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Nayfeh M, Sayed A, Alwan M, Alfawara M, Al Rifai M, Al-Mallah MH. Hybrid Imaging: Calcium Score and Myocardial Perfusion Imaging. Semin Nucl Med 2024; 54:638-647. [PMID: 39034159 DOI: 10.1053/j.semnuclmed.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 07/23/2024]
Abstract
Coronary heart disease (CHD) remains the top cause of death due to cardiovascular conditions worldwide, with someone suffering a myocardial infarction every 40 seconds. This highlights the importance of non-invasive imaging technologies like myocardial perfusion imaging (MPI), which are crucial for detecting coronary artery disease (CAD) early, even before symptoms appear. However, the reliance solely on MPI has shifted due to its limitations in definitively ruling out atherosclerosis, leading to the adoption of hybrid imaging techniques. Hybrid imaging combines computed tomography (CT) with MPI techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). This integration, often within a single gantry system, enhances the diagnostic accuracy by allowing for attenuation correction (AC), acquisition of the coronary artery calcium score (CACS), and more precise tracing of radiotracer uptake. The built-in CT in modern MPI systems assists in these functions, which is essential for better diagnosis and risk assessment in patients. The addition of CACS to MPI, a method involving the assessment of calcified plaque in coronary arteries, notably enhances diagnostic and prognostic capabilities. CACS helps in identifying atherosclerosis and predicting potential cardiac events, facilitating personalized risk management and the initiation of tailored interventions like statins and aspirin. Such comprehensive imaging strategies not only improve the accuracy of detecting CAD but also help in stratifying patient risk more effectively. In this paper, we discuss how the incorporation of CAC into MPI protocols enhances the diagnostic sensitivity for detecting obstructive CAD, as evidenced by several studies where the addition of CAC to MPI has led to improved outcomes in diagnosing CAD. Moreover, CAC has been shown to unmask silent coronary atherosclerosis in patients with normal MPI results, highlighting its incremental diagnostic value. We will discuss the evolving role of hybrid imaging in guiding therapeutic decisions, particularly the use of statins for cardiovascular prevention. The integration of CAC assessment with MPI not only aids in the early detection and management of CAD but also optimizes therapeutic strategies, enhancing patient care through a more accurate and personalized approach. Such advancements underscore the need for further research to fully establish the benefits of combining CAC with MPI in the clinical assessment of cardiovascular risk.
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Affiliation(s)
- Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | | | - Maria Alwan
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Moath Alfawara
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
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2
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Groen RA, Jukema JW, van Dijkman PRM, Bax JJ, Lamb HJ, Antoni ML, de Graaf MA. The Clear Value of Coronary Artery Calcification Evaluation on Non-Gated Chest Computed Tomography for Cardiac Risk Stratification. Cardiol Ther 2024; 13:69-87. [PMID: 38349434 PMCID: PMC10899125 DOI: 10.1007/s40119-024-00354-9] [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: 11/21/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
To enhance risk stratification in patients suspected of coronary artery disease, the assessment of coronary artery calcium (CAC) could be incorporated, especially when CAC can be readily assessed on previously performed non-gated chest computed tomography (CT). Guidelines recommend reporting on patients' extent of CAC on these non-cardiac directed exams and various studies have shown the diagnostic and prognostic value. However, this method is still little applied, and no current consensus exists in clinical practice. This review aims to point out the clinical utility of different kinds of CAC assessment on non-gated CTs. It demonstrates that these scans indeed represent a merely untapped and underestimated resource for risk stratification in patients with stable chest pain or an increased risk of cardiovascular events. To our knowledge, this is the first review to describe the clinical utility of different kinds of visual CAC evaluation on non-gated unenhanced chest CT. Various methods of CAC assessment on non-gated CT are discussed and compared in terms of diagnostic and prognostic value. Furthermore, the application of these non-gated CT scans in the general practice of cardiology is discussed. The clinical utility of coronary calcium assessed on non-gated chest CT, according to the current literature, is evident. This resource of information for cardiac risk stratification needs no specific requirements for scan protocol, and is radiation-free and cost-free. However, some gaps in research remain. In conclusion, the integration of CAC on non-gated chest CT in general cardiology should be promoted and research on this method should be encouraged.
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Affiliation(s)
- Roos A Groen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
| | - Paul R M van Dijkman
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - M Louisa Antoni
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
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3
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Wu M, Mirkin S, Nagy S, McPhail MN, Demory Beckler M, Kesselman MM. Computed Tomography (CT) Calcium Scoring in Primary Prevention of Acute Coronary Syndrome and Future Cardiac Events in Patients With Systemic Lupus Erythematosus. Cureus 2023; 15:e47157. [PMID: 38022274 PMCID: PMC10653626 DOI: 10.7759/cureus.47157] [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: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex and chronic autoimmune disease that impacts multiple organ systems and presents with varying symptomatology that makes targeting treatment extremely difficult. The cardiovascular system and more specifically the coronary arteries are heavily affected by SLE causing increased atherosclerosis and subsequently increased acute coronary syndrome (ACS) and increased future cardiac events. ACS is a common occurrence in patients with SLE due to the premature development of atherosclerosis due to the dysregulation of pro-inflammatory cytokines. Calcium scoring has been effectively utilized to identify plaque burden in patients with coronary artery calcification (CAC). Calcium scoring is a score obtained from a computed tomography (CT) image using non-contrast imaging, which provides quantitative information regarding CAC and aids in assessing cardiovascular risk. A calcium score of zero Hounsfeild units can be obtained using CT calcium scoring which indicates no calcium is identified in the coronary arteries and is a strong negative risk predictor for coronary artery disease. Early screening of SLE patients with CT calcium scoring could aid in early detection and treatment subsequently leading to delay of premature coronary atherosclerosis and future cardiac events in this patient population. Multiple studies have used calcium scoring as a method to measure arterial calcification in SLE patients. The Society of Cardiovascular Imaging has now endorsed the idea of obtaining a baseline calcium artery score with a repeat progression scan in 3-5 years. Calcium scoring has also been identified as an effective initial tool for stratification and identification of possible ACS. The various advantages of early calcium scoring signify the further research needed to fully understand and implement the advantages calcium scoring has to offer patients with SLE.
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Affiliation(s)
- Michael Wu
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Sophia Mirkin
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Stephanie Nagy
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Marissa N McPhail
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Michelle Demory Beckler
- Microbiology and Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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Zhou Y, Eastman E, Lee C, Scott A. Optimal dose determination for coronary artery calcium scoring CT at standard tube voltage. Eur J Radiol 2023; 167:111029. [PMID: 37579562 DOI: 10.1016/j.ejrad.2023.111029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/31/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES Coronary artery calcium scoring (CACs) at 120 kVp is the standard practice. It is an important tool for preventative management of asymptomatic patients. However, the current dose delivery, albeit patient-size dependent, does not connect the CACs specific noise requirement to the dose, causing significant dose variations. We propose a new approach for optimal dose determination by incorporating the patient-size dependent noise threshold. METHODS A polyethylene-based Mercury phantom of various diameters was scanned with a dual-source CT using CACs gating at different volume CT dose index (CTDIvol). The relationship of noise to the diameter and CTDIvol was obtained. The phantom diameter was then converted to the patient chest diameter through a retrospective analysis of a clinical cohort (N = 140). Finally, the patient-size dependent noise threshold was applied, and the optimal dose was derived. The prescribed doses were compared with those from a clinical CACs cohort (N = 262). RESULTS A power-exponential relationship was found for the noise versus CTDIvol and phantom diameter (R2 = 0.988). The phantom diameter versus the patient effective diameter was found to obey a linear relationship (R2 = 0.998). Two noise threshold settings were made for dose options: one for more dose saving, and another for tighter noise constraint. Retrospective comparisons with clinical CACs studies showed an average dose reduction of 23% in 80.5% of the cases with option 1. The average dose reduction is 23% in 77.9% of the cases with option 2. CONCLUSION A new optimal dose scheme dictated by the target noise was established for CACs at 120 kVp. The proposed dose modulation can serve as the baseline from which further dose reduction is possible.
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Affiliation(s)
- Yifang Zhou
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.
| | - Emi Eastman
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Christina Lee
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Alexander Scott
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
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Lee JO, Park EA, Park D, Lee W. Deep Learning-Based Automated Quantification of Coronary Artery Calcification for Contrast-Enhanced Coronary Computed Tomographic Angiography. J Cardiovasc Dev Dis 2023; 10:jcdd10040143. [PMID: 37103022 PMCID: PMC10146297 DOI: 10.3390/jcdd10040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Background: We evaluated the accuracy of a deep learning-based automated quantification algorithm for coronary artery calcium (CAC) based on enhanced ECG-gated coronary CT angiography (CCTA) with dedicated coronary calcium scoring CT (CSCT) as the reference. Methods: This retrospective study included 315 patients who underwent CSCT and CCTA on the same day, with 200 in the internal and 115 in the external validation sets. The calcium volume and Agatston scores were calculated using both the automated algorithm in CCTA and the conventional method in CSCT. The time required for computing calcium scores using the automated algorithm was also evaluated. Results: Our automated algorithm extracted CACs in less than five minutes on average with a failure rate of 1.3%. The volume and Agatston scores by the model showed high agreement with those from CSCT with concordance correlation coefficients of 0.90–0.97 for the internal and 0.76–0.94 for the external. The accuracy for classification was 92% with a 0.94 weighted kappa for the internal and 86% with a 0.91 weighted kappa for the external set. Conclusions: The deep learning-based and fully automated algorithm efficiently extracted CACs from CCTA and reliably assigned categorical classification for Agatston scores without additional radiation exposure.
