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Boninsegna E, Piffer S, Simonini E, Romano M, Lettieri C, Colopi S, Barai G. CT angiography prior to endovascular procedures: can artificial intelligence improve reporting? Phys Eng Sci Med 2024; 47:643-649. [PMID: 38294678 DOI: 10.1007/s13246-024-01393-1] [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: 11/29/2022] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
CT angiography prior to endovascular aortic surgery is the standard non-invasive imaging method for evaluation of aortic dimensions and access sites. A detailed report is crucial to a proper planning. We assessed Artificial Intelligence (AI)-algorithm accuracy to measure vessels diameters at CT prior to transcatheter aortic valve implantation (TAVI). CT scans of 50 patients were included. Two Radiologists with experience in vascular imaging together manually assessed diameters at nine landmark positions according to the American Heart Association guidelines: 450 values were obtained. We implemented TOST (Two One-Sided Test) to determine whether the measurements were equivalent to the values obtained from the AI algorithm. When the equivalence bound was a range of ± 2 mm the test showed equivalence for every point; if the range was equal to ± 1 mm the two measurements were not equivalent in 6 points out of 9 (p-value > 0.05), close to the aortic valve. The time for automatic evaluation (average 1 min 47 s) was significantly lower compared with manual measurements (5 min 41 s) (p < 0.01). In conclusion, our results indicate that AI-algorithms can measure aortic diameters at CT prior to endovascular surgery with high accuracy. AI-assisted reporting promises high efficiency, reduced inter-reader variabilities and time saving. In order to perform optimal TAVI procedure planning aortic root analysis could be improved, including annulus dimensions.
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Affiliation(s)
- Enrico Boninsegna
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, St. Lago Paiolo 10, 46100, Mantova, Italy.
| | - Stefano Piffer
- Department of Medical Physics, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Emilio Simonini
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, St. Lago Paiolo 10, 46100, Mantova, Italy
| | - Michele Romano
- Department of Cardiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Corrado Lettieri
- Department of Cardiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Stefano Colopi
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, St. Lago Paiolo 10, 46100, Mantova, Italy
| | - Giampietro Barai
- Department of Medical Physics, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
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Hagar MT, Kluemper T, Hein M, von Zur Muhlen C, Faby S, Capilli F, Schuppert C, Schmitt R, Ruile P, Westermann D, Schlett CL, Bamberg F, Krauss T, Soschynski M. Photon-counting CT-angiography in pre-TAVR aortic annulus assessment: effects of retrospective vs. prospective ECG-synchronization on prosthesis valve selection. Int J Cardiovasc Imaging 2024; 40:811-820. [PMID: 38360986 PMCID: PMC11052843 DOI: 10.1007/s10554-024-03050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/07/2024] [Indexed: 02/17/2024]
Abstract
To compare the diagnostic value of ultrahigh-resolution CT-angiography (UHR-CTA) compared with high-pitch spiral CTA (HPS-CTA) using a first-generation, dual-source photon-counting CT (PCD-CT) scanner for preprocedural planning of transcatheter aortic valve replacement (TAVR). Clinically referred patients with severe aortic valve stenosis underwent both, retrospective ECG-gated cardiac UHR-CTA (collimation: 120 × 0.2 mm) and prospective ECG-triggered aortoiliac HPS-CTA (collimation: 144 × 0.4 mm, full spectral capabilities) for TAVR planning from August 2022 to March 2023. Radiation dose was extracted from the CT reports, and the effective dose was calculated. Two radiologists analyzed UHR-CTA and HPS-CTA datasets, assessing the image quality of the aortic annulus, with regard to the lumen visibility and margin delineation using a 4-point visual-grading scale (ranges: 4 = "excellent" to 1 = "poor"). Aortic annulus area (AAA) measurements were taken for valve prosthesis sizing, with retrospective UHR-CTA serving as reference standard. A total of 64 patients were included (mean age, 81 years ± 7 SD; 28 women) in this retrospective study. HPS-CTA showed a lower radiation dose, 4.1 mSv vs. 12.6 mSv (p < 0.001). UHR-CTA demonstrated higher image quality to HPS-CTA (median score, 4 [IQR, 3-4] vs. 3 [IQR, 2-3]; p < 0.001). Quantitative assessments of AAA from both CTA datasets were strongly positively correlated (mean 477.4 ± 91.1 mm2 on UHR-CTA and mean 476.5 ± 90.4 mm2 on HPS-CTA, Pearson r2 = 0.857, p < 0.001) with a mean error of 22.3 ± 24.6 mm2 and resulted in identical valve prosthesis sizing in the majority of patients (91%). Patients with lower image quality on HPS-CTA (score value 1 or 2, n = 28) were more likely to receive different sizing recommendations (82%). Both UHR-CTA and HPS-CTA acquisitions using photon-counting CT technology provided reliable aortic annular assessments for TAVR planning. While UHR-CTA offers superior image quality, HPS-CTA is associated with lower radiation exposure. However, severely impaired image quality on HPS-CTA may impact on prosthesis sizing, suggesting that immediate post-scan image evaluations may require complementary UHR-CTA scanning.
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Affiliation(s)
- Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Theresa Kluemper
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Muhlen
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Faby
- Computed Tomography, Siemens Healthineers AG, 91301, Forchheim, Germany
| | - Fabio Capilli
- Department of Radiology, Neuroradiology and Nuclear Medicine, Medical Center Vest, Ruhr University Bochum, Dorstener Straße 151, 45657, Recklinghausen, Germany
| | - Christopher Schuppert
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Ramona Schmitt
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Fogante M, Esposto Pirani P, Cela F, Balardi L, Piva T, Argalia G, Schicchi N. Ultra-low radiation dose and contrast volume CT protocol and TAVI-CT score for TAVI planning and outcome. Br J Radiol 2023; 96:20221026. [PMID: 37183830 PMCID: PMC10392642 DOI: 10.1259/bjr.20221026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To investigate the feasibility of an ultra-low radiation dose and contrast volume protocol using third-generation dual-source (DS) CT for transcatheter aortic valve implantation (TAVI) planning with coronary artery disease (CAD) assessment, coronary artery calcium score (CACS) and aortic valve calcium score (AVCS) quantification and to evaluate their relationship with TAVI outcome. METHODS In this retrospective study were selected 203 patients (131 males, 79.4 ± 5.4 years) underwent to TAVI and at 30- and 90-day follow-up. All patients had performed a third-generation 2 × 192-slices DSCT. The CT protocol included a non-contrast and a contrast high-pitch aortic acquisition for TAVI planning and CAD assessment. Semi-qualitative and quantitative image analysis were performed; the performance in CAD assessment was compared with ICA; the relationship between AVCS and CACS and paravalvular aortic regurgitation (PAR) and major cardiovascular events (MACEs) were evaluated. Mean radiation dose were calculated. Non-parametric tests were used. RESULTS Semi-qualitative image analysis was good. Contrast enhancement >500 Hounsfield unit (HU) and contrast-to-noise ratio <20 were obtained in all segments. The diagnostic accuracy in CAD was 89.0%. AVCS was significantly higher in patients with 30-day severe PAR. AVCS and CACS were higher in patients with 90-day MACE complications, respectively, 1904.5 ± 621.3 HU (p < 0.0001) and 769.2 ± 365.5 HU (p < 0.0230). Mean radiation dose was 2.8 ± 0.3 mSv. CONCLUSION A TAVI planning ultra-low radiation dose and contrast volume protocol using third-generation DSCT provides highly diagnostic images with CAD assessment, AVCS and CACS quantification and these latter were related with TAVI outcomes. ADVANCES IN KNOWLEDGE The proposed protocol using third-generation 2 × 192-slices DSCT allows with an ultra-low radiation dose and contrast volume the TAVI planning and the coronary artery assessment.
