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Ishidoya Y, Ranjan R. Novel Approaches to Risk Assessment for Ventricular Tachycardia Induction and Therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-020-00666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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2
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Takigawa M, Duchateau J, Sacher F, Martin R, Vlachos K, Kitamura T, Sermesant M, Cedilnik N, Cheniti G, Frontera A, Thompson N, Martin C, Massoullie G, Bourier F, Lam A, Wolf M, Escande W, André C, Pambrun T, Denis A, Derval N, Hocini M, Haissaguerre M, Cochet H, Jaïs P. Are wall thickness channels defined by computed tomography predictive of isthmuses of postinfarction ventricular tachycardia? Heart Rhythm 2019; 16:1661-1668. [DOI: 10.1016/j.hrthm.2019.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 10/26/2022]
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Chatzaraki V, Thali MJ, Schweitzer W, Ampanozi G. Left myocardial wall measurements on postmortem imaging compared to autopsy. Cardiovasc Pathol 2019; 43:107149. [PMID: 31639653 DOI: 10.1016/j.carpath.2019.107149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/27/2019] [Accepted: 08/12/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The aims of this study were, firstly, to determine the relationship of left ventricular wall thickness (LVWT) measurements between postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMR) and, secondly, to assess the utility of postmortem imaging for LVWT measurements compared to autopsy. MATERIALS AND METHODS All cases ≥18years old, with postmortem interval ≤4days, cardiac PMCT, PMMR, and full forensic autopsy, were reviewed in our database retrospectively. Exclusion criteria were gas accumulations in the myocardial wall and cardiac trauma. LVWT on PMCT and PMMR was assessed. The measurements were repeated by the same rater after 2months. Autopsy reports were reviewed, and LVWT and pericardial fluid volume measured at autopsy were noted. Pericardial fluid volume >50ml was determined positive for pericardial effusion. RESULTS A total of 113 cases were included in the study. Twelve cases had pericardial effusion. Intrarater reliability for imaging based LVWT was excellent. LVWT (free wall) was significantly larger on PMCT (18.3mm) compared to PMMR (17.6mm), but these measurements correlated positively. LVWT (anterior wall) was significantly larger on PMMR (15mm) than at autopsy (14mm), and these measurements also correlated positively. Pericardial effusions led to larger differences between PMMR and autopsy measurements, however without statistical significance. DISCUSSION There exist discrepancies between LVWT as measured on postmortem imaging and at autopsy. Specialists should be aware in order to not misinterpret imaging measurements.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Wolf Schweitzer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Reference parameters for left ventricular wall thickness, thickening, and motion in stress myocardial perfusion CT: Global and regional assessment. Clin Imaging 2019; 56:81-87. [DOI: 10.1016/j.clinimag.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 11/23/2022]
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5
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Attar R, Pereañez M, Gooya A, Albà X, Zhang L, de Vila MH, Lee AM, Aung N, Lukaschuk E, Sanghvi MM, Fung K, Paiva JM, Piechnik SK, Neubauer S, Petersen SE, Frangi AF. Quantitative CMR population imaging on 20,000 subjects of the UK Biobank imaging study: LV/RV quantification pipeline and its evaluation. Med Image Anal 2019; 56:26-42. [PMID: 31154149 DOI: 10.1016/j.media.2019.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 01/02/2023]
Abstract
Population imaging studies generate data for developing and implementing personalised health strategies to prevent, or more effectively treat disease. Large prospective epidemiological studies acquire imaging for pre-symptomatic populations. These studies enable the early discovery of alterations due to impending disease, and enable early identification of individuals at risk. Such studies pose new challenges requiring automatic image analysis. To date, few large-scale population-level cardiac imaging studies have been conducted. One such study stands out for its sheer size, careful implementation, and availability of top quality expert annotation; the UK Biobank (UKB). The resulting massive imaging datasets (targeting ca. 100,000 subjects) has put published approaches for cardiac image quantification to the test. In this paper, we present and evaluate a cardiac magnetic resonance (CMR) image analysis pipeline that properly scales up and can provide a fully automatic analysis of the UKB CMR study. Without manual user interactions, our pipeline performs end-to-end image analytics from multi-view cine CMR images all the way to anatomical and functional bi-ventricular quantification. All this, while maintaining relevant quality controls of the CMR input images, and resulting image segmentations. To the best of our knowledge, this is the first published attempt to fully automate the extraction of global and regional reference ranges of all key functional cardiovascular indexes, from both left and right cardiac ventricles, for a population of 20,000 subjects imaged at 50 time frames per subject, for a total of one million CMR volumes. In addition, our pipeline provides 3D anatomical bi-ventricular models of the heart. These models enable the extraction of detailed information of the morphodynamics of the two ventricles for subsequent association to genetic, omics, lifestyle habits, exposure information, and other information provided in population imaging studies. We validated our proposed CMR analytics pipeline against manual expert readings on a reference cohort of 4620 subjects with contour delineations and corresponding clinical indexes. Our results show broad significant agreement between the manually obtained reference indexes, and those automatically computed via our framework. 80.67% of subjects were processed with mean contour distance of less than 1 pixel, and 17.50% with mean contour distance between 1 and 2 pixels. Finally, we compare our pipeline with a recently published approach reporting on UKB data, and based on deep learning. Our comparison shows similar performance in terms of segmentation accuracy with respect to human experts.