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Affiliation(s)
- Jung Oh Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Correspondence: ; Tel.: +82-2-2072-2584
| | - Daebeom Park
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Bechtiger FA, Grossmann M, Bakula A, Patriki D, von Felten E, Fuchs TA, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Risk stratification using coronary artery calcium scoring based on low tube voltage computed tomography. Int J Cardiovasc Imaging 2022; 38:2227-2234. [PMID: 37726457 PMCID: PMC10509109 DOI: 10.1007/s10554-022-02615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022]
Abstract
To determine if coronary artery calcium (CAC) scoring using computed tomography at 80 kilovolt-peak (kVp) and 70-kVp and tube voltage-adapted scoring-thresholds allow for accurate risk stratification as compared to the standard 120-kVp protocol. We prospectively included 170 patients who underwent standard CAC scanning at 120-kVp and 200 milliamperes and additional scans with 80-kVp and 70-kVp tube voltage with adapted tube current to normalize image noise across scans. Novel kVp-adapted thresholds were applied to calculate CAC scores from the low-kVp scans and were compared to those from standard 120-kVp scans by assessing risk reclassification rates and agreement using Kendall's rank correlation coefficients (Τb) for risk categories bounded by 0, 1, 100, and 400. Interreader reclassification rates for the 120-kVp scans were assessed. Agreement for risk classification obtained from 80-kVp and 70-kVp scans as compared to 120-kVp was good (Τb = 0.967 and 0.915, respectively; both p < 0.001) with reclassification rates of 7.1% and 17.2%, respectively, mostly towards a lower risk category. By comparison, the interreader reclassification rate was 4.1% (Τb = 0.980, p < 0.001). Reclassification rates were dependent on body mass index (BMI) with 7.1% and 13.6% reclassifications for the 80-kVp and 70-kVp scans, respectively, in patients with a BMI < 30 kg/m2 (n = 140), and 2.9% and 7.4%, respectively, in patients with a BMI < 25 kg/m2 (n = 68). Mean effective radiation dose from the 120-kVp, the 80-kVp, and 70-kVp scans was 0.54 ± 0.03, 0.42 ± 0.02, and 0.26 ± 0.02 millisieverts. CAC scoring with reduced tube voltage allows for accurate risk stratification if kVp-adapted thresholds for calculation of CAC scores are applied.ClinicalTrials.gov NCT03637231.
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Affiliation(s)
- Fabiola A Bechtiger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Marvin Grossmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Adam Bakula
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University Zurich, Zurich, Switzerland.
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Ahmed R, Carver C, Foley JRJ, Fent GJ, Garg P, Ripley DP. Cardiovascular imaging techniques for the assessment of coronary artery disease. Br J Hosp Med (Lond) 2022; 83:1-11. [DOI: 10.12968/hmed.2022.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease continues to be the leading cause of morbidity and mortality worldwide. Recent clinical trials have not demonstrated any mortality benefit of percutaneous coronary intervention compared to medical management alone in the treatment of stable angina. While invasive coronary angiography remains the gold standard for diagnosing coronary artery disease, it comes with significant risks, including myocardial infarction, stroke and death. There have been significant advances in imaging techniques to diagnose coronary artery disease in haemodynamically stable patients. The latest National Institute for Health and Care Excellence and European College of Cardiology guidelines emphasise the importance of using these imaging techniques first to inform diagnosis. This review discusses these guidelines and imaging techniques, alongside their benefits and drawbacks.
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Affiliation(s)
- Raheel Ahmed
- Cardiology Department, Royal Brompton Hospital, London, UK
| | - Caleb Carver
- Department of Acute Internal Medicine, Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - James RJ Foley
- Department of Cardiology, Pinderfields General Hospital, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Graham J Fent
- Department of Cardiology, Northern General Hospital, Sheffield, UK
| | - Pankaj Garg
- Department of Cardiology, University of East Anglia, Norwich, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - David P Ripley
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
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Ties D, van der Ende YM, Pundziute G, van der Schouw YT, Bots ML, Xia C, van Ooijen PMA, Pelgrim GJ, Vliegenthart R, van der Harst P. Pre-screening to guide coronary artery calcium scoring for early identification of high-risk individuals in the general population. Eur Heart J Cardiovasc Imaging 2022; 24:27-35. [PMID: 35851802 PMCID: PMC9762935 DOI: 10.1093/ehjci/jeac137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS To evaluate the ability of Systematic COronary Risk Estimation 2 (SCORE2) and other pre-screening methods to identify individuals with high coronary artery calcium score (CACS) in the general population. METHODS AND RESULTS Computed tomography-based CACS quantification was performed in 6530 individuals aged 45 years or older from the general population. Various pre-screening methods to guide referral for CACS were evaluated. Miss rates for high CACS (CACS ≥300 and ≥100) were evaluated for various pre-screening methods: moderate (≥5%) and high (≥10%) SCORE2 risk, any traditional coronary artery disease (CAD) risk factor, any Risk Or Benefit IN Screening for CArdiovascular Disease (ROBINSCA) risk factor, and moderately (>3 mg/24 h) increased urine albumin excretion (UAE). Out of 6530 participants, 643 (9.8%) had CACS ≥300 and 1236 (18.9%) had CACS ≥100. For CACS ≥300 and CACS ≥100, miss rate was 32 and 41% for pre-screening by moderate (≥5%) SCORE2 risk and 81 and 87% for high (≥10%) SCORE2 risk, respectively. For CACS ≥300 and CACS ≥100, miss rate was 8 and 11% for pre-screening by at least one CAD risk factor, 24 and 25% for at least one ROBINSCA risk factor, and 67 and 67% for moderately increased UAE, respectively. CONCLUSION Many individuals with high CACS in the general population are left unidentified when only performing CACS in case of at least moderate (≥5%) SCORE2, which closely resembles current clinical practice. Less stringent pre-screening by presence of at least one CAD risk factor to guide CACS identifies more individuals with high CACS and could improve CAD prevention.
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Affiliation(s)
- Daan Ties
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yldau M van der Ende
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Gabija Pundziute
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Congying Xia
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology and Data Science Center in Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Al-Kindi S, Tashtish N, Rashid I, Gupta A, AnsariGilani K, Gilkeson R, Cainzos-Achirica M, Nasir K, Pronovost P, Simon DI, Rajagopalan S. Effect of No-Charge Coronary Artery Calcium Scoring on Cardiovascular Prevention. Am J Cardiol 2022; 174:40-47. [PMID: 35487777 DOI: 10.1016/j.amjcard.2022.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 12/15/2022]
Abstract
Prevention of cardiovascular disease is currently guided by probabilistic risk scores that may misclassify individual risk and commit many middle-aged patients to prolonged pharmacotherapy. The coronary artery calcium (CAC) score, although endorsed for intermediate-risk patients, is not widely adopted because of barriers in reimbursement. The impact of removing cost barrier on cardiovascular outcomes in real-world settings is not known. Within the University Hospitals Health System (Cleveland, Ohio), CAC was offered to patients with at least 1 cardiovascular risk factor at low charge between 2014 and 2017 ($99) and no charge from January 1, 2018 onward. CAC use and access, patient characteristics, reclassification of risk compared with the pooled cohort equations (PCEs) for atherosclerotic vascular disease, statin use, changes in parameters of cardiometabolic health, downstream cardiovascular testing, downstream coronary revascularization, and cardiovascular outcomes were evaluated. A total of 52,151 patients underwent CAC testing over the study period. Median 10-year PCE for atherosclerotic vascular disease, in the entire cohort was 8.3% (4.0% to 15.9%). Among patients with PCE >20%, 21% had CAC <100, whereas 37% of those with PCE <7.5% had CAC ≥100. Among patients who were not on statin before CAC testing, 1-year statin prescription was 24% and was significantly associated with higher CAC scores. Total cholesterol, low-density lipoprotein cholesterol, and triglycerides all decreased significantly 1-year after CAC, and the degree of decrease was strongly linked with CAC scores. One year after CAC, 14% underwent noninvasive ischemic evaluation, 1.4% underwent invasive coronary angiography, and 0.9% underwent revascularization. The majority (74%) of revascularization procedures occurred in patients with CAC >400. In conclusion, reducing or removing the cost burden of CAC leads to significant test uptake by patients, which is followed by reclassification of statin eligibility, increases in the use of preventive medications, and improvement in risk factors, with very low rates of invasive downstream testing.