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Affiliation(s)
- Marco Fogante
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Paolo Esposto Pirani
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Fatjon Cela
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Liliana Balardi
- Direzione Aziendale, University Hospital of Marche, Ancona, Italy
| | - Tommaso Piva
- SOD Cardiologia Ospedaliera e UTIC, University Hospital of Marche, Ancona, Italy
| | - Giulio Argalia
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Nicolò Schicchi
- SOS Diagnostica Radiologica Cardiovascolare - University Hospital of Marche, Ancona, Italy
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Kędzierski B, Macek P, Dziadkowiec-Macek B, Truszkiewicz K, Poręba R, Gać P. Radiation Doses in Cardiovascular Computed Tomography. Life (Basel) 2023; 13:life13040990. [PMID: 37109519 PMCID: PMC10141413 DOI: 10.3390/life13040990] [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: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
We discussed the contemporary views on the effects of ionising radiation on living organisms and the process of estimating radiation doses in CT examinations and the definitions of the CTDI, CTDIvol, DLP, SSDE, ED. We reviewed the reports from large analyses on the radiation doses in CT examinations of the coronary arteries prior to TAVI procedures, including the CRESCENT, PROTECTION, German Cardiac CT Registry studies. These studies were carried out over the last 10 years and can help confront the daily practice of performing cardiovascular CT examinations in most centres. The reference dose levels for these examinations were also collected. The methods to optimise the radiation dose included tube voltage reduction, ECG-monitored tube current modulation, iterative and deep learning reconstruction techniques, a reduction in the scan range, prospective study protocols, automatic exposure control, heart rate control, rational use of the calcium score, multi-slices and dual-source and wide-field tomography. We also present the studies that indicated the need to raise the organ conversion factor for cardiovascular studies from the 0.014-0.017 mSv/mGy*cm used for chest studies to date to a value of 0.0264-0.03 mSv/mGy*cm.
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Affiliation(s)
- Bartłomiej Kędzierski
- Department of Radiology and Imaging Diagnostics, Emergency Medicine Center, Marciniak Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wrocław, Poland
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Barbara Dziadkowiec-Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Krystian Truszkiewicz
- Department of Radiology and Imaging Diagnostics, Emergency Medicine Center, Marciniak Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wrocław, Poland
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Milo SM, Toia P, Midiri F, D'Alessandro L, Sollami G, Panci A, Pernice V, Violante F, Fattouch K, Cutaia G, Salvaggio G, Lo Re G, Grassedonio E, Galia M, La Grutta L. Aortic valve and vascular calcium score in pre-TAVI CT: correlation with early post-procedural complications. LA RADIOLOGIA MEDICA 2023; 128:299-306. [PMID: 36786969 PMCID: PMC10020291 DOI: 10.1007/s11547-023-01603-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE The aim of our study was to evaluate the prevalence of early complications after Transcatheter Aortic Valve Implantation (TAVI) and their correlation with the Calcium Score (CS) of the aortic valve, aorta and ilio-femoral arteries derived from pre-procedural computed tomography (CT). MATERIALS AND METHODS We retrospectively reviewed 226 patients (100 males, mean age 79.4 ± 6.7 years) undergoing 64-slice CT for pre-TAVI evaluation from January 2018 to April 2021. The population was divided into CS quartiles. RESULTS Overall, 173 patients underwent TAVI procedure, of whom 61% presented paravalvular leak after the procedure, 28% presented bleeding or vascular complications, 25% presented atrioventricular block, and 8% developed acute kidney injury. The prevalence of paravalvular leak and vascular complications was higher in the upper CS quartiles for aortic valve and ilio-femoral arteries. CONCLUSIONS Aortic valve and vascular CS could help to predict post-TAVI early complications.
