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Chen Z, Zeng D, Huang Z, Ma J, Gu Z, Yang Y, Liu X, Zheng H, Liang D, Hu Z. Temporal feature prior-aided separated reconstruction method for low-dose dynamic myocardial perfusion computed tomography. Phys Med Biol 2021; 66:045012. [PMID: 33333495 DOI: 10.1088/1361-6560/abd4ba] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dynamic myocardial perfusion computed tomography (DMP-CT) is an effective medical imaging technique for coronary artery disease diagnosis and therapy guidance. However, the radiation dose received by the patient during repeated CT scans is a widespread concern of radiologists because of the increased risk of cancer. The sparse few-view CT scanning protocol can be a feasible approach to reduce the radiation dose of DMP-CT imaging; however, an advanced reconstruction algorithm is needed. In this paper, a temporal feature prior-aided separated reconstruction method (TFP-SR) for low-dose DMP-CT images reconstruction from sparse few-view sinograms is proposed. To implement the proposed method, the objective perfusion image is divided into the baseline fraction and the enhancement fraction introduced by the arrival of the contrast agent. The core of the proposed TFP-SR method is the utilization of the temporal evolution information that naturally exists in the DMP-CT image sequence to aid the enhancement image reconstruction from limited data. The temporal feature vector of an image pixel is defined by the intensities of this pixel in the pre-reconstructed enhancement sequence, and the connection between two related features is calculated via a zero-mean Gaussian function. A prior matrix is constructed based on the connections between the extracted temporal features and used in the iterative reconstruction of the enhancement images. To evaluate the proposed method, the conventional filtered back-projection algorithm, the total variation regularized PWLS (PWLS-TV) and the prior image constrained compressed sensing are compared in this paper based on studies on a digital extended cardiac-torso (XCAT) thoracic phantom and a preclinical porcine DMP-CT data set that take image misregistration into account. The experimental results demonstrate that the proposed TFP-SR method has superior performance in sparse DMP-CT images reconstruction in terms of image quality and the analyses of the time attenuation curve and hemodynamic parameters.
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Affiliation(s)
- Zixiang Chen
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China
| | - Dong Zeng
- College of Automation Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China
| | - Zhenxing Huang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Zheng Gu
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518107, People's Republic of China
| | - Yongfeng Yang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China
| | - Xin Liu
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China
| | - Hairong Zheng
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China
| | - Dong Liang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China
| | - Zhanli Hu
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China.,Chinese Academy of Sciences Key Laboratory of Health Informatics, Shenzhen 518055, People's Republic of China.,Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518107, People's Republic of China
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2
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Sundell VM, Kortesniemi M, Siiskonen T, Kosunen A, Rosendahl S, Büermann L. PATIENT-SPECIFIC DOSE ESTIMATES IN DYNAMIC COMPUTED TOMOGRAPHY MYOCARDIAL PERFUSION EXAMINATION. RADIATION PROTECTION DOSIMETRY 2021; 193:24-36. [PMID: 33693932 PMCID: PMC8227483 DOI: 10.1093/rpd/ncab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/09/2020] [Accepted: 01/26/2021] [Indexed: 05/07/2023]
Abstract
The study aimed to implement realistic source models of a computed tomography (CT) scanner and Monte Carlo simulations to actual patient data and to calculate patient-specific organ and effective dose estimates for patients undergoing dynamic CT myocardial perfusion examinations. Source models including bowtie filter, tube output and x-ray spectra were determined for a dual-source Siemens Somatom Definition Flash scanner. Twenty CT angiography patient datasets were merged with a scaled International Commission on Radiological Protection (ICRP) 110 voxel phantom. Dose simulations were conducted with ImpactMC software. Effective dose estimates varied from 5.0 to 14.6 mSv for the 80 kV spectrum and from 8.9 to 24.7 mSv for the 100 kV spectrum. Significant differences in organ doses and effective doses between patients emphasise the need to use actual patient data merged with matched anthropomorphic anatomy in the dose simulations to achieve a reasonable level of accuracy in the dose estimation procedure.
