In patients referred to cardiac CT due to chest pain, we found a trend of an association between RA and the combined primary outcome, supporting that RA per se, but in particular seropositive and active RA, may increase the risk of CAD even after initial CAD diagnosis and treatment.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital Skejby, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Ina Trolle Andersen
- Department of Clinical Epidemiology, Aarhus University Hospital Skejby, Aarhus N, Denmark
| | | | - Anders Hammerich Riis
- Department of Clinical Epidemiology, Aarhus University Hospital Skejby, Aarhus N, Denmark
| | | | - Hans Erik Bøtker
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus N, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital Skejby, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Machine-Learning CT-FFR and Extensive Coronary Calcium: Overcoming the Achilles Heel of Coronary Computed Tomography Angiography. JACC Cardiovasc Imaging 2019; 13:771-773. [PMID: 31542540 DOI: 10.1016/j.jcmg.2019.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/20/2019] [Indexed: 01/01/2023]
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Tesche C, Otani K, De Cecco CN, Coenen A, De Geer J, Kruk M, Kim YH, Albrecht MH, Baumann S, Renker M, Bayer RR, Duguay TM, Litwin SE, Varga-Szemes A, Steinberg DH, Yang DH, Kepka C, Persson A, Nieman K, Schoepf UJ. Influence of Coronary Calcium on Diagnostic Performance of Machine Learning CT-FFR: Results From MACHINE Registry. JACC Cardiovasc Imaging 2019; 13:760-770. [PMID: 31422141 DOI: 10.1016/j.jcmg.2019.06.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study was conducted to investigate the influence of coronary artery calcium (CAC) score on the diagnostic performance of machine-learning-based coronary computed tomography (CT) angiography (cCTA)-derived fractional flow reserve (CT-FFR). BACKGROUND CT-FFR is used reliably to detect lesion-specific ischemia. Novel CT-FFR algorithms using machine-learning artificial intelligence techniques perform fast and require less complex computational fluid dynamics. Yet, influence of CAC score on diagnostic performance of the machine-learning approach has not been investigated. METHODS A total of 482 vessels from 314 patients (age 62.3 ± 9.3 years, 77% male) who underwent cCTA followed by invasive FFR were investigated from the MACHINE (Machine Learning based CT Angiography derived FFR: a Multi-center Registry) registry data. CAC scores were quantified using the Agatston convention. The diagnostic performance of CT-FFR to detect lesion-specific ischemia was assessed across all Agatston score categories (CAC 0, >0 to <100, 100 to <400, and ≥400) on a per-vessel level with invasive FFR as the reference standard. RESULTS The diagnostic accuracy of CT-FFR versus invasive FFR was superior to cCTA alone on a per-vessel level (78% vs. 60%) and per patient level (83% vs. 73%) across all Agatston score categories. No statistically significant differences in the diagnostic accuracy, sensitivity, or specificity of CT-FFR were observed across the categories. CT-FFR showed good discriminatory power in vessels with high Agatston scores (CAC ≥400) and high performance in low-to-intermediate Agatston scores (CAC >0 to <400) with a statistically significant difference in the area under the receiver-operating characteristic curve (AUC) (AUC: 0.71 [95% confidence interval (CI): 0.57 to 0.85] vs. 0.85 [95% CI: 0.82 to 0.89], p = 0.04). CT-FFR showed superior diagnostic value over cCTA in vessels with high Agatston scores (CAC ≥ 400: AUC 0.71 vs. 0.55, p = 0.04) and low-to-intermediate Agatston scores (CAC >0 to <400: AUC 0.86 vs. 0.63, p < 0.001). CONCLUSIONS Machine-learning-based CT-FFR showed superior diagnostic performance over cCTA alone in CAC with a significant difference in the performance of CT-FFR as calcium burden/Agatston calcium score increased. (Machine Learning Based CT Angiography Derived FFR: a Multicenter, Registry [MACHINE] NCT02805621).
