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Lisi C, Moser LJ, Mergen V, Flohr T, Eberhard M, Alkadhi H. Increasing the rate of datasets amenable to CT FFR and quantitative plaque analysis: Value of software for reducing stair-step artifacts demonstrated in photon-counting detector CT. Eur J Radiol Open 2024; 12:100574. [PMID: 38882632 PMCID: PMC11179571 DOI: 10.1016/j.ejro.2024.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To determine the value of an algorithm for reducing stair-step artifacts for advanced coronary analyses in sequential mode coronary CT angiography (CCTA). Methods Forty patients undergoing sequential mode photon-counting detector CCTA with at least one stair-step artifact were included. Twenty patients (14 males; mean age 57±17years) with 45 segments showing stair-step artifacts and without atherosclerosis were included for CTFFR analysis. Twenty patients (20 males; mean age 74±13years) with 22 segments showing stair-step artifacts crossing an atherosclerotic plaque were included for quantitative plaque analysis. Artifacts were graded, and CTFFR and quantitative coronary plaque analyses were performed in standard reconstructions and in those reconstructed with a software (entitled ZeeFree) for artifact reduction. Results Stair-step artifacts were significantly reduced in ZeeFree compared to standard reconstructions (p<0.05). In standard reconstructions, CTFFR was not feasible in 3/45 (7 %) segments but was feasible in all ZeeFree reconstructions. In 9/45 (20 %) segments without atherosclerosis, the ZeeFree algorithm led to a change of CTFFR values from pathologic in standard to physiologic values in ZeeFree reconstructions. In one segment (1/22, 5 %), quantitative plaque analysis was not feasible in standard but only in ZeeFree reconstruction. The mean overall plaque volume (111±60 mm3), the calcific (77±47 mm3), fibrotic (31±28 mm3), and lipidic (4±3 mm3) plaque components were higher in standard than in ZeeFree reconstructions (overall 75±50 mm3, p<0.001; calcific 51±42 mm3, p<0.001; fibrotic 22±19 mm3, p<0.05; lipidic 3±3 mm3, p=0.055). Conclusion Despite the lack of reference standard modalities for CTFFR and coronary plaque analysis, initial evidence indicates that an algorithm for reducing stair-step artifacts in sequential mode CCTA increases the rate and quality of datasets amenable to advanced coronary artery analysis, hereby potentially improving patient management.
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Affiliation(s)
- Costanza Lisi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Lukas J Moser
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor Mergen
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Flohr
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Jin L, Jie B, Gao Y, Jiang A, Weng T, Li M. Low dose contrast media in step-and-shoot coronary angiography with third-generation dual-source computed tomography: feasibility of using 30 mL of contrast media in patients with body surface area <1.7 m 2. Quant Imaging Med Surg 2021; 11:2598-2609. [PMID: 34079726 DOI: 10.21037/qims-20-500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Reducing contrast media volume in coronary computed tomography angiography minimizes the risk of adverse events but may compromise diagnostic image quality. We aimed to evaluate coronary computed tomography angiography's diagnostic image quality while using 30 mL of contrast media in patients with a body surface area <1.7 m2. Methods This prospective study included patients who underwent coronary computed tomography angiography from May 2018 to June 2019. The patients were divided into a low-dose group, who received 30 mL of contrast media, and a routine-dose group, who received contrast media based on body weight. Patient characteristics, coronary computed tomography angiography results, and quantitative and qualitative image results were assessed and compared. Results In total, 103 patients with a body surface area <1.7 m2 were 53 in the low-dose group and 50 in the routine-dose group. Sex, age, body surface area, body weight, and heart rate were similar between the groups (P>0.05). A contrast media volume of 30±0 mL was used for the low-dose group, and 41.62±4.59 mL was used for the routine-dose group. The low-dose group's computed tomography values were significantly different from those of the routine-dose group (P<0.05). The radiologists demonstrated agreement regarding diagnostic image quality and accuracy (kappa =0.91 and 0.85, respectively). Conclusions Using 30 mL of contrast media for coronary computed tomography angiography in patients with a body surface area <1.7 m2 provided a suitable diagnostic image quality for coronary artery disease diagnosis. Although radiation doses were similar between the groups, the decreased contrast media volume was likely beneficial for the patients.