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Affiliation(s)
- Rahman Attar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK; Biomedical Imaging Department, Leeds Institute for Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, UK.
| | - Marco Pereañez
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK; Biomedical Imaging Department, Leeds Institute for Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, UK
| | - Ali Gooya
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Xènia Albà
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Universitat Pompeu Fabra, Barcelona, Spain
| | - Le Zhang
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Milton Hoz de Vila
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK; Biomedical Imaging Department, Leeds Institute for Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, UK.
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Takigawa M, Martin R, Cheniti G, Kitamura T, Vlachos K, Frontera A, Martin CA, Bourier F, Lam A, Pillois X, Duchateau J, Klotz N, Pambrun T, Denis A, Derval N, Hocini M, Haïssaguerre M, Sacher F, Jaïs P, Cochet H. Detailed comparison between the wall thickness and voltages in chronic myocardial infarction. J Cardiovasc Electrophysiol 2018; 30:195-204. [PMID: 30288836 DOI: 10.1111/jce.13767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between the local electrograms (EGMs) and wall thickness (WT) heterogeneity within infarct scars has not been thoroughly described. The relationship between WT and voltages and substrates for ventricular tachycardia (VT) was examined. METHODS In 12 consecutive patients with myocardial infarction and VT, WT, defined by a multidetector computed tomography, and voltage were compared. In multicomponent EGMs, amplitudes of both far- and near-field components were manually measured, and the performance of the three-dimensional-mapping system automatic voltage measurement was assessed. RESULTS Of 15 748 points acquired, 2677 points within 5 mm of the endocardial surface were analyzed. In total, 909 (34.0%) multicomponent EGMs were identified; 785 (86.4%) and 883 (97.1%) were distributed in the WT less than 4 and 5 mm, respectively. Far-field EGM voltages increased linearly from 0.14 mV (0.08-0.28 mV) in the WT: 0 to 1 mm to 0.70 mV (0.43-2.62 mV) in the WT: 4 to 5 mm (ρ = 0.430; P < 0.001), and a significant difference was demonstrated between any two WT-groups (P ≤ 0.001). In contrast, near-field EGM voltages varied from 0.27 mV (0.11-0.44 mV) in the WT: 0 to 1 mm to 0.29 mV (0.17-0.53 mV) in the WT: 4 to 5 mm with a poorer correlation (ρ = 0.062, P = 0.04). The proportion of points where the system automatically measured the voltage on near-field EGMs increased from less than 10% in areas of WT: 4 to 5 mm to 50% in areas less than 2 mm. Of 21 VTs observed, seven hemodynamically stable VTs were mapped and terminated in WT: 1 to 4 mm area. CONCLUSIONS Although far-field voltages gradually increase with the WT, near-field does not. The three-dimensional-mapping system preferentially annotates the near-field components in thinner areas (center of the scar) and the far-field component in thicker areas when building a voltage map. Critical sites of VT are distributed in WT: 1 to 4 mm areas.
