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Liguori C, Lassandro G, Ferrandino G, Picchi SG, Tamburrini S, Toro G, Tamburro F, Masala S, Scaglione M. ECG-Gated CCTA in the Assessment of Post-Procedural Complications. Diagnostics (Basel) 2023; 13:2500. [PMID: 37568862 PMCID: PMC10417539 DOI: 10.3390/diagnostics13152500] [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: 05/04/2023] [Revised: 07/15/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the role of ECG-gated coronary CT angiography (CCTA) in the diagnosis, imaging follow-up, and treatment guidance in post-procedural/surgical interventions in the heart and thoracic aorta (PTCA, TAVI, PMK/ICD placement, CABGs). MATERIALS AND METHODS We retrospectively evaluated 294 ECG-gated CCTA studies performed in our center from January 2020 to January 2023. CCTA studies were acquired to detect/exclude possible complications related to the endovascular or surgical procedure. RESULTS There were 27 cases (9.2%) of post-procedural complications. Patients enrolled in the study were 18 males and 9 females (male/female ratio: 2), with age ranging from 47 to 86 years (mean age, 68.3 years). Among percutaneous coronary intervention (PCI) complications, coronary intimal dissection with ascending aorta involvement was found to be the most frequent complication after PTCA (22.2%). Vascular wall pseudoaneurysm formation (11.1%) and coronary stent misalignment or displacement (14.8%) were complications less frequently encountered after PTCA. Right atrial or ventricular perforation with associated hemopericardium were the most common complications (18.5%) after pacemaker implantation. Complications encountered after aortic valve interventions were loosening and dislocation of the prosthesis associated with aortic root pseudoaneurysm (7.4%), para-valvular leak (11.1%), and hemopericardium (7.4%). In one patient who underwent transcatheter repair of patent foramen ovale (3.7%), CTTA detected the dislocation of the Amplatzer septal occluder. CONCLUSIONS ECG-gated CCTA is a fundamental diagnostic tool for the detection of post-procedural endovascular/surgical complications to enable optimal patient management. Radiologists must be familiar with the use of cardiac synchronization in the course of CT and must be aware of all possible complications that can occur in the context of acute settings or routine follow-up studies.
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Affiliation(s)
- Carlo Liguori
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Giovanni Ferrandino
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Stefano Giusto Picchi
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Gabriella Toro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Salvatore Masala
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (S.M.)
| | - Mariano Scaglione
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (S.M.)
- Department of Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
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An H, Xie R, Ge Y, Wang T. Progress of CT aortic angiography combined with coronary artery in the evaluation of acute aortic syndrome. Front Cardiovasc Med 2022; 9:1036982. [PMID: 36479572 PMCID: PMC9719981 DOI: 10.3389/fcvm.2022.1036982] [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: 09/05/2022] [Accepted: 10/12/2022] [Indexed: 09/19/2023] Open
Abstract
Acute aortic syndrome (AAS) is a group of cardiovascular diseases that seriously threaten human life and health. AAS patients are often complicated with coronary artery disease and other related diseases, which require rapid and clear clinical diagnosis to avoid serious adverse events. In recent years, with the progress of science and technology, a variety of computer tomography (CT) angiography techniques have been applied in the clinic, and the diagnosis rate of AAS with coronary heart disease (CAD) has greatly increased. At the same time, the development of surgical technology and endovascular repair technology has significantly reduced the mortality and complication rate of AAS surgery. In the clinical diagnosis of AAS and related diseases, CT aortic angiography (CTA) combined with coronary CTA is increasingly applied to identify related diseases. Here, the current research progress on the technique of aortic CTA combined with coronary CTA is reviewed.