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Affiliation(s)
- Sabrina Maria Milo
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Patrizia Toia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Federico Midiri
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Luigi D'Alessandro
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Giulia Sollami
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Aldo Panci
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Vincenzo Pernice
- GVM Care and Research, Department of Hemodynamics and Interventional Cardiac and Vascular, Maria Eleonora Hospital, Palermo, Italy
| | - Francesco Violante
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Khalil Fattouch
- GVM Care and Research, Department of Cardiovascular Surgery, Maria Eleonora Hospital, Palermo, Italy
| | - Giuseppe Cutaia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Giuseppe Salvaggio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Giuseppe Lo Re
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Emanuele Grassedonio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Massimo Galia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - ProMISE, University of Palermo, Via Del Vespro 12790100, Palermo, Italy.
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Lacy SC, Benjamin MM, Osman M, Syed MA, Kinno M. Low Contrast and Low kV CTA Before Transcatheter Aortic Valve Replacement: A Systematic Review. J Cardiovasc Imaging 2023; 31:108-115. [PMID: 37096677 PMCID: PMC10133812 DOI: 10.4250/jcvi.2022.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Minimizing contrast dose and radiation exposure while maintaining image quality during computed tomography angiography (CTA) for transcatheter aortic valve replacement (TAVR) is desirable, but not well established. This systematic review compares image quality for low contrast and low kV CTA versus conventional CTA in patients with aortic stenosis undergoing TAVR planning. METHODS We performed a systematic literature review to identify clinical studies comparing imaging strategies for patients with aortic stenosis undergoing TAVR planning. The primary outcomes of image quality as assessed by the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were reported as random effects mean difference with 95% confidence interval (CI). RESULTS We included 6 studies reporting on 353 patients. There was no difference in cardiac SNR (mean difference, -1.42; 95% CI, -5.71 to 2.88; p = 0.52), cardiac CNR (mean difference, -3.83; 95% CI, -9.98 to 2.32; p = 0.22), aortic SNR (mean difference, -0.23; 95% CI, -7.83 to 7.37; p = 0.95), aortic CNR (mean difference, -3.95; 95% CI, -12.03 to 4.13; p = 0.34), and ileofemoral SNR (mean difference, -6.09; 95% CI, -13.80 to 1.62; p = 0.12) between the low dose and conventional protocols. There was a difference in ileofemoral CNR between the low dose and conventional protocols with a mean difference of -9.26 (95% CI, -15.06 to -3.46; p = 0.002). Overall, subjective image quality was similar between the 2 protocols. CONCLUSIONS This systematic review suggests that low contrast and low kV CTA for TAVR planning provides similar image quality to conventional CTA.
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Affiliation(s)
- Spencer C. Lacy
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mina M. Benjamin
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mohammed Osman
- Knight & Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Mushabbar A. Syed
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Menhel Kinno
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