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Affiliation(s)
- Masateru Takigawa
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Ruairidh Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France.,Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ghassen Cheniti
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Takeshi Kitamura
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Konstantinos Vlachos
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Antonio Frontera
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Claire A Martin
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Felix Bourier
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Anna Lam
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Xavier Pillois
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Josselin Duchateau
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Klotz
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Thomas Pambrun
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Arnaud Denis
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Mélèze Hocini
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Frédéric Sacher
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Pierre Jaïs
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
| | - Hubert Cochet
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Bordeaux, France
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Sigvardsen PE, Larsen LH, Carstensen HG, Sørgaard M, Hindsø L, Hassager C, Køber L, Møgelvang R, Kofoed KF. Prognostic implications of left ventricular asymmetry in patients with asymptomatic aortic valve stenosis. Eur Heart J Cardiovasc Imaging 2018; 19:168-175. [DOI: 10.1093/ehjci/jew339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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8
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Alkema M, Spitzer E, Soliman OII, Loewe C. Multimodality Imaging for Left Ventricular Hypertrophy Severity Grading: A Methodological Review. J Cardiovasc Ultrasound 2016; 24:257-267. [PMID: 28090249 PMCID: PMC5234336 DOI: 10.4250/jcu.2016.24.4.257] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/28/2016] [Accepted: 11/30/2016] [Indexed: 01/04/2023] Open
Abstract
Left ventricular hypertrophy (LVH), defined by an increase in left ventricular mass (LVM), is a common cardiac finding generally caused by an increase in pressure or volume load. Assessing severity of LVH is of great clinical value in terms of prognosis and treatment choices, as LVH severity grades correlate with the risk for presenting cardiovascular events. The three main cardiac parameters for the assessment of LVH are wall thickness, LVM, and LV geometry. Echocardiography, with large availability and low cost, is the technique of choice for their assessment. Consequently, reference values for LVH severity in clinical guidelines are based on this technique. However, cardiac magnetic resonance (CMR) and computed tomography (CT) are increasingly used in clinical practice, providing excellent image quality. Nevertheless, there is no extensive data to support reference values based on these techniques, while comparative studies between the three techniques show different results in wall thickness and LVM measurements. In this paper, we provide an overview of the different methodologies used to assess LVH severity with echocardiography, CMR and CT. We argue that establishing reference values per imaging modality, and possibly indexed to body surface area and classified per gender, ethnicity and age-group, might be essential for the correct classification of LVH severity.
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Affiliation(s)
- Maaike Alkema
- Department of Biomedical Sciences, Leiden University Medical Center, Leiden, the Netherlands.; Cardialysis, Clinical Trial Management & Core Laboratories, Rotterdam, the Netherlands
| | - Ernest Spitzer
- Cardialysis, Clinical Trial Management & Core Laboratories, Rotterdam, the Netherlands.; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Osama I I Soliman
- Cardialysis, Clinical Trial Management & Core Laboratories, Rotterdam, the Netherlands.; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Roy A, Fuller CD, Rosenthal DI, Thomas CR. Comparison of measurement methods with a mixed effects procedure accounting for replicated evaluations (COM3PARE): method comparison algorithm implementation for head and neck IGRT positional verification. BMC Med Imaging 2015; 15:35. [PMID: 26310853 PMCID: PMC4551570 DOI: 10.1186/s12880-015-0074-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
Purpose Comparison of imaging measurement devices in the absence of a gold-standard comparator remains a vexing problem; especially in scenarios where multiple, non-paired, replicated measurements occur, as in image-guided radiotherapy (IGRT). As the number of commercially available IGRT presents a challenge to determine whether different IGRT methods may be used interchangeably, an unmet need conceptually parsimonious and statistically robust method to evaluate the agreement between two methods with replicated observations. Consequently, we sought to determine, using an previously reported head and neck positional verification dataset, the feasibility and utility of a Comparison of Measurement Methods with the Mixed Effects Procedure Accounting for Replicated Evaluations (COM3PARE), a unified conceptual schema and analytic algorithm based upon Roy’s linear mixed effects (LME) model with Kronecker product covariance structure in a doubly multivariate set-up, for IGRT method comparison. Methods An anonymized dataset consisting of 100 paired coordinate (X/ measurements from a sequential series of head and neck cancer patients imaged near-simultaneously with cone beam CT (CBCT) and kilovoltage X-ray (KVX) imaging was used for model implementation. Software-suggested CBCT and KVX shifts for the lateral (X), vertical (Y) and longitudinal (Z) dimensions were evaluated for bias, inter-method (between-subject variation), intra-method (within-subject variation), and overall agreement using with a script implementing COM3PARE with the MIXED procedure of the statistical software package SAS (SAS Institute, Cary, NC, USA). Results COM3PARE showed statistically significant bias agreement and difference in inter-method between CBCT and KVX was observed in the Z-axis (both p − value<0.01). Intra-method and overall agreement differences were noted as statistically significant for both the X- and Z-axes (all p − value<0.01). Using pre-specified criteria, based on intra-method agreement, CBCT was deemed preferable for X-axis positional verification, with KVX preferred for superoinferior alignment. Conclusions The COM3PARE methodology was validated as feasible and useful in this pilot head and neck cancer positional verification dataset. COM3PARE represents a flexible and robust standardized analytic methodology for IGRT comparison. The implemented SAS script is included to encourage other groups to implement COM3PARE in other anatomic sites or IGRT platforms.
