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Sohn JH, Behr SC, Hernandez PM, Seo Y. Quantitative Assessment of Myocardial Ischemia With Positron Emission Tomography. J Thorac Imaging 2023; 38:247-259. [PMID: 33492046 PMCID: PMC8295411 DOI: 10.1097/rti.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent advances in positron emission tomography (PET) technology and reconstruction techniques have now made quantitative assessment using cardiac PET readily available in most cardiac PET imaging centers. Multiple PET myocardial perfusion imaging (MPI) radiopharmaceuticals are available for quantitative examination of myocardial ischemia, with each having distinct convenience and accuracy profile. Important properties of these radiopharmaceuticals ( 15 O-water, 13 N-ammonia, 82 Rb, 11 C-acetate, and 18 F-flurpiridaz) including radionuclide half-life, mean positron range in tissue, and the relationship between kinetic parameters and myocardial blood flow (MBF) are presented. Absolute quantification of MBF requires PET MPI to be performed with protocols that allow the generation of dynamic multiframes of reconstructed data. Using a tissue compartment model, the rate constant that governs the rate of PET MPI radiopharmaceutical extraction from the blood plasma to myocardial tissue is calculated. Then, this rate constant ( K1 ) is converted to MBF using an established extraction formula for each radiopharmaceutical. As most of the modern PET scanners acquire the data only in list mode, techniques of processing the list-mode data into dynamic multiframes are also reviewed. Finally, the impact of modern PET technologies such as PET/CT, PET/MR, total-body PET, machine learning/deep learning on comprehensive and quantitative assessment of myocardial ischemia is briefly described in this review.
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Affiliation(s)
- Jae Ho Sohn
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Spencer C. Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | | | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Radiation Oncology, University of California, San Francisco, CA
- UC Berkeley-UCSF Graduate Program in Bioengineering, Berkeley and San Francisco, CA
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2
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Lee JW, Choe YH, Kim SM, Choi JH, Pak S, Choo KS, Kim JS, Lee CE, Kim YH. Comparison of diagnostic performance between dynamic versus static adenosine-stress myocardial CT perfusion to detect hemodynamically significant coronary artery stenosis: A prospective multicenter study. Medicine (Baltimore) 2022; 101:e30477. [PMID: 36086714 PMCID: PMC10980466 DOI: 10.1097/md.0000000000030477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 08/02/2022] [Indexed: 12/30/2022] Open
Abstract
Myocardial computed tomography perfusion (CTP) imaging is a noninvasive method for detecting myocardial ischemia. This study aimed to compare the diagnostic performance of dynamic and static adenosine-stress CTPs for detecting hemodynamically significant coronary stenosis. We prospectively enrolled 42 patients (mean age, 59.7 ± 8.8 years; 31 males) with ≥40% coronary artery stenosis. All patients underwent dynamic CTP for adenosine stress. The static CTP was simulated by choosing the seventh dynamic dataset after the initiation of the contrast injection. Diagnostic performance was compared with invasive fractional flow reserve (FFR) <0.8 as the reference. Of the 125 coronary vessels in 42 patients, 20 (16.0%) in 16 (38.1%) patients were categorized as hemodynamically significant. Dynamic and static CTP yielded similar diagnostic accuracy (90.4% vs 88.8% using visual analysis, P = .558; 77.6% vs 80.8% using quantitative analysis, P = .534; 78.4% vs 82.4% using combined visual and quantitative analyses, P = .426). The diagnostic accuracy of combined coronary computed tomography angiography (CCTA) and dynamic CTP (89.6% using visual analysis, P = .011; 88.8% using quantitative analysis, P = .018; 89.6% using combined visual and quantitative analyses, P = .011) and that of combined CCTA and static CTP (88.8% using visual analysis, P = .018; 90.4% using quantitative analysis, P = .006; 91.2% using combined visual and quantitative analyses, P = .003) were significantly higher than that of CCTA alone (77.6%). Dynamic CTP and static CTP showed similar diagnostic performance in the detection of hemodynamically significant stenosis.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Emergency Medicine and Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongyong Pak
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Jeong Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Chong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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3
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Zhang X, Ye RY, Chen XP. Dilated left ventricle with multiple outpouchings — a severe congenital ventricular diverticulum or left-dominant arrhythmogenic cardiomyopathy: A case report. World J Clin Cases 2022; 10:6289-6297. [PMID: 35949831 PMCID: PMC9254184 DOI: 10.12998/wjcc.v10.i18.6289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/20/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Left-dominant arrhythmogenic cardiomyopathy (LDAC) is a relatively rare disease characterized by poor prognosis that exacerbates the incidence of sudden cardiac death and ventricular arrhythmias. Clinically, LDAC is constantly overlooked or misdiagnosed as myocardial infarction, myocarditis, and dilated cardiomyopathy, owing to atypical and nonspecific clinical manifestations at an early stage.