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Three-Dimensional Transesophageal Echocardiography as an Alternative to Multidetector Computed Tomography in Aortic Annular Diameter Measurements for Transcatheter Aortic Valve Implantation. BIOLOGY 2021; 10:biology10020132. [PMID: 33567521 PMCID: PMC7916087 DOI: 10.3390/biology10020132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Simple Summary Patients who have multiple associated comorbidities and need to change the aortic valve may have a contraindication to open-heart surgery, the alternative being transcatheter aortic valve implantation, which requires very precise measurements of the aortic annulus to determine the dimensions of the prostheses. Ultrasonographic imaging techniques, such as transesophageal echocardiography, are constantly evolving. The aim of our study was to compare the three-dimensional transesophageal echocardiography and multi-detector computer tomography methods, with the former being an alternative for patients who cannot undergo computer tomography because of a major contraindication. We have demonstrated that there were small differences between aortic annular measurements using multi-detector computer tomography (2.25 ± 0.19 cm) and three-dimensional transesophageal echocardiography (2.25 ± 0.15 cm). Thus, three-dimensional transesophageal echocardiography can be the solution for aortic annular measurements used to select the correct prosthesis for the transcatheter aortic valve implantation procedure in patients who cannot undergo computer tomography. Abstract Background and objectives: Transcatheter aortic valve implantation (TAVI) is a therapeutic choice for high surgical risk patients, serving as an alternative to open-heart surgery. Correct measurement of the aortic annulus, which leads to the selection of a suitable prosthesis and accurate outcome prediction, is essential for the success of TAVI. The objective of this study is to evaluate the accuracy of novel imaging te chniques in measuring the aortic annulus by comparing multi-detector computer tomography (MDCT) and three-dimensional transesophageal echocardiography (3D TEE) for the selection of the optimal prosthesis. Materials and Methods: Measurements of the aortic annulus have been performed on 25 patients using MDCT and TEE, and the correlation and agreement levels between the two measuring techniques were analyzed. MDCT measurements were used for the sizing of the prostheses. Results: MDCT and TEE measurements of aortic annular diameters were significantly correlated, with a mean difference of 0.001 cm. Conclusions: 3D TEE measurements have been in good agreement with MDCT and, therefore, 3D TEE can be used as an alternative in cases where MDCT is contraindicated or not available.
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Choe YH, Kim SM, Park SJ. Computed tomography and magnetic resonance imaging assessment of aortic valve stenosis: an update. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Kaschwich M, Horn M, Matthiensen S, Stahlberg E, Behrendt CA, Matysiak F, Bouchagiar J, Dell A, Ellebrecht D, Bayer A, Kleemann M. Accuracy evaluation of patient-specific 3D-printed aortic anatomy. Ann Anat 2020; 234:151629. [PMID: 33137459 DOI: 10.1016/j.aanat.2020.151629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION 3D printing has a wide range of applications in medicine. In surgery, this technique can be used for preoperative planning of complex procedures, production of patient specific implants, as well as training. However, accuracy evaluations of 3D vascular models are rare. OBJECTIVES Aim of this study was to investigate the accuracy of patient-specific 3D-printed aortic anatomies. METHODS Patients suffering from aorto-iliac aneurysms and with indication for treatment were selected on the basis of different anatomy and localization of the aneurysm in the period from January 1st 2014 to May 27th 2016. Six patients with aorto-iliac aneurysms were selected out of the database for 3D-printing. Subsequently, computed tomography (CT) images of the printed 3D-models were compared with the original CT data sets. RESULTS The mean deviation of the six 3D-vascular models ranged between -0.73 mm and 0.14 mm compared to the original CT-data. The relative deviation of the measured values showed no significant difference between the 3D-vascular and the original patient CT-data. CONCLUSION Our results showed that 3D printing has the potential to produce patient-specific 3D vascular models with reliable accuracy. This enables the use of such models for the development of new endovascular procedures and devices.