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Affiliation(s)
- Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Otani
- Advanced Therapies Innovation Department, Siemens Healthcare K.K., Tokyo, Japan
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Adriaan Coenen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jakob De Geer
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Mariusz Kruk
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stefan Baumann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Taylor M Duguay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Sheldon E Litwin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Anders Persson
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Koen Nieman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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Guo W, Tripathi P, Yang S, Qian J, Rai B, Zeng M. Modified Subtraction Coronary CT Angiography with a Two-Breathhold Technique: Image Quality and Diagnostic Accuracy in Patients with Coronary Calcifications. Korean J Radiol 2019; 20:1146-1155. [PMID: 31270978 PMCID: PMC6609439 DOI: 10.3348/kjr.2018.0845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/20/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate a modified subtraction coronary computed tomography angiography (CCTA) technique with a two-breathhold approach in terms of image quality and stenosis grading of calcified coronary segments and in the detection of significant coronary stenosis in segments with severe calcification. MATERIALS AND METHODS The institutional board approved this study, and all subjects provided written consent. A total of 128 patients were recruited into this trial, of which 32 underwent subtraction CCTA scans and invasive coronary angiography (ICA). The average Agatston score was 356 ± 145. In severely calcified coronary segments, the presence of significant (> 50%) stenosis was assessed on both conventional CCTA and subtraction CCTA images, and the results were finally compared with ICA findings as the gold standard. RESULTS For severely calcified segments, the image quality in conventional CCTA significantly improved from 2.51 ± 0.98 to 3.12 ± 0.94 in subtraction CCTA (p < 0.001). In target segments, specificity (70% vs. 87%; p = 0.005) and positive predictive value (61% vs. 79%, p < 0.01) were improved using subtraction CCTA in comparison with conventional CCTA, with no loss in the negative predictive value. The segment-based diagnostic accuracy for detecting significant stenosis was significantly better in subtraction CCTA than in conventional CCTA (area under the receiver operating characteristic curve, 0.94 vs. 0.85; p = 0.03). CONCLUSION This modified subtraction CCTA method showed lower misregistration and better image quality in patients with limited breathhold capability. In comparison with conventional CCTA, modified subtraction CCTA would allow stenosis regrading and improve the diagnostic accuracy in coronary segments with severe calcification.
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Affiliation(s)
- Weifeng Guo
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Pratik Tripathi
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bimal Rai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China.
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Øvrehus KA, Veien KT, Lambrechtsen J, Rohold A, Steffensen FH, Gerke O, Jensen LO, Mickley H. Functional and Anatomical Testing in Intermediate Risk Chest Pain Patients with a High Coronary Calcium Score: Rationale and Design of the FACC Study. Cardiology 2019; 142:141-148. [PMID: 31170719 DOI: 10.1159/000499667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/15/2019] [Indexed: 11/19/2022]
Abstract
Current guidelines do not recommend coronary computed tomography angiography (CCTA) in patients with high levels of coronary calcium, as severe calcification leads to difficulties in estimating stenosis severity due to blooming artifacts obscuring the vessel lumen. Whether the CCTA-derived fractional flow reserve (FFRCT) improves the diagnostic performance of CCTA in patients with high levels of coronary calcification has not been sufficiently evaluated. We hypothesize that a noninvasive diagnostic strategy using FFRCT will perform comparably to an invasive diagnostic strategy in the detection of hemodynamically significant coronary artery disease (CAD) in clinical stable chest pain patients with high levels of coronary calcium. In this prospective, blinded, multicenter study, patients with suspected stable CAD referred for CCTA and demonstrating an Agatston score >399 will be included. Patients accepting inclusion will, in addition to CCTA, undergo invasive coronary angiography (ICA) and invasive FFR measurement. FFRCT analyses are performed by an external core laboratory blinded to any patient data, and the FFRCT results are blinded to all participating study sites. The primary objective is to evaluate whether FFRCT can identify patients with and without hemodynamically significant CAD, when ICA with FFR is the reference standard. A negative study result would question the clinical usefulness of FFRCT in patients with high levels of coronary calcium. A positive study result, however, would imply a reduction in the number of patients referred for coronary catheterization and, at the same time, increase the proportion of patients with hemodynamically significant CAD at the subsequent invasive examination.