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Affiliation(s)
- Anuradha Roy
- Department of Management Science and Statistics, The University of Texas at San Antonio, One UTSA Circle, San Antonio, 78249, TX, USA.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA.
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Miller WL, Behrenbeck TR, McCollough CH, Williamson EE, Leng S, Kline TL, Ritman EL. Coronary microcirculation changes in non-ischemic dilated cardiomyopathy identified by novel perfusion CT. Int J Cardiovasc Imaging 2015; 31:881-8. [PMID: 25712168 DOI: 10.1007/s10554-015-0619-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
Intramyocardial microvessels demonstrate functional changes in cardiomyopathies. However, clinical computed tomography (CT) does not have adequate spatial resolution to assess the microvessels. Our hypothesis is that these functional changes manifest as altered heterogeneity of the spatial distribution of arteriolar perfusion territories. Our goal was to determine whether the spatial analysis of perfusion CT could clinically detect changes in the function and structure of the intramyocardial microcirculation in a non-ischemic dilated cardiomyopathy (DCM). Two groups were studied: (1) a Control group (12 male plus 12 female) with no risk factors nor evidence of coronary artery disease, and (2) a DCM group (12 male plus 12 female) with left ventricular ejection fraction ≤40% and no evidence of coronary artery disease. Using the CT scan, the LV free wall thickness and its radius of curvature were measured. The DCM group was sub divided into those with LV free wall thickness <11.5 mm and those with thickness ≥11.5 mm. In the myocardial opacification phase of the CT scan sequence, myocardial perfusion (F) and intramyocardial blood volume (Bv) for multiple intramyocardial regions were computed. No significant differences between the groups were demonstrable in overall myocardial F or Bv. However, the myocardial regional data showed significantly increased spatial heterogeneity in the DCM group when compared to the Control group. The findings demonstrate that altered function of the subresolution intramyocardial microcirculation can be quantified with myocardial perfusion CT and that significant changes in these parameters occur in the DCM subjects with LV wall thickness greater than 11.5 mm.
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Affiliation(s)
- Wayne L Miller
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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11
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Komatsu Y, Cochet H, Jadidi A, Sacher F, Shah A, Derval N, Scherr D, Pascale P, Roten L, Denis A, Ramoul K, Miyazaki S, Daly M, Riffaud M, Sermesant M, Relan J, Ayache N, Kim S, Montaudon M, Laurent F, Hocini M, Haïssaguerre M, Jaïs P. Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate. Circ Arrhythm Electrophysiol 2013; 6:342-50. [PMID: 23476043 DOI: 10.1161/circep.112.000191] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A majority of patients undergoing ablation of ventricular tachycardia have implanted devices precluding substrate imaging with delayed-enhancement MRI. Contrast-enhanced multidetector computed tomography (MDCT) can depict myocardial wall thickness with submillimetric resolution. We evaluated the relationship between regional myocardial wall thinning (WT) imaged by MDCT and arrhythmogenic substrate in postinfarction ventricular tachycardia. METHODS AND RESULTS We studied 13 consecutive postinfarction patients undergoing MDCT before ablation. MDCT data were integrated with high-density 3-dimensional electroanatomic maps acquired during sinus rhythm (endocardium, 509±291 points/map; epicardium, 716±323 points/map). Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were assessed with regard to the WT. A significant correlation was found between the areas of WT <5 mm and endocardial low voltage (correlation-R=0.82; P=0.001), but no such correlation was found in the epicardium. The WT <5 mm area was smaller than the endocardial low-voltage area (54 cm(2) [Q1-Q3, 46-92] versus 71 cm(2) [Q1-Q3, 59-124]; P=0.001). Among a total of 13 060 electrograms reviewed in the whole study population, 538 LAVA were detected and analyzed. LAVA were located within the WT <5 mm (469/538 [87%]) or at its border (100% within 23 mm). Very late LAVA (>100 ms after QRS complex) were almost exclusively detected within the thinnest area (93% in the WT<3 mm). CONCLUSIONS Regional myocardial WT correlates to low-voltage regions and distribution of LAVA critical for the generation and maintenance of postinfarction ventricular tachycardia. The integration of MDCT WT with 3-dimensional electroanatomic maps can help focus mapping and ablation on the culprit regions, even when MRI is precluded by the presence of implanted devices.