CASE SUMMARY A 57-year-old woman was diagnosed with sinus bradycardia and chronic bifascicular block during a health check. She occasionally experienced mild chest pain and paroxysmal palpitation during activity in the past 2 years. Comprehensive auxiliary examinations, including electrocardiogram, echocardiography, coronary computerized tomography angiography, and magnetic resonance imaging, revealed that she had LDAC instead of congenital ventricular diverticulum. The physicians prescribed standard oral therapy for heart failure and implantable cardioverter-defibrillator. Consequently, her left ventricular systolic function and symptoms remained stable at the 2-year follow-up after discharge.
CONCLUSION Based on this case, clinicians need to be aware of LDAC in patients with localized left ventricular lesions and multiple electrocardiographic abnormalities. Multimodality cardiovascular imaging is effective in identification of multiple types of cardiomyopathy and cardiac inner structures.
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Affiliation(s)
- Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Run-Yu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Ping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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4
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Carrabba N, Pontone G, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Francone M, Esposito A. Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation. J Cardiovasc Med (Hagerstown) 2022; 23:290-303. [PMID: 35486680 DOI: 10.2459/jcm.0000000000001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.
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Affiliation(s)
- Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Raggio Emilia University.,Radiology Department, AOU of Modena, Modena
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare -A.S.L Na1- Centro, Naples
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
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5
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Rosmini S, Aggarwal A, Chen DH, Conibear J, Davies CL, Dey AK, Edwards P, Guha A, Ghosh AK. Cardiac computed tomography in cardio-oncology: an update on recent clinical applications. Eur Heart J Cardiovasc Imaging 2021; 22:397-405. [PMID: 33555007 DOI: 10.1093/ehjci/jeaa351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023] Open
Abstract
Chemotherapy and radiotherapy have drastically improved cancer survival, but they can result in significant short- and long-term cardiovascular complications, most commonly heart failure from chemotherapy, whilst radiotherapy increases the risk of premature coronary artery disease (CAD), valve, and pericardial diseases. Cardiac computed tomography (CT) with calcium scoring has a role in screening asymptomatic patients for premature CAD, cardiac CT angiography (CTCA) allows the identification of significant CAD, also in the acute settings where concerns exist towards invasive angiography. CTCA integrates the diagnostic work-up and guides surgical/percutaneous management of valvular heart diseases and allows the assessment of pericardial conditions, including detection of effusion and pericardial calcification. It is a widely available and fast imaging modality that allows a one-step evaluation of CAD, myocardial, valvular, and pericardial disease. This review aims to provide an update on its current use and accompanying evidence-base for cardiac CT in the management of cardio-oncology patients.
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Affiliation(s)
- Stefania Rosmini
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Ankita Aggarwal
- Department of Internal Medicine, Wayne State University, Providence Hospital, Rochester, MI, USA
| | - Daniel H Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| | - John Conibear
- Oncology Department, Barts Cancer Centre, St Bartholomew's Hospital London, UK
| | - Ceri L Davies
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Amit Kumar Dey
- National Heart, Lung and Blood Institute, Bethesda, USA.,Department of Internal Medicine, Georgetown University, Washington, DC, USA
| | - Paula Edwards
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Cleveland, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
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6
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Choi AD, Thomas DM, Lee J, Abbara S, Cury RC, Leipsic JA, Maroules C, Nagpal P, Steigner ML, Wang DD, Williams MC, Zeb I, Villines TC, Blankstein R. 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography: A Statement from the Society of Cardiovascular Computed Tomography. Radiol Cardiothorac Imaging 2021; 3:e200480. [PMID: 33778658 PMCID: PMC7978013 DOI: 10.1148/ryct.2020200480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Cardiovascular computed tomography (CCT) is a well-validated noninvasive imaging tool with an ever-expanding array of applications beyond the assessment of coronary artery disease. These include the evaluation of structural heart diseases, congenital heart diseases, peri-procedural electrophysiology applications, and the functional evaluation of ischemia. This breadth requires a robust and diverse training curriculum to ensure graduates of CCT training programs meet minimum competency standards for independent CCT interpretation. This statement from the Society of Cardiovascular Computed Tomography aims to supplement existing societal training guidelines by providing a curriculum and competency framework to inform the development of a comprehensive, integrated training experience for cardiology and radiology trainees in CCT. This article is being published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, and JACC: Cardiovascular Imaging. © 2020 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.