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Affiliation(s)
- V-M Sundell
- HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Department of Physics, University of Helsinki, P.O. Box 64, 00014 University of Helsinki, Finland
| | - M Kortesniemi
- HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - T Siiskonen
- STUK-Radiation and Nuclear Safety Authority, Laippatie 4, Helsinki 00880, Finland
| | - A Kosunen
- STUK-Radiation and Nuclear Safety Authority, Laippatie 4, Helsinki 00880, Finland
| | - S Rosendahl
- Department 6.2 Dosimetry for radiation therapy and diagnostic radiology, Physikalisch-Technische Bundesanstalt, Bundesallee 100, Braunschweig 38116, Germany
| | - L Büermann
- Department 6.2 Dosimetry for radiation therapy and diagnostic radiology, Physikalisch-Technische Bundesanstalt, Bundesallee 100, Braunschweig 38116, Germany
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3
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Parikh R, Patel A, Lu B, Senapati A, Mahmarian J, Chang SM. Cardiac Computed Tomography for Comprehensive Coronary Assessment: Beyond Diagnosis of Anatomic Stenosis. Methodist Debakey Cardiovasc J 2020; 16:77-85. [PMID: 32670467 PMCID: PMC7350823 DOI: 10.14797/mdcj-16-2-77] [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] [Indexed: 12/20/2022] Open
Abstract
Cardiac computed tomography angiography (CCTA) has evolved into a versatile imaging modality that can depict atherosclerosis burden, determine functional significance of a stenotic lesion, and guide the management and treatment of stable coronary artery disease.1 With newer-generation scanners, diagnostic CCTA can be obtained in the majority of patients with a very acceptable radiation dose. We discuss the ability of CCTA to provide comprehensive assessment of a patient with suspected CAD, including functional techniques of stress-rest myocardial perfusion assessment using a vasodilator and a purely post-processing approach that assesses fractional flow reserve derived by CCTA. In addition, recent data validated the role of CCTA in managing stable patients with chest pain and suspected CAD, serving as a gatekeeper for invasive coronary angiogram as well as optimizing the preprocedural planning of percutaneous coronary revascularization and coronary artery bypass surgery.
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Affiliation(s)
- Roosha Parikh
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Apurva Patel
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Bin Lu
- FUWAI HOSPITAL, PEKING UNION MEDICAL COLLEGE, CHINESE ACADEMY OF MEDICAL SCIENCES, BEIJING, CHINA
| | - Alpana Senapati
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - John Mahmarian
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Su Min Chang
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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4
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Clinical significance of transluminal attenuation gradient in 320-row area detector coronary CT angiography. Heart Vessels 2017; 33:462-469. [PMID: 29134268 DOI: 10.1007/s00380-017-1081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
The clinical significance of the transluminal attenuation gradient (TAG) has not been established. We evaluated the incremental diagnostic value of TAG by 320-row area detector computed tomography (320-ADCT). Subjects were 65 patients who underwent one-rotation scanning by 320-ADCT and invasive coronary angiography (ICA) within 3 months. TAG values were obtained for the major epicardial vessels 2 mm or more each in RCA, LAD and LCX using automatic analysis software. Moreover, TAG values that excluded calcified lesions in calculation of the regression line were also evaluated (excluded-TAG). In LAD, 21 intermediate lesions underwent functional flow reserve (FFR), and the incremental diagnostic value for functional stenosis was evaluated. The TAG values in the normal vessels were - 8.3 ± 5.0 (HU/cm) for the RCA (n = 32), - 23.3 ± 4.3 for the LAD (n = 9) and - 20.6 ± 10.0 for the LCX (n = 32). The RCA value was significantly higher (p < 0.001). The TAG values with stenosis degrees of ≤ 25%, 26-75%, ≥ 76% on ICA were - 8.3 ± 5.0 (n = 32) vs - 10.3 ± 7.2 (n = 25) vs - 10.0 ± 5.4 (n = 4) in the RCA, - 23.3 ± 4.3 (n = 9) vs - 21.0 ± 11.5 (n = 35) vs - 23.5 ± 15.3 (n = 10) in the LAD and - 21.1 ± 15.1 (n = 32) vs - 21.1 ± 15.1 (n = 16) vs - 17.7 ± 15.7 (n = 6) in the LCX, with no significant difference among the three groups. The excluded-TAG values also showed no significant difference. The area under the curve in the diagnosis of FFR < 0.8 in 21 LAD cases was 0.542 for CT only, 0.694 for CT + TAG, and 0.694 for CT + excluded-TAG. In single time-phase scanning by 320-ADCT, TAG does not offer an incremental diagnostic value.