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Affiliation(s)
- Yuki Komatsu
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
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Tian J, Jeudy J, Smith MF, Jimenez A, Yin X, Bruce PA, Lei P, Turgeman A, Abbo A, Shekhar R, Saba M, Shorofsky S, Dickfeld T. Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations. Circ Arrhythm Electrophysiol 2010; 3:496-504. [DOI: 10.1161/circep.109.889311] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Advances in contrast-enhanced multidetector CT enable detailed characterization of the left ventricular myocardium. Myocardial scar and border zone (BZ), as the target of ventricular tachycardia ablations, displays abnormal anatomic, dynamic, and perfusion characteristics during first-pass CT. This study assessed how contrast-enhanced CT can predict voltage-defined scar and BZ and integrate its scar reconstructions into clinical mapping systems to guide ventricular tachycardia ablations.
Methods and Results—
Eleven patients with ischemic cardiomyopathy underwent contrast-enhanced CT before ventricular tachycardia ablation. Segmental anatomic (end-systolic and end-diastolic wall thickness), dynamic (wall thickening, wall motion), and perfusion (hypoenhancement) characteristics were evaluated. Receiver operating characteristic curves assessed the ability of CT to determine voltage-defined scar and BZ segments. Three-dimensional epi- and endocardial surfaces and scar borders were reconstructed, coregistered, and compared to voltages using a 17-segment model. Abnormal anatomic, dynamic, and perfusion data correlated well with abnormal (<1.5 mV) endocardial voltages (
r
=0.77). Three-dimensional reconstruction integrated into the clinical mapping system (registration accuracy, 3.31±0.52 mm) allowed prediction of homogenous abnormal voltage (<1.5 mV) in 81.7% of analyzed segments and correctly displayed transmural extent and intramural scar location. CT hypoperfusion correlated best with scar and BZ areas and encompassed curative ablations in 82% cases.
Conclusions—
Anatomic, dynamic, and perfusion imaging using contrast-enhanced CT allows characterization of left ventricular anatomy and 3D scar and BZ substrate. Integration of reconstructed 3D data sets into clinical mapping systems supplements information of voltage mapping and may enable new image approaches for substrate-guided ventricular tachycardia ablation.
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Affiliation(s)
- Jing Tian
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Jean Jeudy
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Mark F. Smith
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Alejandro Jimenez
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Xianghua Yin
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Patricia A. Bruce
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Peng Lei
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Aharon Turgeman
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Aharon Abbo
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Raj Shekhar
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Magdi Saba
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Stephen Shorofsky
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
| | - Timm Dickfeld
- From the University of Maryland School of Medicine (J.T., J.J., M.F.S., A.J., X.Y., P.A.B., P.L., R.S., M.S., S.S.) and Baltimore VA Medical Center (T.D.), Baltimore, Md; and Biosense Webster Inc (A.T., A.A.), Tirat Carmel, Israel
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13
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Quantitative assessment of left ventricular systolic wall thickening using multidetector computed tomography. Eur J Radiol 2009; 72:92-7. [DOI: 10.1016/j.ejrad.2008.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 06/06/2008] [Accepted: 06/30/2008] [Indexed: 11/17/2022]
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14
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Quantitative evaluation of regional left ventricular function by multidetector computed tomography. J Comput Assist Tomogr 2009; 33:204-10. [PMID: 19346846 DOI: 10.1097/rct.0b013e3181772731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Because most contemporary workstations offer quantitative analysis of regional function by multidetector computed tomography, we aimed to establish typical values for normal, hypokinetic, and akinetic regions, and to establish optimal thresholds to differentiate between normal and abnormal values. METHODS : For 33 patients, quantitative regional functional parameters were compared with visual analysis by both multidetector computed tomography and echocardiography. Normal values were established to normalize for segmental variability. Optimal thresholds were established to differentiate between normal and abnormal segments by receiver operating characteristic analysis. RESULTS : Akinetic, hypokinetic, and normokinetic segments demonstrated significant differences (P < 0.0001) for end-systolic thickness (mean [95% confidence interval], 9.4 [4.5-14.3], 11.7 [7.2-16.2], and 14.3 mm [8.2-20.3 mm]), respectively; thickening, 24% [-22% to 71%], 45% [-16% to 106%], and 82% [10%-154%]), respectively; and motion, 3.5 [-2.0 to 8.9], 6.1 [-0.2 to 12.4], and 8.5 mm [1.8-15.3 mm], respectively). Thickening performed best with area under the curve of 0.87 and sensitivity equal to specificity of 82%. Intraobserver variability was good, but interobserver variability was only moderate. CONCLUSIONS : Quantification of regional myocardial function can be performed to assist the physician in mapping left ventricular function.
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