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Affiliation(s)
| | - Karsten T Veien
- Odense University Hospital Department of Cardiology, Odense, Denmark
| | | | - Allan Rohold
- Esbjerg Hospital Department of Cardiology, Esbjerg, Denmark
| | | | - Oke Gerke
- Odense University Hospital Department of Cardiology, Odense, Denmark
| | - Lisette O Jensen
- Odense University Hospital Department of Cardiology, Odense, Denmark
| | - Hans Mickley
- Odense University Hospital Department of Cardiology, Odense, Denmark,
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Higashikawa T, Ichikawa Y, Ishida M, Kitagawa K, Hirano T, Sakuma H. Assessment of coronary flow velocity reserve with phase-contrast cine magnetic resonance imaging in patients with heavy coronary calcification. Int J Cardiovasc Imaging 2019; 35:897-905. [PMID: 30805755 DOI: 10.1007/s10554-019-01531-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Coronary flow velocity reserve (CFVR) can be noninvasively measured by phase-contrast cine magnetic resonance imaging (PC-MRI). Heavy coronary calcification degrades the diagnostic accuracy for the detection of coronary arterial stenosis on computed tomography (CT). The aim of this study was to evaluate the value of CFVR measurement with PC-MRI for detecting significant coronary stenoses in patients with heavy coronary calcification. Sixteen patients (71 ± 8 years) with coronary calcium score above 400 who had suspected moderate coronary stenosis (50-69% diameter stenosis) on CT angiography were prospectively studied. The CFVR values, calculated as the ratio of peak flow velocity during hyperemia to the peak flow velocity at rest, were measured using breath-hold PC-MRI with 3 T system, and were compared with the results of quantitative coronary angiography (QCA). The mean coronary calcium score was 985 ± 378. CFVR was successfully determined with PC-MRI in 17/18 (94%) vessels. Using a threshold of 1.4 for CFVR, the sensitivity, specificity, and positive and negative predictive value for detecting ≥ 50% stenosis on QCA was 88% (7/8), 89% (8/9), 88% (7/8), 89% (8/9), respectively. When MRI CFVR measurements was added to CT angiography for the evaluation of coronary stenosis, the positive predictive value was 88% (7/8), while the positive predictive value of CT angiography alone was 44% (8/18). PC-MRI can provide noninvasive detection of altered CFVR caused by significant stenosis in patient. CFVR measurement by PC-MRI is useful for diagnosing physiologically significant coronary stenosis in patients with high calcium score on CT.
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Affiliation(s)
- Takatoshi Higashikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tadanori Hirano
- Department of Radiology, Matsusaka Central Hospital, 102 Kobou, Kawai, Matsusaka, Mie, 515-8566, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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The usefulness of low radiation dose subtraction coronary computed tomography angiography for patients with calcification using 320-row area detector CT. J Cardiol 2019; 73:58-64. [DOI: 10.1016/j.jjcc.2018.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/10/2018] [Accepted: 05/22/2018] [Indexed: 01/05/2023]
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Asher A, Singhal A, Thornton G, Wragg A, Davies C. FFR CT derived from computed tomography angiography: the experience in the UK. Expert Rev Cardiovasc Ther 2018; 16:919-929. [PMID: 30347174 DOI: 10.1080/14779072.2018.1538786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Non-invasive fractional flow reserve derived from CT coronary angiography (FFRCT) represents a novel technology to investigate coronary artery disease. The application of computational flow dynamics to anatomical data provides the clinician with a further functional assessment to inform decision-making in patients with coronary artery disease. In the UK FFRCT has received medical technology approval for use since February 2017. Areas covered: This article discusses the mathematical and physiological principles underpinning calculation of non-invasive fractional flow reserve (FFR), as well as discussing the differences between the commercially available technologies. Diagnostic accuracy, cost effectiveness and safety of non-invasive FFR from the early clinical trials is examined. Further to this the potential implications of the use of non-invasive FFR in clinical practice in the UK are discussed. Expert commentary: Non-invasive FFR represents a promising comprehensive imaging technology providing both anatomical and physiological data to accurately diagnose obstructive coronary artery disease. The technology has yet to prove to be cost effective in 'real world' cohorts before becoming integrated into everyday clinical practice and guidelines in the United Kingdom.