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10
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Gupta A, Bera K, Kikano E, Pierce JD, Gan J, Rajdev M, Ciancibello LM, Gupta A, Rajagopalan S, Gilkeson RC. Coronary Artery Calcium Scoring: Current Status and Future Directions. Radiographics 2022; 42:947-967. [PMID: 35657766 DOI: 10.1148/rg.210122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary artery calcium (CAC) scores obtained from CT scans have been shown to be prognostic in assessment of the risk for development of cardiovascular diseases, facilitating the prediction of outcome in asymptomatic individuals. Currently, several methods to calculate the CAC score exist, and each has its own set of advantages and disadvantages. Agatston CAC scoring is the most extensively used method. CAC scoring is currently recommended for use in asymptomatic individuals to predict the risk of developing cardiovascular diseases and the disease-specific mortality. In specific subsets of patients, the CAC score has also been recommended for reclassifying cardiovascular risk and aiding in decision making when planning primary prevention interventions such as statin therapy. The progression of CAC scores on follow-up images has been shown to be linked to risk of myocardial infarction and cardiovascular mortality. While the CAC score is a validated tool used clinically, several challenges, including various pitfalls associated with the acquisition, calculation, and interpretation of the score, prevent more widespread adoption of this metric. Recent research has been focused extensively on strategies to improve existing scoring methods, including measuring calcium attenuation, detecting microcalcifications, and focusing on extracoronary calcifications, and on strategies to improve image acquisition. A better understanding of CAC scoring approaches will help radiologists and other physicians better use and interpret these scores in their workflows. An invited commentary by S. Gupta is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Amit Gupta
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Kaustav Bera
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Elias Kikano
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Jonathan D Pierce
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Jonathan Gan
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Maharshi Rajdev
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Leslie M Ciancibello
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Aekta Gupta
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Sanjay Rajagopalan
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Robert C Gilkeson
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
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11
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Shang J, Guo Y, Ma Y, Hou Y. Cardiac computed tomography radiomics: a narrative review of current status and future directions. Quant Imaging Med Surg 2022; 12:3436-3453. [PMID: 35655815 PMCID: PMC9131324 DOI: 10.21037/qims-21-1022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/23/2022] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVE In an era of profound growth of medical data and rapid development of advanced imaging modalities, precision medicine increasingly requires further expansion of what can be interpreted from medical images. However, the current interpretation of cardiac computed tomography (CT) images mainly depends on subjective and qualitative analysis. Radiomics uses advanced image analysis to extract numerous quantitative features from digital images that are unrecognizable to the naked eye. Visualization of these features can reveal underlying connections between image phenotyping and biological characteristics and support clinical outcomes. Although research into radiomics on cardiovascular disease began only recently, several studies have indicated its potential clinical value in assessing future cardiac risk and guiding prevention and management strategies. Our review aimed to summarize the current applications of cardiac CT radiomics in the cardiovascular field and discuss its advantages, challenges, and future directions. METHODS We searched for English-language articles published between January 2010 and August 2021 in the databases of PubMed, Embase, and Google Scholar. The keywords used in the search included computed tomography or CT, radiomics, cardiovascular or cardiac. KEY CONTENT AND FINDINGS The current applications of radiomics in cardiac CT were found to mainly involve research into coronary plaques, perivascular adipose tissue (PVAT), myocardial tissue, and intracardiac lesions. Related findings on cardiac CT radiomics suggested the technique can assist the identification of vulnerable plaques or patients, improve cardiac risk prediction and stratification, discriminate myocardial pathology and etiologies behind intracardiac lesions, and offer new perspective and development prospects to personalized cardiovascular medicine. CONCLUSIONS Cardiac CT radiomics can gather additional disease-related information at a microstructural level and establish a link between imaging phenotyping and tissue pathology or biology alone. Therefore, cardiac CT radiomics has significant clinical implications, including a contribution to clinical decision-making. Along with advancements in cardiac CT imaging, cardiac CT radiomics is expected to provide more precise phenotyping of cardiovascular disease for patients and doctors, which can improve diagnostic, prognostic, and therapeutic decision making in the future.
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Affiliation(s)
- Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan Guo
- GE Healthcare, Beijing, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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12
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Christian TF, Marfatia R, Chen LQ, Onuegbu AG, Pollack S, Cao J. Harmonizing multimodality imaging results using Bayesian analysis: the case of CT coronary angiography and CT-derived fractional flow reserve. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1409-1419. [PMID: 35092523 DOI: 10.1007/s10554-022-02530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/15/2022] [Indexed: 11/29/2022]
Abstract
Coronary computed tomographic angiography (CCTA) may provide both anatomic and CT fractional flow reserve data (CTFFR). The objective is to use Bayesian analysis to develop a model wherein the probability of significant coronary artery disease (CAD) by CTFFR can be determined given the prior probability (P) of the combined clinical and CCTA result. 172 patients referred for CCTA and subsequently underwent coronary angiography were automatically referred to CTFFR analysis. A clinical P risk score (CRS) was calculated per patient. CCTA exams were scored using CAD-RADS classification. CTFFR results were generated. CAD was defined as ≥ 3 RAD class for CCTA and ≤ .80 by CTFFR. P was calculated using CCTA and CTFFR accuracy from a prior clinical trial: post-test P for the CCTA result used the CRS as the prior risk, and CTFFR P used the post-test CRS + CCTA P as the prior risk (tri-variable). Patients were classified for each model into low (< 5%), intermediate, (5-70%) and high (> 70%) risk groups. There were 100 patients (58%), who had significant CAD at angiography. 58 patients had discordant CCTA/CTFFR results. The inclusion of the CRS and CRS + CCTA in the prior progressively reduced the intermediate risk cohort from 83 to 41% (p < 0.0001). Correct classifications (low-risk, negative angiogram plus high-risk, positive angiogram) increased by model: CRS = 12%, CRS + CCTA = 25%, CRS + CTFFR = 33%, CRS + CCTA + CTFFR = 44% (p < 0.001). Incorrect classifications were reduced to 15%. The tri-variable model performed better than either CCTA or CTFFR alone for all patients and for the sub-group with discordant imaging results. Discrepant CCTA and CTFFR results are present in one third of patients. The use of both the CRS and CCTA as the prior risk synergistically maximized the accuracy of the accuracy of the CTFFR technique.
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Affiliation(s)
- Timothy F Christian
- Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway, Bronx, NY, USA.
| | - Ravi Marfatia
- St Francis Hospital-The Heart Center/DeMatteis Research Center for Cardiovascular Disease, Greenvale, USA
| | - Lu Q Chen
- St Francis Hospital-The Heart Center/DeMatteis Research Center for Cardiovascular Disease, Greenvale, USA
| | - Afiachukwu G Onuegbu
- St Francis Hospital-The Heart Center/DeMatteis Research Center for Cardiovascular Disease, Greenvale, USA
| | - Simcha Pollack
- St Francis Hospital-The Heart Center/DeMatteis Research Center for Cardiovascular Disease, Greenvale, USA
| | - Jane Cao
- St Francis Hospital-The Heart Center/DeMatteis Research Center for Cardiovascular Disease, Greenvale, USA
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13
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Ties D, van Dorp P, Pundziute G, Lipsic E, van der Aalst CM, Oudkerk M, de Koning HJ, Vliegenthart R, van der Harst P. Multi-Modality Imaging for Prevention of Coronary Artery Disease and Myocardial Infarction in the General Population: Ready for Prime Time? J Clin Med 2022; 11:jcm11112965. [PMID: 35683356 PMCID: PMC9181560 DOI: 10.3390/jcm11112965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
Cardiovascular disease (CVD) remains a leading cause of death and disability worldwide. Acute myocardial infarction (AMI) causes irreversible myocardial damage, heart failure, life-threatening arrythmias and sudden cardiac death (SCD), and is a main driver of CVD mortality and morbidity. To control the forecasted increase in CVD burden for both the individual and society, improved strategies for the prevention of AMI and SCD are required. Current prevention of AMI and SCD is directed towards risk-modifying interventions, guided by risk assessment using clinical risk prediction scores (CRPSs) and the coronary artery calcium score (CACS). Early detection of more advanced coronary artery disease (CAD), beyond risk assessment by CRPSs or CACS, is a promising strategy to allow personalized treatment for the improved prevention of AMI and SCD in the general population. We review evidence for further testing, beyond CRPSs and CACS, and therapies focusing on promising targets, including subclinical obstructive CAD, high-risk plaques, and silent myocardial ischemia. We also evaluate the potential of multi-modality imaging to enhance the conduction of adequately powered trials to provide high-quality evidence on the impact of add-on tests and therapies in the prevention of AMI and SCD in asymptomatic individuals. To conclude, we discuss the occurrence of AMI and SCD in individuals currently estimated to be at “low-risk” by the current strategy based on CRPSs, and methods to improve prevention of AMI and SCD in this “low-risk” population.
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Affiliation(s)
- Daan Ties
- University Medical Center Groningen, Thorax Centre, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.T.); (P.v.D.); (G.P.); (E.L.)
| | - Paulien van Dorp
- University Medical Center Groningen, Thorax Centre, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.T.); (P.v.D.); (G.P.); (E.L.)
| | - Gabija Pundziute
- University Medical Center Groningen, Thorax Centre, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.T.); (P.v.D.); (G.P.); (E.L.)
| | - Erik Lipsic
- University Medical Center Groningen, Thorax Centre, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.T.); (P.v.D.); (G.P.); (E.L.)
| | - Carlijn M. van der Aalst
- Erasmus Medical Center, Department of Public Health, Erasmus University, 3015 CE Rotterdam, The Netherlands; (C.M.v.d.A.); (H.J.d.K.)
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Harry J. de Koning
- Erasmus Medical Center, Department of Public Health, Erasmus University, 3015 CE Rotterdam, The Netherlands; (C.M.v.d.A.); (H.J.d.K.)
| | - Rozemarijn Vliegenthart
- University Medical Center Groningen, Department of Radiology, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Pim van der Harst
- University Medical Center Groningen, Thorax Centre, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.T.); (P.v.D.); (G.P.); (E.L.)
- University Medical Center Utrecht, Department of Cardiology, University of Utrecht, 3584 CX Utrecht, The Netherlands
- Correspondence:
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14
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Kamani CH, Huang W, Lutz J, Giannopoulos AA, Patriki D, von Felten E, Schwyzer M, Gebhard C, Benz DC, Fuchs TA, Gräni C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Impact of Adaptive Statistical Iterative Reconstruction-V on Coronary Artery Calcium Scores Obtained From Low-Tube-Voltage Computed Tomography - A Patient Study. Acad Radiol 2022; 29 Suppl 4:S11-S16. [PMID: 33187851 DOI: 10.1016/j.acra.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of adaptive statistical iterative reconstruction-V (ASIR-V) on the accuracy of ultra-low-dose coronary artery calcium (CAC) scoring. MATERIALS AND METHOD One-hundred-and-three patients who underwent computed tomography (CT) for CAC scoring were prospectively included. All underwent standard scanning with 120-kilovolt-peak (kVp) and with 80- and 70-kVp tube voltage. ASiR-V was applied to the 80- and 70-kVp scans at different levels. The 120-kVp scans reconstructed with filtered back projection served as the standard of reference. Recently published novel kVp-adapted thresholds were used for calculation of CAC scores from 80- and 70-kVp scans and the resulting CAC scores were compared against the standard of reference. Patients were stratified into six CAC score risk categories: 0, 1-10, 11-100, 101-400, 401-1000, and >1000. RESULTS Increasing levels of ASIR-V led to an increasing underestimation of CAC scores with bias ranging from -128 to -118 and from -205 to -198 for the 80- and 70-kVp scans, respectively, when compared with the standard of reference. Reconstruction with 20% and 40% ASIR-V for the 80- and 70-kVp scans, respectively, yielded noise levels comparable to the standard of reference. Nevertheless, a change in risk-class was observed in 29 (28.6%) and 46 (44.7%) patients, exclusively to a lower risk-class, when CAC scores were derived from these reconstructions. CONCLUSION ASIR-V leads to noise reduction in CT scans acquired with low tube-voltages. However, ASIR-V introduces substantial inaccuracies and marked underestimation of ultra-low-dose CAC scoring as compared with standard-dose CAC scoring despite normalization of noise.