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Affiliation(s)
- Mark Kaschwich
- Biomedical Engineering Laboratory, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Department of Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Marco Horn
- Department of Surgery, Division of Vascular and Endovascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Sarah Matthiensen
- Biomedical Engineering Laboratory, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Erik Stahlberg
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Florian Matysiak
- Biomedical Engineering Laboratory, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Juljan Bouchagiar
- Biomedical Engineering Laboratory, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Annika Dell
- Biomedical Engineering Laboratory, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | | | - Andreas Bayer
- Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Markus Kleemann
- Biomedical Engineering Laboratory, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Kliniken Dr. Erler, 90429 Nürnberg, Germany
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Coronary artery bypass grafting and perioperative stroke: imaging of atherosclerotic plaques in the ascending aorta with ungated high-pitch CT-angiography. Sci Rep 2020; 10:13909. [PMID: 32807858 PMCID: PMC7431556 DOI: 10.1038/s41598-020-70830-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Abstract
Perioperative stroke is a devastating complication after coronary artery bypass graft (CABG) surgery, with atherosclerosis of the ascending aorta as important risk factor. During surgical manipulation, detachment of plaques can lead to consecutive embolization into brain-supplying arteries. High-pitch computed tomography angiography (HP-CTA) represents a non-invasive imaging modality, which provides the opportunity for comprehensive imaging of the ascending aorta, including plaque detection and advanced characterization. In our present retrospective study on 719 individuals, who had undergone HP-CTA within 6 months prior to CABG, atherosclerotic disease of the ascending aorta was evaluated with respect to perioperative stroke rates. For image analysis, the ascending aorta was divided into a proximal and distal part, consisting of four segments, and evaluated for presence and distribution of calcified and mixed plaques. All patients with perioperative stroke presented with atherosclerotic disease of the ascending aorta. The stroke rate was significantly associated with the presence and extent of atherosclerotic disease. Patients burdened with mixed plaques presented with significantly higher perioperative stroke rates. This study demonstrates that HP-CTA allows accurate evaluation of plaque extent and composition in the ascending aorta, and therefore may improve risk stratification of stroke prior to CABG.
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Long Q, Ye X, Zhao Q. Artificial intelligence and automation in valvular heart diseases. Cardiol J 2020; 27:404-420. [PMID: 32567669 DOI: 10.5603/cj.a2020.0087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
Abstract
Artificial intelligence (AI) is gradually changing every aspect of social life, and healthcare is no exception. The clinical procedures that were supposed to, and could previously only be handled by human experts can now be carried out by machines in a more accurate and efficient way. The coming era of big data and the advent of supercomputers provides great opportunities to the development of AI technology for the enhancement of diagnosis and clinical decision-making. This review provides an introduction to AI and highlights its applications in the clinical flow of diagnosing and treating valvular heart diseases (VHDs). More specifically, this review first introduces some key concepts and subareas in AI. Secondly, it discusses the application of AI in heart sound auscultation and medical image analysis for assistance in diagnosing VHDs. Thirdly, it introduces using AI algorithms to identify risk factors and predict mortality of cardiac surgery. This review also describes the state-of-the-art autonomous surgical robots and their roles in cardiac surgery and intervention.
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Affiliation(s)
- Qiang Long
- Department of Cardiac Surgery,Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, China.
| | - Xiaofeng Ye
- Department of Cardiac Surgery,Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, China
| | - Qiang Zhao
- Department of Cardiac Surgery,Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, China
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Third generation dual source CT with ultra-high pitch protocol for TAVI planning and coronary tree assessment: feasibility, image quality and diagnostic performance. Eur J Radiol 2020; 122:108749. [DOI: 10.1016/j.ejrad.2019.108749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 01/14/2023]
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Chiocchi M, Forcina M, Morosetti D, Pugliese L, Cavallo AU, Citraro D, De Stasio V, Presicce M, Floris R, Romeo F. The role of computed tomography in the planning of transcatheter aortic valve implantation: a retrospective analysis in 200 procedures. J Cardiovasc Med (Hagerstown) 2019; 19:571-578. [PMID: 30015782 DOI: 10.2459/jcm.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM The aim of our study is to show the importance of multislice computed tomography (CT) assessment in the overall management and diagnostic framework of transcatheter aortic valve replacement (TAVI) procedure candidates. METHODS Between June 2015 and April 2017, 200 patients with severe aortic stenosis, not eligible for surgery, were enrolled, as defined by EuroSCORE; they were submitted to TAVI at the interventional cardiology department of the Tor Vergata Polyclinic. CT studies were performed using a 64-slice scanner. RESULTS The reports and datasets produced during the pre-TAVI CT evaluation were retrospectively evaluated. DISCUSSION In TAVI candidates, accurate aortic valve shape and dimensions evaluation is crucial for the proper deployment of the prosthetic valve and in order to reduce postprocedural complications. ECG retrospective gated cardiac CT gives the clinician three-dimensional images of the heart, with high spatial resolution and multiplanar reconstructions allowing accurate visualization of the aortic annulus and coronary ostia to be obtained, and the evaluation of arterial calcifications. Furthermore, CT can provide data on the suitability of peripheral vascular accesses. Moreover, this technique can point out the presence of clinically relevant extracardiac findings. Therefore, CT evaluation assures a safe, reliable and prognostically relevant method for TAVI preprocedural planning. CONCLUSION Our study remarks the importance of CT assessment in the overall management and diagnostic framework of TAVI candidates; the information provided is essential in order to minimize possible complications and to improve the quality of the therapeutic planning.