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Affiliation(s)
- Alex Asher
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - Arvind Singhal
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - George Thornton
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - Andrew Wragg
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - Ceri Davies
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
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Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6528238. [PMID: 30306089 PMCID: PMC6165606 DOI: 10.1155/2018/6528238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
Coronary stenosis severity is both a powerful and a still debated predictor of prognosis in coronary artery disease. Coronary computed tomographic angiography (CCTA) has emerged as a noninvasive technique that enables anatomic visualization of coronary artery disease (CAD). CCTA with newer applications, plaque characterization and physiologic/functional evaluation, allows a comprehensive diagnostic and prognostic assessment of otherwise low-intermediate subjects for primary prevention. CCTA measures the overall plaque burden, differentiates plaque subtypes, and identifies high-risk plaque with good reproducibility. Research in this field may also advance towards an era of personalized risk prediction and individualized medical therapy. It has been demonstrated that statins may delay plaque progression and change some plaque features. The potential effects on plaque modifications induced by other medical therapies have also been investigated. Although it is not currently possible to recommend routinely serial scans to monitor the therapeutic efficacy of medical interventions, the plaque modulation, as a part of risk modification, appears a feasible strategy. In this review we summarize the current evidence regarding vulnerable plaque and effects of lipid lowering therapy on morphological features of CAD. We also discuss the potential ability of CCTA to characterize coronary atherosclerosis, stratify prognosis of asymptomatic subjects, and guide medical therapy.
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A phantom based evaluation of vessel lumen area quantification for coronary CT angiography. Int J Cardiovasc Imaging 2018; 35:551-557. [PMID: 30196453 DOI: 10.1007/s10554-018-1452-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
Coronary computed tomography (CT) angiography is a noninvasive method for visualizing coronary artery disease. However, coronary CT angiography is limited in assessment of stenosis severity by the partial volume effect and calcification. Therefore, an accurate method for assessment of stenosis severity is needed. A 10 cm diameter cylindrical Lucite phantom with holes in the range of 0.4-4.5 mm diameter was fitted in a chest phantom. The holes were filled with an iodine solution of 8 mg/mL. To simulate coronary artery disease, different levels of stenosis were created by inserting Lucite rods into the holes with diameter range of 2-4.5 mm. The resulting lumen cross sectional areas ranged from 1.4 to 12.3 mm2. To simulate arterial calcification, calcium hydroxyapatite rods were inserted into the holes with diameter range of 2-4.5 mm. Images of the phantoms were acquired at 100 kVp using a 320-slice CT scanner. A maual and a semi-automated technique based on integrated Hounsfield units was used to calculate vessel cross-sectional area. There was an excellent correlation between the measured and the known cross-sectional area for both normal and stenotic vessels using the manual and the semi-automated techniques. However, the overall measurement error for the manual method was more than twice as compared with the integrated HU technique. Determination of vessel lumen area using the semi-automated integrated Hounsfield unit technique yields more than a factor of two improvement in precision and accuracy as compared to the existing manual technique for vessels with and without stenosis. This technique can also be used to accurately measure arterial cross-sectional area in the presence of coronary calcification.