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Affiliation(s)
- Christel H Kamani
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Wenjie Huang
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Joel Lutz
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | | | - Dimitri Patriki
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Elia von Felten
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Moritz Schwyzer
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Catherine Gebhard
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Dominik C Benz
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Tobias A Fuchs
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | - Christoph Gräni
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND
| | | | | | - Ronny R Buechel
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, SWITZERLAND.
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15
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Schill F, Persson M, Engström G, Melander O, Enhörning S. Copeptin as a marker of atherosclerosis and arteriosclerosis. Atherosclerosis 2021; 338:64-68. [PMID: 34785062 PMCID: PMC7612343 DOI: 10.1016/j.atherosclerosis.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/12/2021] [Accepted: 10/29/2021] [Indexed: 01/14/2023]
Abstract
Background and aims The precursor peptide of vasopressin, copeptin, has previously been linked to increased risk of developing diabetes mellitus, coronary artery disease and cardiovascular mortality. Whether elevated copeptin is associated with markers of atherosclerosis and arteriosclerosis in the general population is not known. Methods In this population-based, cross-sectional study, coronary artery calcium score (CACS), carotid-femoral pulse wave velocity (c-f PWV) and fasting plasma copeptin were measured in 5303 individuals in the Swedish cardiopulmonary bioimage study (SCAPIS). Multivariable logistic regression models were used to analyze the associations between copeptin and high CACS (>100) and high c-f PWV (>10 m/s), respectively. Results The number of individuals with high CACS and c-f PWV increased across increasing tertile of copeptin (11.7%, 13.3% and 16.3% for CACS and 6.9%, 8.5% and 10.6% for c-f PWV). The top tertile of copeptin was, compared with reference tertile 1, significantly associated with both high CACS and high c-f PWV after adjustment for age, sex, hypertension, diabetes mellitus, HDL, triglycerides, BMI, smoking status, creatinine and high sensitive CRP with an odds ratio (OR) of 1.260 (95% confidence interval (CI): 1.022–1.555) for CACS and OR 1.389 (95% CI: 1.069–1.807) for PWV. Conclusions Copeptin is associated with both coronary atherosclerosis and increased arterial stiffness in the general population. Our data indicates that copeptin may be a useful marker in the assessment of cardiovascular risk.
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Affiliation(s)
- Fredrika Schill
- Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, 214 28, Malmö, Sweden; Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden.
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Jan Waldenströms gata 11 A, 214 28, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Jan Waldenströms gata 11 A, 214 28, Malmö, Sweden
| | - Sofia Enhörning
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Jan Waldenströms gata 11 A, 214 28, Malmö, Sweden
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16
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Juntunen MAK, Kotiaho AO, Nieminen MT, Inkinen SI. Optimizing iterative reconstruction for quantification of calcium hydroxyapatite with photon counting flat-detector computed tomography: a cardiac phantom study. J Med Imaging (Bellingham) 2021; 8:052102. [PMID: 33718518 PMCID: PMC7946398 DOI: 10.1117/1.jmi.8.5.052102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: Coronary artery calcium (CAC) scoring with computed tomography (CT) has been proposed as a screening tool for coronary artery disease, but concerns remain regarding the radiation dose of CT CAC scoring. Photon counting detectors and iterative reconstruction (IR) are promising approaches for patient dose reduction, yet the preservation of CAC scores with IR has been questioned. The purpose of this study was to investigate the applicability of IR for quantification of CAC using a photon counting flat-detector. Approach: We imaged a cardiac rod phantom with calcium hydroxyapatite (CaHA) inserts with different noise levels using an experimental photon counting flat-detector CT setup to simulate the clinical CAC scoring protocol. We applied filtered back projection (FBP) and two IR algorithms with different regularization strengths. We compared the air kerma values, image quality parameters [noise magnitude, noise power spectrum, modulation transfer function (MTF), and contrast-to-noise ratio], and CaHA quantification accuracy between FBP and IR. Results: IR regularization strength influenced CAC scores significantly ( p < 0.05 ). The CAC volumes and scores between FBP and IRs were the most similar when the IR regularization strength was chosen to match the MTF of the FBP reconstruction. Conclusion: When the regularization strength is selected to produce comparable spatial resolution with FBP, IR can yield comparable CAC scores and volumes with FBP. Nonetheless, at the lowest radiation dose setting, FBP produced more accurate CAC volumes and scores compared to IR, and no improved CAC scoring accuracy at low dose was demonstrated with the utilized IR methods.
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Affiliation(s)
- Mikael A. K. Juntunen
- University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Antti O. Kotiaho
- Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Miika T. Nieminen
- University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Satu I. Inkinen
- University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Oulu, Finland
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17
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Hu X, Tao X, Zhang Y, Niu Z, Zhang Y, Allmendinger T, Kuang Y, Chen B. Accurate Measurement of Agatston Score Using kVp-Independent Reconstruction Algorithm for Ultra-High-Pitch Sn150 kVp CT. Korean J Radiol 2021; 22:1777-1785. [PMID: 34431246 PMCID: PMC8546135 DOI: 10.3348/kjr.2021.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the accuracy of the Agatston score obtained with the ultra-high-pitch (UHP) acquisition mode using tin-filter spectral shaping (Sn150 kVp) and a kVp-independent reconstruction algorithm to reduce the radiation dose. MATERIALS AND METHODS This prospective study included 114 patients (mean ± standard deviation, 60.3 ± 9.8 years; 74 male) who underwent a standard 120 kVp scan and an additional UHP Sn150 kVp scan for coronary artery calcification scoring (CACS). These two datasets were reconstructed using a standard reconstruction algorithm (120 kVp + Qr36d, protocol A; Sn150 kVp + Qr36d, protocol B). In addition, the Sn150 kVp dataset was reconstructed using a kVp-independent reconstruction algorithm (Sn150 kVp + Sa36d, protocol C). The Agatston scores for protocols A and B, as well as protocols A and C, were compared. The agreement between the scores was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. The radiation doses for the 120 kVp and UHP Sn150 kVp acquisition modes were also compared. RESULTS No significant difference was observed in the Agatston score for protocols A (median, 63.05; interquartile range [IQR], 0-232.28) and C (median, 60.25; IQR, 0-195.20) (p = 0.060). The mean difference in the Agatston score for protocols A and C was relatively small (-7.82) and with the limits of agreement from -65.20 to 49.56 (ICC = 0.997). The Agatston score for protocol B (median, 34.85; IQR, 0-120.73) was significantly underestimated compared with that for protocol A (p < 0.001). The UHP Sn150 kVp mode facilitated an effective radiation dose reduction by approximately 30% (0.58 vs. 0.82 mSv, p < 0.001) from that associated with the standard 120 kVp mode. CONCLUSION The Agatston scores for CACS with the UHP Sn150 kVp mode with a kVp-independent reconstruction algorithm and the standard 120 kVp demonstrated excellent agreement with a small mean difference and narrow agreement limits. The UHP Sn150 kVp mode allowed a significant reduction in the radiation dose.
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Affiliation(s)
- Xi Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinwei Tao
- Siemens Healthineers China, Shanghai, China
| | - Yueqiao Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongfeng Niu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Thomas Allmendinger
- Computed Tomography-Research & Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Yu Kuang
- Medical Physics Program, University of Nevada, Las Vegas, NV, USA.
| | - Bin Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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18
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Mousseaux E, Fayol A, Danchin N, Soulat G, Charpentier E, Livrozet M, Carves JB, Tea V, Salem FB, Chamandi C, Hulot JS, Puymirat E. Association between coronary artery calcifications and 6-month mortality in hospitalized patients with COVID-19. Diagn Interv Imaging 2021; 102:717-725. [PMID: 34312110 PMCID: PMC8275480 DOI: 10.1016/j.diii.2021.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
Purpose The purpose of this study was to evaluate the association between coronary artery calcium (CAC) visual score and 6-month mortality in patients with coronavirus disease 2019 (COVID-19). Material and methods A single-center prospective observational cohort was conducted in 169 COVID-19 consecutive hospitalized patients between March 13 and April 1, 2020, and follow-up for 6-months. A four-level visual CAC scoring was assessed by analyzing images obtained after the first routine non-ECG-gated CT performed to detect COVID-19 pneumonia. Results Among 169 confirmed COVID-19 patients (118 men, 51 women; mean age, 65.6 ± 18.8 [SD] years; age range: 30–95 years) 63 (37%) presented with either moderate (n = 26, 15.3%) or heavy (n = 37, 21.8%) CAC detected by CT and 20 (11.8%) had history of cardiovascular disease requiring specific preventive treatment. At six months, mortality rate (45/169; 26.6%) increased with magnitude of CAC and was 7/64 (10.9%), 11/42 (26.2%), 10/26 (38.5%), 17/37 (45.9%) for no-CAC, mild-CAC, moderate-CAC and heavy-CAC groups, respectively (P = 0.001). Compared to the no CAC group, risk of death increased after adjustment with magnitude of CAC (HR: 2.23, 95% CI: 0.73–6.87, P = 0.16; HR: 2.78, 95% CI: 0.85–9.07, P0.09; HR: 5.38, 95% CI: 1.57–18.40, P = 0.007; in mild CAC, moderate and heavy CAC groups, respectively). In patients without previous coronary artery disease (154/169; 91%), mortality increased from 10.9% to 45.8% (P = 0.001) according to the magnitude of CAC categories. After adjustment, presence of moderate or heavy CAC was associated with higher mortality (HR: 2.26, 95% CI: 1.09–4.69, P = 0.03). Conclusion By using non-ECG-gated CT during the initial pulmonary assessment of COVID-19, heavy CAC is independently associated with 6-month mortality in patients hospitalized for severe COVID-19 pneumonia.