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5
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome. J Int Med Res 2017; 45:1680-1692. [PMID: 29239257 PMCID: PMC5805198 DOI: 10.1177/0300060517698265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chest pain is an important presenting symptom. However, few cases of chest pain
are diagnosed as acute coronary syndrome (ACS) in the acute setting. This
results in frequent inappropriate discharge and major delay in treatment for
patients with underlying ACS. The conventional methods of assessing ACS, which
include electrocardiography and serological markers of infarct, can take time to
manifest. Recent studies have investigated more sensitive and specific imaging
modalities that can be used. Diastolic dysfunction occurs early following
coronary artery occlusion and its detection is useful in confirming the
diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic
resonance provides a single imaging modality for comprehensive evaluation of
chest pain in the acute setting. In particular, cardiac magnetic resonance has
many imaging techniques that assess diastolic dysfunction post-coronary artery
occlusion. Techniques such as measurement of left atrial size, mitral inflow,
and mitral annular and pulmonary vein flow velocities with phase-contrast
imaging enable general assessment of ventricular diastolic function. More novel
imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and
myocardial tagging, allow early determination of regional diastolic dysfunction
and oedema. These findings may correspond to specific infarcted arteries that
may be used to tailor eventual percutaneous coronary artery intervention.
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Affiliation(s)
- Shah M. Azarisman
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
- Department of Internal Medicine,
International Islamic University Malaysia, Pahang, Malaysia
- Shah M Azarisman, Professor of Medicine,
International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar
InderaMahkota, 25200 Kuantan, Pahang, Malaysia.
| | - Karen S Teo
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
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Gong C, Han C, Gan G, Deng Z, Zhou Y, Yi J, Zheng X, Xie C, Jin X. Low-dose dynamic myocardial perfusion CT image reconstruction using pre-contrast normal-dose CT scan induced structure tensor total variation regularization. Phys Med Biol 2017; 62:2612-2635. [PMID: 28140366 DOI: 10.1088/1361-6560/aa5d40] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dynamic myocardial perfusion CT (DMP-CT) imaging provides quantitative functional information for diagnosis and risk stratification of coronary artery disease by calculating myocardial perfusion hemodynamic parameter (MPHP) maps. However, the level of radiation delivered by dynamic sequential scan protocol can be potentially high. The purpose of this work is to develop a pre-contrast normal-dose scan induced structure tensor total variation regularization based on the penalized weighted least-squares (PWLS) criteria to improve the image quality of DMP-CT with a low-mAs CT acquisition. For simplicity, the present approach was termed as 'PWLS-ndiSTV'. Specifically, the ndiSTV regularization takes into account the spatial-temporal structure information of DMP-CT data and further exploits the higher order derivatives of the objective images to enhance denoising performance. Subsequently, an effective optimization algorithm based on the split-Bregman approach was adopted to minimize the associative objective function. Evaluations with modified dynamic XCAT phantom and preclinical porcine datasets have demonstrated that the proposed PWLS-ndiSTV approach can achieve promising gains over other existing approaches in terms of noise-induced artifacts mitigation, edge details preservation, and accurate MPHP maps calculation.
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Affiliation(s)
- Changfei Gong
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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7
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Zeng D, Gong C, Bian Z, Huang J, Zhang X, Zhang H, Lu L, Niu S, Zhang Z, Liang Z, Feng Q, Chen W, Ma J. Robust dynamic myocardial perfusion CT deconvolution for accurate residue function estimation via adaptive-weighted tensor total variation regularization: a preclinical study. Phys Med Biol 2016; 61:8135-8156. [PMID: 27782004 DOI: 10.1088/0031-9155/61/22/8135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dynamic myocardial perfusion computed tomography (MPCT) is a promising technique for quick diagnosis and risk stratification of coronary artery disease. However, one major drawback of dynamic MPCT imaging is the heavy radiation dose to patients due to its dynamic image acquisition protocol. In this work, to address this issue, we present a robust dynamic MPCT deconvolution algorithm via adaptive-weighted tensor total variation (AwTTV) regularization for accurate residue function estimation with low-mA s data acquisitions. For simplicity, the presented method is termed 'MPD-AwTTV'. More specifically, the gains of the AwTTV regularization over the original tensor total variation regularization are from the anisotropic edge property of the sequential MPCT images. To minimize the associative objective function we propose an efficient iterative optimization strategy with fast convergence rate in the framework of an iterative shrinkage/thresholding algorithm. We validate and evaluate the presented algorithm using both digital XCAT phantom and preclinical porcine data. The preliminary experimental results have demonstrated that the presented MPD-AwTTV deconvolution algorithm can achieve remarkable gains in noise-induced artifact suppression, edge detail preservation, and accurate flow-scaled residue function and MPHM estimation as compared with the other existing deconvolution algorithms in digital phantom studies, and similar gains can be obtained in the porcine data experiment.