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Affiliation(s)
- Liang Jin
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - Bing Jie
- Radiology Department, Shanghai Pulmonary Hospital, Affiliated with Tongji University, Shanghai, China
| | - Yiyi Gao
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - An'qi Jiang
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - Tingwen Weng
- Cardiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
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Yang CC, Law WY, Lu KM, Wu TH. Relationship between heart rate and optimal reconstruction phase in coronary CT angiography performed on a 256-slice multidetector CT. Br J Radiol 2019; 92:20180945. [PMID: 31322906 DOI: 10.1259/bjr.20180945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the relationship between heart rate (HR) and optimal reconstruction phase in prospectively electrocardiogram (ECG)-triggered coronary CT angiography (CCTA) performed on a newly introduced 256-slice multidetector CT (MDCT). METHODS All the cases were selected retrospectively from the patients scheduled for CCTA in our department between January and April 2017. The scanner selected the optimal exposure phase based on 10 s ECG recordings. To ensure the success of CCTA, the operator also checked patient's age, breathing control, emotional status and past medical history to decide whether the automatically selected scan phase needs manual adjustment or not. Images were reconstructed in 1% steps of the R-R interval to determine the cardiac phase with least coronary motion. If CCTA images showed moderate motion blurring or discontinuity in the course of coronary segments, a cardiac motion correction algorithm was applied to the reconstructed images. Subjective diagnostic image quality was evaluated with 4-point grading scale. RESULTS A total of 87 consecutive CCTA examinations were investigated in this study. Diastolic reconstruction was applied to all vessel segments in patients with HR <63 bpm, where 36.5 and 77.8% of vessel segments were reconstructed with the use of motion correction in HR ≤57 and 58-62 bpm, respectively. As for patients with HR ≥63 bpm, 89.3 and 71.7% of vessel segments were reconstructed in diastole in HR 63-67 and ≥68 bpm, respectively, while 81 and 100% of vessel segments were reconstructed with the use of motion correction in the same HR groups. CONCLUSION Based on our results, a HR less than 67 bpm can be used to identify appropriate patients for diastolic reconstruction. Although the motion correction algorithm is an effective approach to reduce the impact of cardiac motion in CCTA, HR control is still important to optimize the image quality of CCTA. The relationship between HR and optimal reconstruction phase established in this study could be further used to tailor the ECG pulsing window for dose reduction in patients undergoing CCTA performed on the 256-slice MDCT. ADVANCES IN KNOWLEDGE The HR thresholds to identify patients who are the best suitable candidates for diastolic or systolic reconstruction are scanner specific. This study investigated the relationship between HR and optimal reconstruction phase in prospectively ECG-triggered CCTA for a newly introduced 256-slice MDCT. Once the relationship is established, it could be used to tailor the ECG pulsing window for radiation dose reduction.
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Affiliation(s)
- Ching-Ching Yang
- 1Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Yip Law
- 2Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kun-Mu Lu
- 2Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Tung-Hsin Wu
- 3Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
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Age-related differences in image quality of prospectively ECG-triggered axial and helical scans for coronary CT angiography. Radiol Phys Technol 2016; 9:214-20. [PMID: 26984733 DOI: 10.1007/s12194-016-0351-8] [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: 10/23/2015] [Revised: 02/27/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
We investigated the underlying reasons for the occurrence of misalignment artifacts in prospectively ECG-triggered axial coronary CT angiography scans. In this study we analyzed 56 consecutive patients scanned in axial mode and 66 consecutive patients scanned in helical mode. Predictors for the occurrence of misalignment artifacts were evaluated by multivariable logistic regression analysis for those patients scanned in the axial mode; advanced age was identified as the sole independent predictor (odds ratio: 1.088; 95 % CI: 1.012-1.170; p = 0.0228). In a comparison with the patients scanned in the helical mode, the image quality score for patients aged 65 years or older was significantly higher in helical mode than in axial mode (2.6 ± 0.5 and 2.4 ± 0.7, respectively; p = 0.0313). Misalignment artifacts in the image are more common in the elderly than in younger. Helical mode should be preferred in this older patient population to allow for good diagnostic image quality.