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Affiliation(s)
- Elie Mousseaux
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Assistance Publique-Hôpitaux des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France.
| | - Antoine Fayol
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France; CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Nicolas Danchin
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Gilles Soulat
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Assistance Publique-Hôpitaux des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France
| | - Etienne Charpentier
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Assistance Publique-Hôpitaux des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Marine Livrozet
- Université de Paris, Faculté de Médecine, 75006 Paris, France; CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Jean-Baptiste Carves
- Université de Paris, Faculté de Médecine, 75006 Paris, France; CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Victoria Tea
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France
| | - Fares Ben Salem
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Assistance Publique-Hôpitaux des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Chekrallah Chamandi
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France; CIC1418 and DMU CARTE, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Etienne Puymirat
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France; Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France
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Salem HT, Sabek EAS. Value of Coronary Calcium Scoring in Symptomatic and Asymptomatic Coronary Artery Disease Patients. Curr Med Imaging 2021; 17:517-523. [PMID: 33100206 DOI: 10.2174/1573405616666201023142030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
AIM AND OBJECTIVE The study aimed to estimate the relationship between Coronary Calcium Scoring (CCS) and the presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection. BACKGROUND Coronary Calcium Scoring (CCS) is a test that uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep "patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information". METHODS Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, and measures to keep them as low as possible were presented. CCS and Framingham risk estimates were compared to obtain the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions. RESULTS CCS is a strong discriminator for obstructive CAD with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate, which has high sensitivity and low specificity. CONCLUSION CCS helps to reduce the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions are unlikely, and this as a test does not use contrast material, thus harmful effect on the kidney will be avoided as most of the coronary atherosclerotic patients have renal problems.
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Affiliation(s)
- Hala T Salem
- Department of Health and Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Eman A S Sabek
- Department of Health and Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
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20
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Nasir K, Cainzos-Achirica M. Role of coronary artery calcium score in the primary prevention of cardiovascular disease. BMJ 2021; 373:n776. [PMID: 33947652 DOI: 10.1136/bmj.n776] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.
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Affiliation(s)
- Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
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21
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Coronary artery calcium scoring at lower tube voltages - Dose determination and scoring mechanism. Eur J Radiol 2021; 139:109680. [PMID: 33848779 DOI: 10.1016/j.ejrad.2021.109680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Population dose has been a concern with coronary artery calcium scoring CT since it is performed in adults with borderline risk. Lower tube voltage acquisitions are appealing but there are no agreed schemes for reduced dose determination. Moreover, conventional scoring cannot be used without changing the multiple Agatston thresholds. METHODS By applying consistent calcium contrast-to-noise ratio to two anthropomorphic heart phantoms (medium and large) with 3-cm hydroxyapatite (HA) inserts, scanned using a dual-source CT, the relationship was derived between the volume CT dose index (CTDIvol) at lower tube voltages and the baseline CTDIvol at 120 kVp. The baseline CTDIvol was obtained using the noise thresholds from the images acquired at 120 kVp. To preserve the conventional Agatston thresholds, down-scaling with the found factors was applied to images acquired at lower voltages with a dynamic heart module and 1.2-5 mm inserts (50-400 mg/cc) on the coronary tracks. Scores were evaluated on the scaled images by six readers. RESULTS The CTDIvol at lower voltages was related to the baseline CTDIvol following a power form of the voltage (index 1.246), regardless of the phantom size. The baseline CTDIvol was 1.5 and 4.5 mGy, for the medium and large phantoms, respectively. Correspondingly, the reduced CTDIvol at 100-70 kVp were 1.28-0.76 mGy, and 3.57-2.32 mGy. The downscaling factors were 0.88-0.63. The calcium scores at lower voltages were found within 12 % of the ground-truths. CONCLUSION A vendor-independent approach was established to obtain the reduced dose and correct coronary calcium scores at lower tube voltages.
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22
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Chamberlin J, Kocher MR, Waltz J, Snoddy M, Stringer NFC, Stephenson J, Sahbaee P, Sharma P, Rapaka S, Schoepf UJ, Abadia AF, Sperl J, Hoelzer P, Mercer M, Somayaji N, Aquino G, Burt JR. Automated detection of lung nodules and coronary artery calcium using artificial intelligence on low-dose CT scans for lung cancer screening: accuracy and prognostic value. BMC Med 2021; 19:55. [PMID: 33658025 PMCID: PMC7931546 DOI: 10.1186/s12916-021-01928-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) in diagnostic radiology is undergoing rapid development. Its potential utility to improve diagnostic performance for cardiopulmonary events is widely recognized, but the accuracy and precision have yet to be demonstrated in the context of current screening modalities. Here, we present findings on the performance of an AI convolutional neural network (CNN) prototype (AI-RAD Companion, Siemens Healthineers) that automatically detects pulmonary nodules and quantifies coronary artery calcium volume (CACV) on low-dose chest CT (LDCT), and compare results to expert radiologists. We also correlate AI findings with adverse cardiopulmonary outcomes in a retrospective cohort of 117 patients who underwent LDCT. METHODS A total of 117 patients were enrolled in this study. Two CNNs were used to identify lung nodules and CACV on LDCT scans. All subjects were used for lung nodule analysis, and 96 subjects met the criteria for coronary artery calcium volume analysis. Interobserver concordance was measured using ICC and Cohen's kappa. Multivariate logistic regression and partial least squares regression were used for outcomes analysis. RESULTS Agreement of the AI findings with experts was excellent (CACV ICC = 0.904, lung nodules Cohen's kappa = 0.846) with high sensitivity and specificity (CACV: sensitivity = .929, specificity = .960; lung nodules: sensitivity = 1, specificity = 0.708). The AI findings improved the prediction of major cardiopulmonary outcomes at 1-year follow-up including major adverse cardiac events and lung cancer (AUCMACE = 0.911, AUCLung Cancer = 0.942). CONCLUSION We conclude the AI prototype rapidly and accurately identifies significant risk factors for cardiopulmonary disease on standard screening low-dose chest CT. This information can be used to improve diagnostic ability, facilitate intervention, improve morbidity and mortality, and decrease healthcare costs. There is also potential application in countries with limited numbers of cardiothoracic radiologists.
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Affiliation(s)
- Jordan Chamberlin
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Madison R Kocher
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Jeffrey Waltz
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Madalyn Snoddy
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Natalie F C Stringer
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Joseph Stephenson
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | | | | | | | - U Joseph Schoepf
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Andres F Abadia
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | | | | | - Megan Mercer
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Nayana Somayaji
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Gilberto Aquino
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Jeremy R Burt
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA.
- MUSC-ART, Cardiothoracic Imaging, 25 Courtenay Drive, MSC 226, 2nd Floor, Rm 2256, Charleston, SC, 29425, USA.
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Coronary CT Angiography Guided Medical Therapy in Subclinical Atherosclerosis. J Clin Med 2021; 10:jcm10040625. [PMID: 33562179 PMCID: PMC7914610 DOI: 10.3390/jcm10040625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
The goals of primary prevention in coronary atherosclerosis are to avoid sudden cardiac death, myocardial infarction or the need for revascularization procedures. Successful prevention will rely on accurate identification, effective therapy and monitoring of those at risk. Identification and potential monitoring can be achieved using cardiac computed tomography (CT). Cardiac CT can determine coronary artery calcification (CAC), a useful surrogate of coronary atherosclerosis burden. Cardiac CT can also assess coronary CT angiography (CCTA). CCTA can identify arterial lumen narrowing and highlight mural atherosclerosis hitherto hidden from other anatomical approaches. Herein we consider the role of CCTA and CAC-scoring in subclinical atherosclerosis. We explore the use of these modalities in screening and discuss data that has used CCTA for guiding primary prevention. We examine therapeutic trials using CCTA to determine the effects of plaque-modifying therapies. Finally, we address the role of CCTA and CAC to guide therapy as defined in current primary prevention documents. CCTA has emerged as an essential tool in the detection and management of clinical coronary artery disease. To date, its role in subclinical atherosclerosis is less well defined, yet with modern CT scanners and continued pharmacotherapy development, CCTA is likely to achieve a more prominent place in the primary prevention of coronary atherosclerosis.