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Affiliation(s)
- Dong Zeng
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, People's Republic of China. Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, People's Republic of China
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8
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Chaikriangkrai K, Choi SY, Nabi F, Chang SM. Important advances in technology and unique applications to cardiovascular computed tomography. Methodist Debakey Cardiovasc J 2015; 10:152-8. [PMID: 25574342 DOI: 10.14797/mdcj-10-3-152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
For the past decade, multidetector cardiac computed tomography and its main application, coronary computed tomography angiography, have been established as a noninvasive technique for anatomical assessment of coronary arteries. This new era of coronary artery evaluation by coronary computed tomography angiography has arisen from the rapid advancement in computed tomography technology, which has led to massive diagnostic and prognostic clinical studies in various patient populations. This article gives a brief overview of current multidetector cardiac computed tomography systems, developing cardiac computed tomography technologies in both hardware and software fields, innovative radiation exposure reduction measures, multidetector cardiac computed tomography functional studies, and their newer clinical applications beyond coronary computed tomography angiography.
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Affiliation(s)
| | - Su Yeon Choi
- Seoul National University Hospital, Seoul, South Korea
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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9
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Regadenoson-Stress Dynamic Myocardial Perfusion Improves Diagnostic Performance of CT Angiography in Assessment of Intermediate Coronary Artery Stenosis in Asymptomatic Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:105629. [PMID: 26236712 PMCID: PMC4506745 DOI: 10.1155/2015/105629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
The prospective study included 54 asymptomatic high-risk patients who underwent coronary CT angiography (CTA) and regadenoson-induced stress CT perfusion (rsCTP). Diagnostic accuracy of significant stenosis (≥50%) determination was evaluated for CTA alone and CTA + rsCTP in 27 patients referred to ICA due to the positive rsCTP findings. Combined evaluation of CTA + rsCTP had higher diagnostic accuracy over CTA alone (per-segment: specificity 96 versus 68%, p = 0.002; per-vessel: specificity 95 versus 75%, p = 0.012) and high overruling rate of rsCTP was proved in intermediate stenosis (40–70%). Results demonstrate a significant additional value of rsCTP in the assessment of intermediate coronary artery stenosis found with CTA.
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10
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Sun Z. Evidence for myocardial CT perfusion imaging in the diagnosis of hemodynamically significant coronary artery disease. Cardiovasc Diagn Ther 2015; 5:58-62. [PMID: 25774349 DOI: 10.3978/j.issn.2223-3652.2015.01.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 01/17/2023]
Abstract
This editorial discusses a recent paper published in the August issue of Radiology about the diagnostic value of myocardial computer tomography (CT) perfusion imaging in the detection of hemodynamically significant coronary stenosis when compared to single-photon emission CT (SPECT) imaging based on a secondary analysis of CORE320 study. Three aspects including high diagnostic sensitivity of CT perfusion imaging, moderate specificity of SPECT imaging and lack of use of attenuation correction in SPECT imaging have been discussed with reference to the current literature, and some suggestions have been highlighted for future studies to improve the diagnostic performance of CT perfusion and SPECT imaging in the diagnostic evaluation of coronary artery disease.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia 6845, Australia
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11
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Li W, Zhu X, Li J, Peng C, Chen N, Qi Z, Yang Q, Gao Y, Zhao Y, Sun K, Li K. Comparison of the sensitivity and specificity of 5 image sets of dual-energy computed tomography for detecting first-pass myocardial perfusion defects compared with positron emission tomography. Medicine (Baltimore) 2014; 93:e329. [PMID: 25526492 PMCID: PMC4603095 DOI: 10.1097/md.0000000000000329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The sensitivity and specificity of 5 different image sets of dual-energy computed tomography (DECT) for the detection of first-pass myocardial perfusion defects have not systematically been compared using positron emission tomography (PET) as a reference standard. Forty-nine consecutive patients, with known or strongly suspected of coronary artery disease, were prospectively enrolled in our study. Cardiac DECT was performed at rest state using a second-generation 128-slice dual-source CT. The DECT data were reconstructed to iodine maps, monoenergetic images, 100 kV images, nonlinearly blended images, and linearly blended images by different postprocessing techniques. The myocardial perfusion defects on DECT images were visually assessed by 5 observers, using standard 17-segment model. Diagnostic accuracy of 5 image sets was assessed using nitrogen-13 ammonia PET as the gold standard. Discrimination was quantified using the area under the receiver operating characteristic curve (AUC), and AUCs were compared using the method of DeLong. The DECT and PET examinations were successfully completed in 30 patients and a total of 90 territories and 510 segments were analyzed. Cardiac PET revealed myocardial perfusion defects in 56 territories (62%) and 209 segments (41%). The AUC of iodine maps, monoenergetic images, 100 kV images, nonlinearly blended images, and linearly blended images were 0.986, 0.934, 0.913, 0.881, and 0.871, respectively, on a per-territory basis. These values were 0.922, 0.813, 0.779, 0.763, and 0.728, respectively, on a per-segment basis. DECT iodine maps shows high sensitivity and specificity, and is superior to other DECT image sets for the detection of myocardial perfusion defects in the first-pass myocardial perfusion.