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Günther A, Aaberge L, Abildgaard A, Ragnarsson A, Edvardsen T, Jakobsen J, Andersen R. Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose. Acta Radiol 2018; 59:1066-1073. [PMID: 29260577 DOI: 10.1177/0284185117748354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS). Results Interpretable CCTA images were acquired in 570 (95%) coronary artery segments ≥2 mm in diameter. Sensitivity, specificity, and positive and negative predictive values of CCTA for the detection of segments with significant stenosis (lumen reduction ≥50%) on ICA were 100%, 98%, 7.7%, and 100%, respectively. Twelve significant stenoses were located in segments with uninterpretable image quality or vessel diameter <2 mm; only one was eligible for intervention. IVUS detected CAV (maximal intimal thickness ≥0.5 mm) in 33/41 (81%) patients; CCTA and ICA identified CAV (any wall or luminal irregularity) in 18 (44%) and 14 (34%) of these 33 patients, respectively. The mean estimated radiation dose was 19.0 ± 3.4 mSv for CCTA and 5.7 ± 3.3 mSv for ICA ( P < 0.001). Conclusion CCTA with interpretable image quality had a high negative predictive value for ruling out significant stenoses suitable for intervention. The modest detection of CAV by CCTA implied a limited value in identifying subtle CAV. The high estimated radiation dose for 64-MDCT is of concern considering the need for repetitive examinations in the HTX population.
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Affiliation(s)
- Anne Günther
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andreas Abildgaard
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Asgrimur Ragnarsson
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jarl Jakobsen
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rune Andersen
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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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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Blooming Artifact Reduction in Coronary Artery Calcification by A New De-blooming Algorithm: Initial Study. Sci Rep 2018; 8:6945. [PMID: 29720611 PMCID: PMC5931966 DOI: 10.1038/s41598-018-25352-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/16/2018] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to investigate the use of de-blooming algorithm in coronary CT angiography (CCTA) for optimal evaluation of calcified plaques. Calcified plaques were simulated on a coronary vessel phantom and a cardiac motion phantom. Two convolution kernels, standard (STND) and high-definition standard (HD STND), were used for imaging reconstruction. A dedicated de-blooming algorithm was used for imaging processing. We found a smaller bias towards measurement of stenosis using the de-blooming algorithm (STND: bias 24.6% vs 15.0%, range 10.2% to 39.0% vs 4.0% to 25.9%; HD STND: bias 17.9% vs 11.0%, range 8.9% to 30.6% vs 0.5% to 21.5%). With use of de-blooming algorithm, specificity for diagnosing significant stenosis increased from 45.8% to 75.0% (STND), from 62.5% to 83.3% (HD STND); while positive predictive value (PPV) increased from 69.8% to 83.3% (STND), from 76.9% to 88.2% (HD STND). In the patient group, reduction in calcification volume was 48.1 ± 10.3%, reduction in coronary diameter stenosis over calcified plaque was 52.4 ± 24.2%. Our results suggest that the novel de-blooming algorithm could effectively decrease the blooming artifacts caused by coronary calcified plaques, and consequently improve diagnostic accuracy of CCTA in assessing coronary stenosis.
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Patterns of Coronary Calcification and Their Impact on the Diagnostic Accuracy of Computed Tomography Coronary Angiography. J Comput Assist Tomogr 2018; 42:263-268. [PMID: 29189397 DOI: 10.1097/rct.0000000000000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite coronary calcifications being a major factor affecting the diagnostic accuracy of coronary computed tomography angiography (CTA), there is a lack of established criteria for categorizing calcifications. We aimed to evaluate patterns of coronary calcification based on quantitative radiodensity and size parameters to provide coronary calcium categories and assess their impact on the accuracy of coronary CTA. METHODS AND RESULTS We analyzed length, maximum thickness, volume, mean density, and maximum density of coronary calcium and divided each of these parameters into tertiles. Subsequently, we summarized the tertiles for each individual calcification and divided them into 3 equal groups of: mild, moderate, and severe calcification. The accuracy of coronary CTA was defined as the difference between the measurements obtained on coronary CTA versus the reference of intravascular ultrasound (IVUS). We evaluated 252 coronary calcifications within 97 arteries of 60 patients. There was an expected increase in size and density values for mild versus moderate versus severe calcifications, but there was no difference in IVUS measured minimum lumen area among the 3 groups. Of note, coronary CTA significantly underestimated IVUS minimum lumen area measurement by 1.2 ± 1.6 mm (14.6 ± 23.1%, P < 0.001) for severe calcifications and by 0.5 ± 2.0 mm (3.7 ± 32.1%, P = 0.021) for moderate calcifications. Within mild calcifications, the difference was not significant. CONCLUSION Based on their dimensional and radiodensity characteristics, our analysis revealed patterns of individual coronary artery calcifications that affected the accuracy of coronary CTA measurements; coronary CTA inaccuracy was associated with the presence of moderate or severe calcifications, but not mild calcifications.