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Obisesan OH, Osei AD, Uddin SI, Dzaye O, Blaha MJ. An Update on Coronary Artery Calcium Interpretation at Chest and Cardiac CT. Radiol Cardiothorac Imaging 2021; 3:e200484. [PMID: 33778659 PMCID: PMC7977732 DOI: 10.1148/ryct.2021200484] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Coronary artery calcium (CAC) is a marker of overall coronary atherosclerotic burden in an individual. As such, it is an important tool in cardiovascular risk stratification and preventive treatment of asymptomatic patients with unclear cardiovascular disease risk. Several guidelines have recommended the use of CAC testing in shared decision making between the clinician and patient. With recent updates in clinical management guidelines and broad recommendations for CAC, there is a need for concise updated information on CAC interpretation on traditional electrocardiographically gated scans and nongated thoracic scans. Important points to report when interpreting CAC scans include: the absolute Agatston score and the age, sex, and race-specific CAC percentile; general recommendations on time-to-rescan for individuals with a CAC score of 0; the number of vessels with CAC; the presence of CAC in the left main coronary artery; and specific highlighting of individuals with very high CAC scores of greater than 1000. When risk factor information is available, the 10-year coronary heart disease risk can also be easily assessed using the free online Multi-Ethnic Study of Atherosclerosis risk score calculator. Recent improvements in standardizing the reporting of CAC findings across gated and nongated studies, such as the CAC Data and Reporting System, show promise for improving the widespread clinical value of CAC in clinical practice. © RSNA, 2021.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Albert D. Osei
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - S.M. Iftekhar Uddin
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Omar Dzaye
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Michael J. Blaha
- From the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
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25
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Terra L, Hooning MJ, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Mom C, van Dorst EBL, Mourits MJE, Slangen BFM, Gaarenstroom KN, Zillikens MC, Leiner T, van der Kolk L, Collee M, Wevers M, Ausems MGEM, van Engelen K, Berger LP, van Asperen CJ, Gomez-Garcia EB, van de Beek I, Rookus MA, Hauptmann M, Bleiker EM, Schagen SB, Aaronson NK, Maas AHEM, van Leeuwen FE. Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study). JMIR Res Protoc 2021; 10:e24414. [PMID: 33480862 PMCID: PMC7864779 DOI: 10.2196/24414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID) DERR1-10.2196/24414
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Affiliation(s)
- Lara Terra
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Marc van Beurden
- Department of Gynaecology, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Helena C van Doorn
- Department for Gynaecologic Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne A de Hullu
- Department for Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Constantijne Mom
- Department of Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eleonora B L van Dorst
- Department for Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marian J E Mourits
- Department for Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Brigitte F M Slangen
- Department for Gynaecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- Department Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lizet van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Margriet Collee
- Department for Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marijke Wevers
- Department for Clinical Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Klaartje van Engelen
- Department for Clinical Genetics, Amsterdam University Medical Centers, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Lieke Pv Berger
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Irma van de Beek
- Department for Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Matti A Rookus
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Hauptmann
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Eveline M Bleiker
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Neil K Aaronson
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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Focused, low tube potential, coronary calcium assessment prior to coronary CT angiography: A prospective, randomized clinical trial. J Cardiovasc Comput Tomogr 2020; 15:240-245. [PMID: 32868247 DOI: 10.1016/j.jcct.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) scanning is commonly performed before coronary CT angiography (CTA) based partly on its potential to influence CTA scan parameters. Encompassing the whole heart and performed at high tube potential (120 kVp), standard (Agatston) CAC scanning adds to patient radiation exposure. Most CAC exists in the proximal and mid coronary segments and is easily visualized at low kVp. METHODS We tested the impact of a modified calcium scan on coronary CTA acquisition decision-making and image quality in a randomized clinical trial. Providers documented planned CTA acquisition parameters prior to CAC scanning in a blinded manner. Standard Agatston CAC scans proceeded in typical fashion whereas modified scans utilized 80 kVp and reduced z-axis length focused on the proximal-to-mid coronary arteries. CTA providers reviewed the CAC burden then documented final acquisition parameters. RESULTS The study included 172 patients (48% female; mean age 59 ± 6.7). As planned, the calcium scan effective dose was significantly lower in the modified CAC scan group (0.14 vs. 0.74 mSv using a 0.014 k-factor or 0.26 vs. 1.38 mSv using a 0.026 k-factor; both p < 0.001). Initially selected CTA parameters were changed at an identical rate following visual CAC assessment (59%). There was no significant difference in coronary CTA image quality (median quality score = 4 in both groups, p = 0.26), noise (31.0 vs 31.4 HU; p = 0.81), or signal/noise ratio (17.9 vs 16.8; p = 0.26). CONCLUSIONS A low-kVp scan with focused field-of-view provides actionable information regarding the presence and severity of CAC prior to coronary CTA. Coronary CTA parameters based on patient variables are frequently modified after assessing CAC burden in the CTA suite. CLINICALTRIALS. GOV REGISTRATION NUMBER NCT02972242.
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Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci 2020; 21:ijms21082992. [PMID: 32340284 PMCID: PMC7216001 DOI: 10.3390/ijms21082992] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.
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Henein MY, Vancheri S, Bajraktari G, Vancheri F. Coronary Atherosclerosis Imaging. Diagnostics (Basel) 2020; 10:E65. [PMID: 31991633 PMCID: PMC7168918 DOI: 10.3390/diagnostics10020065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 02/05/2023] Open
Abstract
Identifying patients at increased risk of coronary artery disease, before the atherosclerotic complications become clinically evident, is the aim of cardiovascular prevention. Imaging techniques provide direct assessment of coronary atherosclerotic burden and pathological characteristics of atherosclerotic lesions which may predict the progression of disease. Atherosclerosis imaging has been traditionally based on the evaluation of coronary luminal narrowing and stenosis. However, the degree of arterial obstruction is a poor predictor of subsequent acute events. More recent techniques focus on the high-resolution visualization of the arterial wall and the coronary plaques. Most acute coronary events are triggered by plaque rupture or erosion. Hence, atherosclerotic plaque imaging has generally focused on the detection of vulnerable plaque prone to rupture. However, atherosclerosis is a dynamic process and the plaque morphology and composition may change over time. Most vulnerable plaques undergo progressive transformation from high-risk to more stable and heavily calcified lesions, while others undergo subclinical rupture and healing. Although extensive plaque calcification is often associated with stable atherosclerosis, the extent of coronary artery calcification strongly correlates with the degree of atherosclerosis and with the rate of future cardiac events. Inflammation has a central role in atherogenesis, from plaque formation to rupture, hence in the development of acute coronary events. Morphologic plaque assessment, both invasive and non-invasive, gives limited information as to the current activity of the atherosclerotic disease. The addition of nuclear imaging, based on radioactive tracers targeted to the inflammatory components of the plaques, provides a highly sensitive assessment of coronary disease activity, thus distinguishing those patients who have stable disease from those with active plaque inflammation.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden; (M.Y.H.); (G.B.)
- Departments of Fluid Mechanics, Brunel University, Middlesex, London UB8 3PH, UK
- Molecular and Nuclear Research Institute, St George’s University, London SW17 0RE, UK
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden; (M.Y.H.); (G.B.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
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Hou KY, Tsujioka K, Yang CC. Optimization of HU threshold for coronary artery calcium scans reconstructed at 0.5-mm slice thickness using iterative reconstruction. J Appl Clin Med Phys 2020; 21:111-120. [PMID: 31889419 PMCID: PMC7021007 DOI: 10.1002/acm2.12806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/30/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This work investigated the simultaneous influence of tube voltage, tube current, body size, and HU threshold on calcium scoring reconstructed at 0.5-mm slice thickness using iterative reconstruction (IR) through multivariate analysis. Regression results were used to optimize the HU threshold to calibrate the resulting Agatston scores to be consistent with those obtained from the conventional protocol. METHODS A thorax phantom set simulating three different body sizes was used in this study. A total of 14 coronary artery calcium (CAC) protocols were studied, including 1 conventional protocol reconstructed at 3-mm slice thickness, 1 FBP protocol, and 12 statistical IR protocols (3 kVp values*4 SD values) reconstructed at 0.5-mm slice thickness. Three HU thresholds were applied for calcium identification, including 130, 150, and 170 HU. A multiple linear regression method was used to analyze the impact of kVp, SD, body size, and HU threshold on the Agatston scores of three calcification densities for IR-reconstructed CAC scans acquired with 0.5-mm slice thickness. RESULTS Each regression relationship has R2 larger than 0.80, indicating a good fit to the data. Based on the regression models, the HU thresholds as a function of SD estimated to ensure the quantification accuracy of calcium scores for 120-, 100-, and 80-kVp CAC scans reconstructed at 0.5-mm slice thickness using IR for three different body sizes were proposed. Our results indicate that the HU threshold should be adjusted according to the imaging condition, whereas a 130-HU threshold is appropriate for 120-kVp CAC scans acquired with SD = 55 for body size of 24.5 cm. CONCLUSION The optimized HU thresholds were proposed for CAC scans reconstructed at 0.5-mm slice thickness using IR. Our study results may provide a potential strategy to improve the reliability of calcium scoring by reducing partial volume effect while keeping radiation dose as low as reasonably achievable.
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Affiliation(s)
- Kuei-Yuan Hou
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan
| | - Katsumi Tsujioka
- Faculty of Radiological Technology, Fujita Health University, Aichi, Japan
| | - Ching-Ching Yang
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Enhanced radiation exposure associated with anterior-posterior x-ray tube position in young women undergoing cardiac computed tomography. Am Heart J 2019; 215:91-94. [PMID: 31295633 DOI: 10.1016/j.ahj.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/08/2019] [Indexed: 12/22/2022]
Abstract
Given the current increase in the incidence of coronary artery disease in younger women as well as the high lifetime risk of developing an x-ray-induced malignancy in this population, we aimed at assessing chest radiation in 206 women ≤55 years old undergoing coronary calcium scoring (CACS) by using a Monte Carlo simulation tool. Our data indicate that the simulated radiation dose of the female breast during CACS depends substantially on the starting position of the x-ray tube, with an almost 2 times excess of breast radiation exposure being measured during anterior-posterior tube positioning. Thus, an additional technical feature taking into account the position of the x-ray tube when acquisition is triggered might be an important tool to reduce radiation exposure of the female breast during CACS.