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Affiliation(s)
- Hengbin An
- School of Basic Medicine, Xinxiang Medical University, Xinxiang, China
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
- Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou, China
| | - Ruigang Xie
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
- Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou, China
| | - Yinghui Ge
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
- Henan Provincial Key Laboratory of Cardiology Medical Imaging, Zhengzhou, China
| | - Tianyun Wang
- School of Basic Medicine, Xinxiang Medical University, Xinxiang, China
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Huang H, Liang J, Chen X, Shi L, Zeng G, Wu Y, Yang C. Clinical Application Value of Multimedia Education and Nursing Intervention in a Coronary Computed Tomography Angiography. Clin Nurs Res 2022; 31:607-614. [PMID: 35306865 DOI: 10.1177/10547738221075726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To explore the application value of multimedia education and nursing intervention in a coronary computed tomography angiography (CCTA). A total of 120 patients who underwent a 256-slice spiral CCTA examination in our hospital from April 2019 to April 2020 were selected. Patients were divided into two groups of 60 patients each, that is, the control group and the observation group, using a random number table method. The control group received traditional education before an examination, and patients were given routine breathing training. The observation group was given multimedia education and nursing intervention. The heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), and respiratory rate in the two groups were observed. The psychological status, imaging quality, and incidence of adverse reactions were compared between the two groups. The HR, DBP, SBP, and respiratory rate of the observation group were all lower compared to those in control group, and the differences were statistically significant ( p < 0.05). Following multimedia education and nursing intervention, the anxiety and depression scores of patients in the observation group were considerably lower compared with those in the control group, and the differences were statistically significant ( p < 0.05). Observation group image quality I level higher than the control group, and the proportion of patients with the difference was statistically significant ( p < 0.05). The proportion of grade II to IV patients was lower in the observation group than in the control group; however, the difference was not statistically significant ( p > 0.05). There was a significant difference in the incidence of adverse reactions between the two groups (χ2, p = .031). For patients undergoing a CCTA examination, multimedia education and nursing intervention can effectively improve their immediate psychological state, control their heart rate, and blood pressure before the examination, reduce the incidence of adverse reactions and improve imaging quality, thereby improving the overall reliability of a clinical diagnosis.
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Affiliation(s)
- Hongfang Huang
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Junli Liang
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Xiuzhen Chen
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Lili Shi
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Guanzhen Zeng
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Yaomin Wu
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Chunhong Yang
- The First Affiliated Hospital of Guangxi Medical University, China
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Jiang J, Zhang M, Ji Y, Li C, Fang X, Zhang S, Wang W, Wang L, Liu A. An Individualized Contrast-Enhanced Liver Computed Tomography Imaging Protocol Based on Body Mass Index in 126 Patients Seen for Liver Cirrhosis. Med Sci Monit 2021; 27:e932109. [PMID: 34162827 PMCID: PMC8240488 DOI: 10.12659/msm.932109] [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] [Indexed: 11/09/2022] Open
Abstract
Background Computed tomography (CT) imaging using iodinated contrast medium is associated with the radiation dose to the patient, which may require reduction in individual circumstances. This study aimed to evaluate an individualized liver CT protocol based on body mass index (BMI) in 126 patients investigated for liver cirrhosis. Material/Methods From November 2017 to December 2020, in this prospective study, 126 patients with known or suspected liver cirrhosis were recruited. Patients underwent liver CT using individualized protocols based on BMI, as follows. BMI ≤24.0 kg/m2: 80 kV, 352 mg I/kg; BMI 24.1–28.0 kg/m2: 100 kV, 440 mg I/kg; BMI ≥28.1 kg/m2: 120 kV, 550 mg I/kg. Figure of merit (FOM) and size-specific dose estimates (SSDEs) were calculated and compared using the Mann-Whitney U test. Subjective image quality and timing adequacy of the late arterial phase were evaluated with Likert scales. Results The SSDE was significantly lower in the 80 kV protocol, corresponding to a dose reduction of 36% and 50% compared with the others (all P<0.001). In the comparison of 80-, 100-, and 120-kV protocols, no statistically significant differences were found in FOMs (P=0.108~0.620). Of all the examinations, 95.2% (120 of 126) were considered as appropriate timing for the late arterial phase. In addition, overall image quality, hepatocellular carcinoma conspicuity, and detection rate did not differ significantly among the 3 protocols (P=0.383~0.737). Conclusions This study demonstrated the feasibility of using an individualized liver CT protocol based on BMI, and showed that patients with lower BMI should receive lower doses of iodinated contrast medium and significantly reduced radiation dose.
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Affiliation(s)
- Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Maowei Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Yuan Ji
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Chunfeng Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Xin Fang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Shuyuan Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Wei Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China (mainland)
| | - Lijun Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Ailian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
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Schicchi N, Fogante M, Palumbo P, Agliata G, Esposto Pirani P, Di Cesare E, Giovagnoni A. The sub-millisievert era in CTCA: the technical basis of the new radiation dose approach. Radiol Med 2020; 125:1024-1039. [PMID: 32930945 DOI: 10.1007/s11547-020-01280-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit-risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose.
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Affiliation(s)
- Nicolò Schicchi
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
| | - Marco Fogante
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy.
| | - Pierpaolo Palumbo
- Radiology Department, Azienda Ospedaliero Universitaria "San Salvatore", 60126, L'Aquila, Italy
| | - Giacomo Agliata
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
| | - Paolo Esposto Pirani
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
| | - Ernesto Di Cesare
- Radiology Department, Azienda Ospedaliero Universitaria "San Salvatore", 60126, L'Aquila, Italy
| | - Andrea Giovagnoni
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy
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