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Wen D, Li J, Zhao H, Li J, Zheng M. Diagnostic performance of two corrected transluminal attenuation gradient metrics in coronary CT angiography for the evaluation of significant in-stent restenosis by dual-source CT: a validation study with invasive coronary angiography. Clin Radiol 2018; 73:592.e1-592.e8. [PMID: 29454588 DOI: 10.1016/j.crad.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
AIM To determine the diagnostic potential of transluminal attenuation gradients (TAG) with exclusion of stented coronary segments (TAG-ExS) and TAG-corrected contrast opacification (CCO) excluding stented coronary segments (TAG-CCO-ExS) for the assessment of in-stent restenosis (ISR). MATERIALS AND METHODS TAG-ExS and TAG-CCO-ExS were calculated in 93 coronary arteries with 190 stents. The diagnostic performances and the incremental values of the two metrics to coronary computed tomography angiography (CCTA) were analysed and compared. RESULTS For all stents and stents >3 mm in diameter, TAG-ExS and TAG-CCO-ExS were significantly lower in ≥50% than that in <50% of ISR (both p<0.05). For stent diameters ≤3 mm, significantly lower TAG-CCO-ExS (p=0.000), but not TAG-ExS (p=0.059), was found in ≥50% than in <50% of ISR. Addition of TAG-ExS or TAG-CCO-ExS to CCTA, did not improve the diagnostic accuracy of CCTA significantly (all p>0.05). Only TAG-CCO-ExS had a significant impact on CCTA for the reclassifications of ISR (p=0.046) in stent diameters ≤3 mm. CONCLUSIONS TAG-ExS and TAG-CCO-ExS did not provide incremental diagnostic value over CCTA in assessing ISR. TAG-CCO-ExS slightly enhanced the reclassifications of ISR for stents ≤3 mm in diameter.
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Affiliation(s)
- D Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - J Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - H Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - J Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China
| | - M Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi province, China.
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CT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic valve replacement. J Cardiovasc Comput Tomogr 2017; 11:338-346. [PMID: 28662835 DOI: 10.1016/j.jcct.2017.06.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) and aortic stenosis share pathophysiological mechanisms and risk factors. We evaluated the clinical utility of coronary computed tomography angiography (CTA) to identify CAD and revascularization requirement in patients with severe aortic stenosis considered for transcatheter aortic valve replacement (TAVR). METHODS Consecutive patients without known CAD underwent calcium scoring, CTA and invasive coronary angiography (ICA). A second-generation dual-source CT scanner was used. ICA-quantitative coronary angiography (QCA) served as reference standard. CAD was reported using a lenient threshold of ≥50% and a stricter threshold of ≥70% diameter reduction. Findings of ≥70% diameter reduction and of high-risk CAD were used to predict revascularization. RESULTS The study included 140 patients [68 males; 82.3 (7.7) years]. CAD defined by the 50% threshold on ICA was found in 58/140 (41%) patients. CAD by the 70% threshold was found in 23/140 (16%) patients. High-risk CAD was found in 16/140 (11%) patients. CTA and ICA had similar odd-ratios of 3.22 (1.26-8.23) and 4.62 (1.64-13.05), respectively, in predicting revascularization. Forty-two/140 (30%) patients had <400 Agatston calcium score, 98/140 (70%) patients had ≥400 calcium score. The diagnostic performance of CTA in the low calcium score group was better than the high calcium score group (AUC 0.81 vs. 0.63). CONCLUSION CTA remained questionable to rule-out CAD as gatekeeper to ICA in TAVR candidates who had severe coronary calcifications. In patients with less severe coronary calcifications, accounting for 30% of participants in this study, CTA may play a clinical role.