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Gräni C, Vontobel J, Benz DC, Bacanovic S, Giannopoulos AA, Messerli M, Grossmann M, Gebhard C, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Ultra-low-dose coronary artery calcium scoring using novel scoring thresholds for low tube voltage protocols-a pilot study. Eur Heart J Cardiovasc Imaging 2019; 19:1362-1371. [PMID: 29432592 DOI: 10.1093/ehjci/jey019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 11/13/2022] Open
Abstract
Aims To determine if tube-adapted thresholds for coronary artery calcium (CAC) scoring by computed tomography at 80 kilovolt-peak (kVp) tube voltage and 70-kVp yield comparable results to the standard 120-kVp protocol. Methods and results We prospectively included 103 patients who underwent standard scanning with 120-kVp tube voltage and additional scans with 80 kVp and 70 kVp. Mean body mass index (BMI) was 27.9 ± 5.1 kg/m2. For the lowered tube voltages, we applied novel kVp-adapted thresholds for calculation of CAC scores and compared them with standard 120-kVp scans using intraclass correlation and Bland-Altman (BA) analysis. Furthermore, risk-class (CAC score 0/1-10/11-100/101-400/>400) changes were assessed. Median CAC score from 120-kVp scans was 212 (interquartile range 25-901). Thirteen (12.6%) patients had zero CAC. Using the novel kVp-adapted thresholds, CAC scores derived from 80-kVp scans showed excellent correlation (r = 0.994, P < 0.001) with standard 120-kVp scans with BA limits of agreement of -235 (-39.5%) to 172 (28.9%). Similarly, for 70-kVp scans, correlation was excellent (r = 0.972, P < 0.001) but with broader limits of agreement of -476 (-85.0%) to 270 (48.2%). Only 2 (2.8%) reclassifications were observed for the 80-kVp scans in patients with a BMI <30 kg/m2 (n = 71), and 2 (6.1%) for the 70-kVp scans in patients with a BMI <25 kg/m2 (n = 33). Mean effective radiation dose was 0.60 ± 0.07 millisieverts (mSv), 0.19 ± 0.02 mSv, and 0.12 ± 0.01 mSv for the 120-kVp, 80-kVp, and 70-kVp scans, respectively. Conclusion The present study suggests that CAC scoring with reduced peak tube voltage is accurate if kVp-adapted thresholds for calculation of CAC scores are applied while offering a substantial further radiation dose reduction.
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Affiliation(s)
- Christoph Gräni
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Jan Vontobel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Sara Bacanovic
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Michael Messerli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Marvin Grossmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Cathérine Gebhard
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
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Texture Analysis and Machine Learning for Detecting Myocardial Infarction in Noncontrast Low-Dose Computed Tomography: Unveiling the Invisible. Invest Radiol 2019; 53:338-343. [PMID: 29420321 DOI: 10.1097/rli.0000000000000448] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to test whether texture analysis and machine learning enable the detection of myocardial infarction (MI) on non-contrast-enhanced low radiation dose cardiac computed tomography (CCT) images. MATERIALS AND METHODS In this institutional review board-approved retrospective study, we included non-contrast-enhanced electrocardiography-gated low radiation dose CCT image data (effective dose, 0.5 mSv) acquired for the purpose of calcium scoring of 27 patients with acute MI (9 female patients; mean age, 60 ± 12 years), 30 patients with chronic MI (8 female patients; mean age, 68 ± 13 years), and in 30 subjects (9 female patients; mean age, 44 ± 6 years) without cardiac abnormality, hereafter termed controls. Texture analysis of the left ventricle was performed using free-hand regions of interest, and texture features were classified twice (Model I: controls versus acute MI versus chronic MI; Model II: controls versus acute and chronic MI). For both classifications, 6 commonly used machine learning classifiers were used: decision tree C4.5 (J48), k-nearest neighbors, locally weighted learning, RandomForest, sequential minimal optimization, and an artificial neural network employing deep learning. In addition, 2 blinded, independent readers visually assessed noncontrast CCT images for the presence or absence of MI. RESULTS In Model I, best classification results were obtained using the k-nearest neighbors classifier (sensitivity, 69%; specificity, 85%; false-positive rate, 0.15). In Model II, the best classification results were found with the locally weighted learning classification (sensitivity, 86%; specificity, 81%; false-positive rate, 0.19) with an area under the curve from receiver operating characteristics analysis of 0.78. In comparison, both readers were not able to identify MI in any of the noncontrast, low radiation dose CCT images. CONCLUSIONS This study indicates the ability of texture analysis and machine learning in detecting MI on noncontrast low radiation dose CCT images being not visible for the radiologists' eye.
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Affiliation(s)
| | - Christina Stewart
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas W Weir
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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Choi AD, Leifer ES, Yu JH, Datta T, Bronson KC, Rollison SF, Schuzer JL, Steveson C, Shanbhag SM, Chen MY. Reduced radiation dose with model based iterative reconstruction coronary artery calcium scoring. Eur J Radiol 2019; 111:1-5. [DOI: 10.1016/j.ejrad.2018.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023]
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Vonder M, van der Werf NR, Leiner T, Greuter MJ, Fleischmann D, Vliegenthart R, Oudkerk M, Willemink MJ. The impact of dose reduction on the quantification of coronary artery calcifications and risk categorization: A systematic review. J Cardiovasc Comput Tomogr 2018; 12:352-363. [DOI: 10.1016/j.jcct.2018.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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Patel AA, Fine J, Naghavi M, Budoff MJ. Radiation exposure and coronary artery calcium scans in the society for heart attack prevention and eradication cohort. Int J Cardiovasc Imaging 2018; 35:179-183. [PMID: 30084106 DOI: 10.1007/s10554-018-1431-0] [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: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 01/30/2023]
Abstract
Coronary artery calcium (CAC) scoring is used in asymptomatic patients to improve their clinically predicted risk for future cardiovascular events. Current CT protocols seek to reduce radiation exposure without diminishing image quality. Reported radiation exposure remains widely variable (0.8-5 mSv) depending on the type of protocol. In this study, we report the radiation exposure of CAC scoring from the Society for Heart Attack Prevention and Eradication (SHAPE) early detection program cohort sites, which spanned multiple centers using 64-MDCT (multi-detector computed tomography) scanners. We reviewed radiation exposure in milliSieverts (mSv) for 82,214 participants from the SHAPE early detection program cohort who underwent CAC scoring. This occurred over a 2.5-year period (2012-2014) divided among 33 sites in 7 countries with four different types 64-MDCT scanners. The effective radiation dose was reported as mSv. Mean radiation dosing amongst all 82,214 participants was 1.03 mSv, a median dose of 0.94 mSv. The mean radiation dose ranged from 0.76 to 1.31 mSv across the 33 sites involved with the SHAPE program cohort. Subgroup analysis by age, gender or body mass index (BMI) less than 30 kg/m2 showed no variability. Radiation dose in patients with BMI > 30 kg/m2 were significantly greater than other subgroups (µ = 1.96 mSv, p < 0.001). The use of 64-MDCT scanners and protocols provide the effective radiation dose for CAC scoring, which is approximately 1 mSv. This is consistently lower than previously reported for CAC scanning, regardless of scanner type, age or gender. In contrast, a greater BMI influenced mean radiation doses.
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Affiliation(s)
- Amish A Patel
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.,Riverside School of Medicine Department of Cardiovascular Medicine, University of California, Riverside, CA, USA
| | - Jeffrey Fine
- Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA
| | - Morteza Naghavi
- Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA. .,Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA.
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Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol 2018; 72:434-447. [PMID: 30025580 PMCID: PMC6056023 DOI: 10.1016/j.jacc.2018.05.027] [Citation(s) in RCA: 530] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Abstract
Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. On the basis of single-center and multicenter clinical and population-based studies with short-term and long-term outcomes data (up to 15-year follow-up), CAC scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially useful in asymptomatic people for planning primary prevention interventions such as statins and aspirin. CAC testing in asymptomatic populations is cost effective across a broad range of baseline risk. This review summarizes evidence concerning CAC, including its pathobiology, modalities for detection, predictive role, use in prediction scoring algorithms, CAC progression, evidence that CAC changes the clinical approach to the patient and patient behavior, novel applications of CAC, future directions in scoring CAC scans, and new CAC guidelines.
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Affiliation(s)
- Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland. https://twitter.com/MichaelJBlaha
| | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Clinic, Essen, Germany
| | - Karol E Watson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. https://twitter.com/kewatson
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Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology? JACC Cardiovasc Imaging 2018; 10:923-937. [PMID: 28797416 DOI: 10.1016/j.jcmg.2017.05.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Abstract
Quantification of coronary artery calcium (CAC) has been shown to be reliable, reproducible, and predictive of cardiovascular risk. Formal CAC scoring was introduced in 1990, with early scoring algorithms notable for their simplicity and elegance. Yet, with little evidence available on how to best build a score, and without a conceptual model guiding score development, these scores were, to a large degree, arbitrary. In this review, we describe the traditional approaches for clinical CAC scoring, noting their strengths, weaknesses, and limitations. We then discuss a conceptual model for developing an improved CAC score, reviewing the evidence supporting approaches most likely to lead to meaningful score improvement (for example, accounting for CAC density and regional distribution). After discussing the potential implementation of an improved score in clinical practice, we follow with a discussion of the future of CAC scoring, asking the central question: do we really need a new CAC score?
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Rajesh Tota-Maharaj
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Florida Heart and Vascular Multi-Specialty Group, Leesburg, Florida
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; IDIBELL-Bellvitge Biomedical Research Institute, Barcelona, Spain; RTI Health Solutions, Barcelona, Spain
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Vonder M, van der Aalst CM, Vliegenthart R, van Ooijen PMA, Kuijpers D, Gratama JW, de Koning HJ, Oudkerk M. Coronary Artery Calcium Imaging in the ROBINSCA Trial: Rationale, Design, and Technical Background. Acad Radiol 2018; 25:118-128. [PMID: 28843465 DOI: 10.1016/j.acra.2017.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES To describe the rationale, design, and technical background of coronary artery calcium (CAC) imaging in the large-scale population-based cardiovascular disease screening trial (Risk Or Benefit IN Screening for CArdiovascular Diseases [ROBINSCA]). MATERIALS AND METHODS First, literature search was performed to review the logistics, setup, and settings of previously performed CAC imaging studies, and current clinical CAC imaging protocols of participating centers in the ROBINSCA trial were evaluated. A second literature search was performed to evaluate the impact of computed tomography parameter settings on CAC score. RESULTS Based on literature reviews and experts opinion an imaging protocol accompanied by data management protocol was created for ROBINSCA. The imaging protocol should consist of a fixed tube voltage, individually tailored tube current setting, mid-diastolic electrocardiography-triggering, fixed field-of-view, fixed reconstruction kernel, fixed slice thickness, overlapping reconstruction and without iterative reconstruction. The analysis of scans is performed with one type and version of CAC scoring software, by two dedicated and experienced researchers. The data management protocol describes the organization of data handling between the coordinating center, participating centers, and core analysis center. CONCLUSION In this paper we describe the rationale and technical considerations to be taken in developing CAC imaging protocol, and we present a detailed protocol that can be implemented for CAC screening purposes.