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Affiliation(s)
- Wenhuan Li
- From the Department of Radiology (WL, XZ, NC, ZQ, QY, YG, YZ, KS, KL); Department of Cardiology (JL); and PET Centre (CP), Xuanwu Hospital of Capital Medical University, Beijing, China
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12
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Brix G, Lechel U, Nekolla E, Griebel J, Becker C. Radiation protection issues in dynamic contrast-enhanced (perfusion) computed tomography. Eur J Radiol 2014; 84:2347-58. [PMID: 25480677 DOI: 10.1016/j.ejrad.2014.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/11/2014] [Indexed: 11/25/2022]
Abstract
Dynamic contrast-enhanced (DCE) CT studies are increasingly used in both medical care and clinical trials to improve diagnosis and therapy management of the most common life-threatening diseases: stroke, coronary artery disease and cancer. It is thus the aim of this review to briefly summarize the current knowledge on deterministic and stochastic radiation effects relevant for patient protection, to present the essential concepts for determining radiation doses and risks associated with DCE-CT studies as well as representative results, and to discuss relevant aspects to be considered in the process of justification and optimization of these studies. For three default DCE-CT protocols implemented at a latest-generation CT system for cerebral, myocardial and cancer perfusion imaging, absorbed doses were measured by thermoluminescent dosimeters at an anthropomorphic body phantom and compared with thresholds for harmful (deterministic) tissue reactions. To characterize stochastic radiation risks of patients from these studies, life-time attributable cancer risks (LAR) were estimated using sex-, age-, and organ-specific risk models based on the hypothesis of a linear non-threshold dose-response relationship. For the brain, heart and pelvic cancer studies considered, local absorbed doses in the imaging field were about 100-190 mGy (total CTDI(vol), 200 mGy), 15-30 mGy (16 mGy) and 80-270 mGy (140 mGy), respectively. According to a recent publication of the International Commission on Radiological Protection (ICRP Publication 118, 2012), harmful tissue reactions of the cerebro- and cardiovascular systems as well as of the lenses of the eye become increasingly important at radiation doses of more than 0.5 Gy. The LARs estimated for the investigated cerebral and myocardial DCE-CT scenarios are less than 0.07% for males and 0.1% for females at an age of exposure of 40 years. For the considered tumor location and protocol, the corresponding LARs are more than 6 times as high. Stochastic radiation risks decrease substantially with age and are markedly higher for females than for males. To balance the diagnostic needs and patient protection, DCE-CT studies have to be strictly justified and carefully optimized in due consideration of the various aspects discussed in some detail in this review.
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Affiliation(s)
- Gunnar Brix
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstädter Landstraße 1, D-85764 Oberschleissheim, Germany.
| | - Ursula Lechel
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstädter Landstraße 1, D-85764 Oberschleissheim, Germany.
| | - Elke Nekolla
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstädter Landstraße 1, D-85764 Oberschleissheim, Germany.
| | - Jürgen Griebel
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstädter Landstraße 1, D-85764 Oberschleissheim, Germany.
| | - Christoph Becker
- Department of Clinical Radiology, Grosshadern Clinic, Hospital of the Ludwig-Maximilians University, Marchioninistraße 15, D-81377 Munich, Germany.