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Coronary Calcium Score May Replace Cardiovascular Risk Factors as Primary Risk Stratification Tool Before Kidney Transplantation. Transplantation 2017; 100:2177-87. [PMID: 26555948 DOI: 10.1097/tp.0000000000000992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiac evaluation before kidney transplantation is recommended, but no unequivocal screening strategy has yet been identified. We investigated if coronary artery calcium score (CACS) can replace cardiovascular risk factor assessment in selection of kidney transplantation candidates for cardiac evaluation and the choice of noninvasive modality for diagnosing obstructive coronary artery disease (CAD). METHODS We conducted a prospective study of 167 patients referred for pretransplantation cardiac evaluation. Patients underwent risk factor assessment, CACS, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography. In total, 138 patients completed all diagnostic tests. RESULTS In patients with CAD (22%), the number of risk factors and CACS score were higher than that in patients without CAD. The accuracy evaluated by the receiver-operating characteristic curve was higher for CACS than for risk factors, 0.85 versus 0.71 (P = 0.01). Adding CACS to the risk factor increased correct categorical net reclassification (0.58, P < 0.0001). Combining risk factors (≥3) with SPECT to identify patients with obstructive CAD resulted in less sensitivity (47% vs 80%) and higher specificity (94% vs 74%), compared with CCTA. In patients with low CACS (<400), SPECT had a lower sensitivity than CCTA (60% versus 80%) but the same specificity (80%). In patients with high CACS (≥400), SPECT had lower sensitivity than CCTA (50% vs 100%) and higher specificity (88% vs 8%). CONCLUSIONS In kidney transplantation candidates, CACS outperformed risk factor assessment for predicting obstructive CAD and is a better tool for selecting patients and guiding the choice of noninvasive diagnostic modality in CAD.
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48
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Akers SR, Panchal V, Ho VB, Beache GM, Brown RK, Ghoshhajra BB, Greenberg SB, Hsu JY, Kicska GA, Min JK, Stillman AE, Stojanovska J, Abbara S, Jacobs JE. ACR Appropriateness Criteria ® Chronic Chest Pain—High Probability of Coronary Artery Disease. J Am Coll Radiol 2017; 14:S71-S80. [DOI: 10.1016/j.jacr.2017.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
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Bittner DO, Mayrhofer T, Bamberg F, Hallett TR, Janjua S, Addison D, Nagurney JT, Udelson JE, Lu MT, Truong QA, Woodard PK, Hollander JE, Miller C, Chang AM, Singh H, Litt H, Hoffmann U, Ferencik M. Impact of Coronary Calcification on Clinical Management in Patients With Acute Chest Pain. Circ Cardiovasc Imaging 2017; 10:e005893. [PMID: 28487318 PMCID: PMC5901678 DOI: 10.1161/circimaging.116.005893] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/28/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). METHODS AND RESULTS This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network-Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (≥70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). CONCLUSIONS Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01084239 and NCT00933400.
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Affiliation(s)
- Daniel O Bittner
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.).
| | - Thomas Mayrhofer
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Fabian Bamberg
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Travis R Hallett
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Sumbal Janjua
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Daniel Addison
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - John T Nagurney
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - James E Udelson
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Michael T Lu
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Quynh A Truong
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Pamela K Woodard
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Judd E Hollander
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Chadwick Miller
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Anna Marie Chang
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Harjit Singh
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Harold Litt
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Udo Hoffmann
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
| | - Maros Ferencik
- From the Cardiac MR PET CT Program (D.O.B., T.M., F.B., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), Department of Radiology (D.O.B., T.M., T.R.H., S.J., D.A., M.T.L., U.H., M.F.), and Department of Emergency Medicine (J.T.N.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany (D.O.B.); School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.); Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany (F.B.); Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Department of Radiology, Weill Cornell Medicine, New York City (Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (P.K.W.); Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (J.E.H., A.M.C.); Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC (C.M.); Penn State Heart and Vascular Institute, Hershey, PA (H.S.); Perelman School of Medicine of the University of Pennsylvania, Philadelphia (H.L.); and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.)
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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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