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Koplay M, Celik M, Avcı A, Erdogan H, Demir K, Sivri M, Nayman A. Comparison Between Prospectively Electrocardiogram-Gated High-Pitch Mode and Retrospectively Electrocardiogram-Gated Mode for Dual-Source CT Coronary Angiography. Pol J Radiol 2015; 80:561-8. [PMID: 26767072 PMCID: PMC4699622 DOI: 10.12659/pjr.895232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/04/2015] [Indexed: 01/01/2023] Open
Abstract
Background We aimed to report the image quality, relationship between heart rate and image quality, amount of contrast agent given to the patients and radiation doses in coronary CT angiography (CTA) obtained by using high-pitch prospectively ECG-gated “Flash Spiral” technique (method A) or retrospectively ECG-gated technique (method B) using 128×2-slice dual-source CT. Material/Methods A total of 110 patients who were evaluated with method A and method B technique with a 128×2-detector dual-source CT device were included in the study. Patients were divided into three groups based on their heart rates during the procedure, and a relationship between heart rate and image quality were evaluated. The relationship between heart rate, gender and radiation dose received by the patients was compared. Results A total of 1760 segments were evaluated in terms of image quality. Comparison of the relationship between heart rate and image quality revealed a significant difference between heart rate <60 beats/min group and >75 beats/min group whereas <60 beats/min and 60–75 beats/min groups did not differ significantly. The average effective dose for coronary CTA was calculated as 1.11 mSv (0.47–2.01 mSv) for method A and 8.22 mSv (2.19–12.88 mSv) for method B. Conclusions Method A provided high quality images with doses as low as <1 mSv in selected patients who have low heart rates with a high negative predictive value to rule out coronary artery disease. Although method B increases the amount of effective dose, it provides high diagnostic quality images for patients who have a high heart rate and arrhythmia which makes it is difficult to obtain images.
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Affiliation(s)
- Mustafa Koplay
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Mahmut Celik
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Ahmet Avcı
- Department of Cardiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Hasan Erdogan
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Kenan Demir
- Department of Cardiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Mesut Sivri
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Alaaddin Nayman
- Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey
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Celeng C, Vadvala H, Puchner S, Pursnani A, Sharma U, Kovacs A, Maurovich-Horvat P, Hoffmann U, Ghoshhajra B. Defining the optimal systolic phase targets using absolute delay time for reconstructions in dual-source coronary CT angiography. Int J Cardiovasc Imaging 2015; 32:91-100. [PMID: 26335369 DOI: 10.1007/s10554-015-0755-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
To define the optimal systolic phase for dual-source computed tomography angiography using an absolute reconstruction delay time after the R-R interval based on the coronary artery motion, we analyzed images reconstructed between 200 and 420 miliseconds (ms) after the R wave at 20 ms increments in 21 patients. Based on the American Heart Association coronary segmentation guidelines, the origin of six coronary artery landmarks (RCA, AM1, PDA, LM, OM1, and D2) were selected to calculate the coronary artery motion velocity. The velocity of the given landmark was defined as the quotient of the route and the length of the time interval. The x, y and z-coordinates of the selected landmark were recorded, and were used for the calculation of the 3D route of coronary artery motion by using a specific equation. Differences in velocities were assessed by analysis of variance for repeated measures; Bonferroni post hoc tests were used for multiple pair wise comparisons. 1488 landmarks were measured (6 locations at 12 systolic time points) in 21 patients and were analyzed. The mean values of the minimum velocities were calculated separately for each heart rate group (i.e. <65; 65-80; and >80 bpm). The mean lowest coronary artery velocities in each segment occurred in the middle period of each time interval of the acquired systolic phase i.e. 280-340 ms. No differences were found in the minimal coronary artery velocities between the three HR groups, with the exception of the AM1 branch (p = 0.00495) between <65 and >80 bpm (p = 0.03), and at HRs of 65-80 versus >80 bpm (p = 0.006). During an absolute delay of 200-420 ms after the R-wave, the ideal reconstruction interval varies significantly among coronary artery segments. Decreased velocities occur between 280 to 340 ms. Therefore a narrow range of systolic intervals, rather than a single phase, should be acquired.