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Affiliation(s)
- Marcello Chiocchi
- Fondazione PTV Policlinico Tor Vergata, Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Rome, Italy
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Annoni AD, Andreini D, Pontone G, Mancini ME, Formenti A, Mushtaq S, Baggiano A, Conte E, Guglielmo M, Muscogiuri G, Muratori M, Fusini L, Trabattoni D, Teruzzi G, Coutinho Santos AI, Agrifoglio M, Pepi M. CT angiography prior to TAVI procedure using third-generation scanner with wide volume coverage: feasibility, renal safety and diagnostic accuracy for coronary tree. Br J Radiol 2018; 91:20180196. [PMID: 30004788 DOI: 10.1259/bjr.20180196] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE: To evaluate feasibility, image quality and accuracy of a reduced contrast volume protocol for pre-procedural CT imaging in transcatheter aortic valve implantation (TAVI) using a third generation wide array CT scanner. METHODS: 115 consecutive patients (51F, mean age 82.5 ± 6.2 y, mean BMI 26.7 ± 3.6) referred for TAVI were examined with wide-array CT scanner with a combined scan protocol and a total amount of 50 ml contrast agent. A 4-point visual scale (4-1) was used to assess image quality . Contrast attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries. Coronary tree was assessed and compared with invasive coronary angiography (ICA). Aortic annulus measurements were compared with final procedural results. Patients creatinine was monitored at the baseline and 72 h after procedure. RESULTS: Median quality score value was >3. Mean CNR at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries were 14.8 ± 2.3, 15.7 ± 1.7, 14.9 ± 3.1, 15.8 ± 4.7, 20.3 ± 9.9, 20.8 ± 6.9 respectively. Only 1 patient had moderate paravalvular regurgitation. In comparison with ICA for coronary assessment CTA showed in a segment based analysis sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 97, 85, 99,62 and 88% respectively. Mean creatinine before CT and 72 h after procedure were 1.21 ± 0.52 and1.22 ± 0.49 mg dl-1. Mean DLP was 442.4 ± 21.2 mGy/cm. CONCLUSION: CT with low contrast volume is feasible and clinically useful, allowing precise pre-procedural TAVI planning with accurate assessment of coronary tree. ADVANCES IN KNOWLEDGE: third generation CT scanner with whole heart coverage allows examinations for assessment of aorta and coronary arteries in TAVI planning using low dose of contrast medium maintaining good quality and high diagnostic accuracy.
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Affiliation(s)
- Andrea D Annoni
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Daniele Andreini
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Gianluca Pontone
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | | | - Alberto Formenti
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Saima Mushtaq
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | | | - Edoardo Conte
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Marco Guglielmo
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Giuseppe Muscogiuri
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Manuela Muratori
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Laura Fusini
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Daniela Trabattoni
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Giovanni Teruzzi
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Ana I Coutinho Santos
- 2 Imaging Department, Centro Hospitalar de Lisboa Ocidental, E.P.E , Lisboa , Portugal
| | - Marco Agrifoglio
- 3 Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy.,4 Cardiac Surgery Department, Centro Cardiologico Monzino, IRCCS , Milan , Italy
| | - Mauro Pepi
- 1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan , Italy
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