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13
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Abstract
Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review.
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Affiliation(s)
- Ran Heo
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | | | - Dan Kalra
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021.
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14
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome. World J Cardiol 2014; 6:405-414. [PMID: 24976912 PMCID: PMC4072830 DOI: 10.4330/wjc.v6.i6.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/10/2014] [Accepted: 04/19/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
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Stuijfzand WJ, Danad I, Raijmakers PG, Marcu CB, Heymans MW, van Kuijk CC, van Rossum AC, Nieman K, Min JK, Leipsic J, van Royen N, Knaapen P. Additional value of transluminal attenuation gradient in CT angiography to predict hemodynamic significance of coronary artery stenosis. JACC Cardiovasc Imaging 2014; 7:374-86. [PMID: 24631509 DOI: 10.1016/j.jcmg.2013.12.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The current study evaluates the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (CCO), and TAG with exclusion of calcified coronary segments (ExC) over coronary computed tomography angiogram (CTA) alone using fractional flow reserve (FFR) as the gold standard. BACKGROUND TAG is defined as the contrast opacification gradient along the length of a coronary artery on a coronary CTA. Preliminary data suggest that TAG provides additional functional information. Interpretation of TAG is hampered by multiple heartbeat acquisition algorithms and coronary calcifications. Two correction models have been proposed based on either dephasing of contrast delivery by relating coronary density to corresponding descending aortic opacification (TAG-CCO) or excluding calcified coronary segments (TAG-ExC). METHODS Eighty-five patients with intermediate probability of coronary artery disease were prospectively included. All patients underwent step-and-shoot 256-slice coronary CTA. TAG, TAG-CCO, and TAG-ExC analyses were performed followed by invasive coronary angiography in conjunction with FFR measurements of all major coronary branches. RESULTS Thirty-four patients (40%) were diagnosed with hemodynamically-significant coronary artery disease (i.e., FFR ≤0.80). On a per-vessel basis (n = 253), 59 lesions (23%) were graded as hemodynamically significant, and the diagnostic accuracy of coronary CTA (diameter stenosis ≥50%) was 95%, 75%, 98%, and 54% for sensitivity, specificity, negative predictive value, and positive predictive value, respectively. TAG and TAG-ExC did not discriminate between vessels with or without hemodynamically significant lesions (-13.5 ± 17.1 HU [Hounsfield units] × 10 mm(-1) vs. -11.6 ± 13.3 HU × 10 mm(-1), p = 0.36; and 13.1 ± 15.9 HU × 10 mm(-1) vs. -11.4 ± 11.7 HU × 10 mm(-1), p = 0.77, respectively). TAG-CCO was lower in vessels with a hemodynamically-significant lesion (-0.050 ± 0.051 10 mm(-1) vs. -0.036 ± 0.034 10 mm(-1), p = 0.03) and TAG-ExC resulted in a slight improvement of the net reclassification index (0.021, p < 0.05). CONCLUSIONS TAG did not provide incremental diagnostic value over 256-slice coronary CTA alone in assessing the hemodynamic consequences of a coronary stenosis. Correction for temporal nonuniformity of contrast delivery or exclusion of calcified coronary segments slightly enhanced the results.
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Affiliation(s)
- Wynand J Stuijfzand
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine, and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - C Bogdan Marcu
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Cornelis C van Kuijk
- Department of Radiology, Nuclear Medicine, and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Koen Nieman
- Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - James K Min
- Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
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Nolte F, Hyde ER, Rolandi C, Lee J, van Horssen P, Asrress K, van den Wijngaard JPHM, Cookson AN, van de Hoef T, Chabiniok R, Razavi R, Michler C, Hautvast GLTF, Piek JJ, Breeuwer M, Siebes M, Nagel E, Smith NP, Spaan JAE. Myocardial perfusion distribution and coronary arterial pressure and flow signals: clinical relevance in relation to multiscale modeling, a review. Med Biol Eng Comput 2013; 51:1271-86. [DOI: 10.1007/s11517-013-1088-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/11/2013] [Indexed: 01/25/2023]
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Crown years for non-invasive cardiovascular imaging (Part IV): 30 years of cardiac computed tomography. Neth Heart J 2013; 21:315-8. [PMID: 23640578 PMCID: PMC3722385 DOI: 10.1007/s12471-013-0427-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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