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Affiliation(s)
- Csilla Celeng
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. .,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
| | - Harshna Vadvala
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Stefan Puchner
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Amit Pursnani
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Umesh Sharma
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Attila Kovacs
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
| | - Pâl Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
| | - Udo Hoffmann
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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He G, Liu X, Liu Y, Wang W, Ke Z. Dose study of electrocardiogram automatic tube current modulation technology in prospective coronary computed tomography angiography scans of overweight patients. Exp Ther Med 2015; 9:2384-2388. [PMID: 26136992 DOI: 10.3892/etm.2015.2412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/06/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the X-ray absorption dose and clinical applications of electrocardiogram (ECG)-gated automatic tube current modulation (ATCM) technology in prospective sequential computed tomography coronary angiography (CTCA) scans of overweight patients. A total of 40 patients with a body mass index of >24 were divided at random into groups A and B. Group A consisted of 20 patients, who were examined using ECG-ATCM scanning. For the patients in group A with heart rates <70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose X-rays for 60-80% of the R-R interval. For the group A patients with heart rates >70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose scanning for 35-55% of the R-R interval. For the 20 patients in group B, the scanning range was 20-80% of the R-R interval and patients received a full dose of X-ray radiation for the entire scanning period. The image quality and radiation dose was compared between the two groups. The average radiation dose in groups A and B was 6.91±2.78 and 10.43±3.36, respectively. The radiation doses in group A were reduced by 33.77% when compared with group B (P<0.05). However, there was no marked difference observed in image quality. In summary, using ECG-ATCM technology in prospective sequential CTCA scanning may significantly reduce the radiation dose required for overweight patients.
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Affiliation(s)
- Guiru He
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Xiaopei Liu
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Yan Liu
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Wei Wang
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
| | - Zhiliang Ke
- CT/MR Room, The Fifth Affiliated Hospital of Xinjiang Medical University, ürümqi, Xinjiang 830000, P.R. China
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Diagnostic quality of dual-source coronary CT examinations performed without heart rate control: importance of obesity and heart rate on image quality. J Comput Assist Tomogr 2015; 38:949-55. [PMID: 25032805 DOI: 10.1097/rct.0000000000000135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For dual-source cardiac computed tomography (CT) scans without heart rate (HR) control, the influence of body habitus on quality is uncertain. We evaluated study quality across a range of HRs and body size. METHODS One hundred sixty subjects were randomly selected for 4 HR groups (<70, 70-79, 80-89, ≥90 beats per minute) from 703 subjects who underwent cardiac CT without premedication. Coronary visualization quality was scored on a 3-point scale (1, nondiagnostic; 2, diagnostic; 3, excellent). RESULTS Ninety-nine percent of coronaries were diagnostic quality. Six vessels were nondiagnostic, mostly due to motion. Nondiagnostic or diagnostic scores (<3) were greatest in the group with HR of more than or equal to 90 beats per minute. All normal weight subjects had excellent quality, but 6% of vessels in overweight and 17% in obese subjects had diagnostic scores less than 3. The mean effective dose was 11.4 mSv and correlated with body size. CONCLUSIONS Diagnostic quality cardiac CT examinations can be obtained without premedication regardless of body size.
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