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Affiliation(s)
- Marleen Vonder
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands
| | - Carlijn M van der Aalst
- Erasmus MC-University Medical Centre, Department of Public Health, Rotterdam, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Dirkjan Kuijpers
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; Department of Radiology, Haaglanden Medical Center Bronovo, The Hague, The Netherlands
| | - Jan Willem Gratama
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; Department of Radiology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Harry J de Koning
- Erasmus MC-University Medical Centre, Department of Public Health, Rotterdam, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
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Ballard DH, Trace AP, Ali S, Hodgdon T, Zygmont ME, DeBenedectis CM, Smith SE, Richardson ML, Patel MJ, Decker SJ, Lenchik L. Clinical Applications of 3D Printing: Primer for Radiologists. Acad Radiol 2018; 25:52-65. [PMID: 29030285 DOI: 10.1016/j.acra.2017.08.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 12/22/2022]
Abstract
Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.
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Wolterink JM, Leiner T, Viergever MA, Isgum I. Generative Adversarial Networks for Noise Reduction in Low-Dose CT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:2536-2545. [PMID: 28574346 DOI: 10.1109/tmi.2017.2708987] [Citation(s) in RCA: 436] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Noise is inherent to low-dose CT acquisition. We propose to train a convolutional neural network (CNN) jointly with an adversarial CNN to estimate routine-dose CT images from low-dose CT images and hence reduce noise. A generator CNN was trained to transform low-dose CT images into routine-dose CT images using voxelwise loss minimization. An adversarial discriminator CNN was simultaneously trained to distinguish the output of the generator from routine-dose CT images. The performance of this discriminator was used as an adversarial loss for the generator. Experiments were performed using CT images of an anthropomorphic phantom containing calcium inserts, as well as patient non-contrast-enhanced cardiac CT images. The phantom and patients were scanned at 20% and 100% routine clinical dose. Three training strategies were compared: the first used only voxelwise loss, the second combined voxelwise loss and adversarial loss, and the third used only adversarial loss. The results showed that training with only voxelwise loss resulted in the highest peak signal-to-noise ratio with respect to reference routine-dose images. However, CNNs trained with adversarial loss captured image statistics of routine-dose images better. Noise reduction improved quantification of low-density calcified inserts in phantom CT images and allowed coronary calcium scoring in low-dose patient CT images with high noise levels. Testing took less than 10 s per CT volume. CNN-based low-dose CT noise reduction in the image domain is feasible. Training with an adversarial network improves the CNNs ability to generate images with an appearance similar to that of reference routine-dose CT images.
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Ryan AJ, Choi AD, Choi BG, Lewis JF. Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women. Clin Cardiol 2017; 40:648-653. [PMID: 28444996 DOI: 10.1002/clc.22702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/19/2022] Open
Abstract
Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.
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Affiliation(s)
- Angela J Ryan
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Brian G Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Jannet F Lewis
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
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Zaid M, Fujiyoshi A, Kadota A, Abbott RD, Miura K. Coronary Artery Calcium and Carotid Artery Intima Media Thickness and Plaque: Clinical Use in Need of Clarification. J Atheroscler Thromb 2016; 24:227-239. [PMID: 27904029 PMCID: PMC5383538 DOI: 10.5551/jat.rv16005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atherosclerosis begins in early life and has a long latent period prior to onset of clinical disease. Measures of subclinical atherosclerosis, therefore, may have important implications for research and clinical practice of atherosclerotic cardiovascular disease (ASCVD). In this review, we focus on coronary artery calcium (CAC) and carotid artery intima-media thickness (cIMT) and plaque as many population-based studies have investigated these measures due to their non-invasive features and ease of administration. To date, a vast majority of studies have been conducted in the US and European countries, in which both CAC and cIMT/plaque have been shown to be associated with future risk of ASCVD, independent of conventional risk factors. Furthermore, these measures improve risk prediction when added to a global risk prediction model, such as the Framingham risk score. However, no clinical trial has assessed whether screening with CAC or cIMT/plaque will lead to improved clinical outcomes and healthcare costs. Interestingly, similar levels of CAC or cIMT/plaque among various regions and ethnic groups may in fact be associated with significantly different levels of absolute risk of ASCVD. Therefore, it remains to be determined whether measures of subclinical atherosclerosis improve risk prediction in non-US/European populations. Although CAC and cIMT/plaque are promising surrogates of ASCVD in research, we conclude that their use in clinical practice, especially as screening tools for primary prevention in asymptomatic adults, is premature due to many vagaries that remain to be clarified.
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Affiliation(s)
- Maryam Zaid
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, Ungprasert P, Sigurdsson G, Nabi F, Mahmarian JJ, Chang SM. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. Ann Emerg Med 2016; 68:659-670. [DOI: 10.1016/j.annemergmed.2016.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/24/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023]
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Fent GJ, Greenwood JP, Plein S, Buch MH. The role of non-invasive cardiovascular imaging in the assessment of cardiovascular risk in rheumatoid arthritis: where we are and where we need to be. Ann Rheum Dis 2016; 76:1169-1175. [PMID: 27895040 DOI: 10.1136/annrheumdis-2016-209744] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/09/2016] [Indexed: 02/02/2023]
Abstract
This review assesses the risk assessment of cardiovascular disease (CVD) in rheumatoid arthritis (RA) and how non-invasive imaging modalities may improve risk stratification in future. RA is common and patients are at greater risk of CVD than the general population. Cardiovascular (CV) risk stratification is recommended in European guidelines for patients at high and very high CV risk in order to commence preventative therapy. Ideally, such an assessment should be carried out immediately after diagnosis and as part of ongoing long-term patient care in order to improve patient outcomes. The risk profile in RA is different from the general population and is not well estimated using conventional clinical CVD risk algorithms, particularly in patients estimated as intermediate CVD risk. Non-invasive imaging techniques may therefore play an important role in improving risk assessment. However, there are currently very limited prognostic data specific to patients with RA to guide clinicians in risk stratification using these imaging techniques. RA is associated with increased risk of CV mortality, mainly attributable to atherosclerotic disease, though in addition, RA is associated with many other disease processes which further contribute to increased CV mortality. There is reasonable evidence for using carotid ultrasound in patients estimated to be at intermediate risk of CV mortality using clinical CVD risk algorithms. Newer imaging techniques such as cardiovascular magnetic resonance and CT offer the potential to improve risk stratification further; however, longitudinal data with hard CVD outcomes are currently lacking.
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Affiliation(s)
- Graham J Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Choi AD, Leifer ES, Yu J, Shanbhag SM, Bronson K, Arai AE, Chen MY. Prospective evaluation of the influence of iterative reconstruction on the reproducibility of coronary calcium quantification in reduced radiation dose 320 detector row CT. J Cardiovasc Comput Tomogr 2016; 10:359-63. [PMID: 27591767 PMCID: PMC7458582 DOI: 10.1016/j.jcct.2016.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/13/2016] [Accepted: 07/16/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) predicts coronary heart disease events and is important for individualized cardiac risk assessment. This report assesses the interscan variability of CT for coronary calcium quantification using image acquisition with standard and reduced radiation dose protocols and whether the use of reduced radiation dose acquisition with iterative reconstruction (IR; "reduced-dose/IR ") allows for similar image quality and reproducibility when compared to standard radiation dose acquisition with filtered back projection (FBP; "standard-dose/FBP") on 320-detector row computed tomography (320-CT). METHODS 200 consecutive patients (60 ± 9 years, 59% male) prospectively underwent two standard- and two reduced-dose acquisitions (800 total scans, 1600 reconstructions) using 320 slice CT and 120 kV tube voltage. Automated tube current modulation was used and for reduced-dose scans, prescribed tube current was lowered by 70%. Image noise and Agatston scores were determined and compared. RESULTS Regarding stratification by Agatston score categories (0, 1-10, 11-100, 101-400, >400), reduced-dose/IR versus standard-dose/FBP had excellent agreement at 89% (95% CI: 86-92%) with kappa 0.86 (95% CI: 0.81-0.90). Standard-dose/FBP rescan agreement was 93% (95% CI: 89-96%) with kappa = 0.91 (95% CI: 0.86-0.95) while reduced-dose/IR rescan agreement was similar at 91% (95% CI: 87-94%) with kappa 0.88 (95% CI: 0.83-0.93). Image noise was significantly higher but clinically acceptable for reduced-dose/IR (18 Hounsfield Unit [HU] mean) compared to standard-dose/FBP (16 HU; p < 0.0001). Median radiation exposure was 74% lower for reduced- (0.37 mSv) versus standard-dose (1.4 mSv) acquisitions. CONCLUSION Rescan agreement was excellent for reduced-dose image acquisition with iterative reconstruction and standard-dose acquisition with filtered back projection for the quantification of coronary calcium by CT. These methods make it possible to reduce radiation exposure by 74%. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT01621594. UNIQUE IDENTIFIER NCT01621594.
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Affiliation(s)
- Andrew D Choi
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Eric S Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeannie Yu
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sujata M Shanbhag
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathie Bronson
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus Y Chen
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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