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7
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Du H, Shao K, Bao F, Zhang Y, Gao C, Wu W, Zhang C. Automated coronary artery tree segmentation in coronary CTA using a multiobjective clustering and toroidal model-guided tracking method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105908. [PMID: 33373814 DOI: 10.1016/j.cmpb.2020.105908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Accurate coronary artery tree segmentation can now be developed to assist radiologists in detecting coronary artery disease. In clinical medicine, the noise, low contrast, and uneven intensity of medical images along with complex shapes and vessel bifurcation structures make coronary artery segmentation challenging. In this work, we propose a multiobjective clustering and toroidal model-guided tracking method that can accurately extract coronary arteries from computed tomography angiography (CTA) imagery. METHODS Utilizing integrated noise reduction, candidate region detection, geometric feature extraction, and coronary artery tracking techniques, a new segmentation framework for 3D coronary artery trees is presented. The candidate regions are extracted using a multiobjective clustering method, and the coronary arteries are tracked by a toroidal model-guided tracking method. RESULTS The qualitative and quantitative results demonstrate the effectiveness of the presented framework, which achieves better performance than the compared segmentation methods in three widely used evaluation indices: the Dice similarity coefficient (DSC), Jaccard index and Recall across the CTA data. The proposed method can accurately identify the coronary artery tree with a mean DSC of 84%, a Jaccard index of 74%, and a Recall of 93%. CONCLUSIONS The proposed segmentation framework effectively segments the coronary tree from the CTA volume, which improves the accuracy of 3D vascular tree segmentation.
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Affiliation(s)
- Hongwei Du
- School of Mathmatics, Shandong University, Jinan, Shandong 250100, China; Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China
| | - Kai Shao
- Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China; School of Computer Science and Technology, Shandong University of Finance and Economics, Jinan, Shandong 250014, China
| | - Fangxun Bao
- School of Mathmatics, Shandong University, Jinan, Shandong 250100, China.
| | - Yunfeng Zhang
- Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China; School of Computer Science and Technology, Shandong University of Finance and Economics, Jinan, Shandong 250014, China
| | - Chengyong Gao
- School of Physics, Shandong University, Jinan, Shandong 250100, China
| | - Wei Wu
- Department of Cerebrovascular Diseases, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Caiming Zhang
- Shandong Provincial Key Laboratory of Digital Media Technology, Jinan, Shandong 250014, China; School of Computer Science and Technology, Shandong University, Jinan, Shandong 250101, China
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8
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Punzo B, Cavaliere C, Maffei E, Bossone E, Saba L, Cademartiri F. Narrative review of cardiac computed tomography perfusion: insights into static rest perfusion. Cardiovasc Diagn Ther 2021; 10:1946-1953. [PMID: 33381436 DOI: 10.21037/cdt-20-552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac or left ventricular perfusion performed with cardiac computed tomography (CCT) is a developing method that may have the potential to complete in a very straight forward way the assessment of ischemic heart disease by means of CT. Myocardial CT perfusion (CTP) can be achieved with a single static scan during the first-pass of the iodinate contrast agent, with the monoenergetic or dual-energy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents. Several methods can be performed, and we focused on static perfusion. CTP may serve as a useful adjunct to coronary CT angiography (CTA) to improve specificity of detecting myocardial ischemia. Technological advances will reduce the radiation dose of myocardial CTP, such as low tube voltage imaging or new reconstruction algorithms, making it a more viable clinical option. The advantages of static first-pass non-stress perfusion are several; the main one is that it can be done to each and every patient who undergoes CCT for the assessment of coronary artery tree. Future advances in CTP will likely improve the diagnostic accuracy of CTP + CTA, and will better estimate the severity of ischemia Therefore, it is simple and comprehensive. However, it has several limitations. In this review we will discuss the technique with its advantages and limitations.
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Affiliation(s)
- Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
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9
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Choi AD, Thomas DM, Lee J, Abbara S, Cury RC, Leipsic JA, Maroules C, Nagpal P, Steigner ML, Wang DD, Williams MC, Zeb I, Villines TC, Blankstein R. 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography: A Statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:2-15. [PMID: 33032977 PMCID: PMC7427549 DOI: 10.1016/j.jcct.2020.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular computed tomography (CCT) is a well-validated non-invasive imaging tool with an ever-expanding array of applications beyond the assessment of coronary artery disease. These include the evaluation of structural heart diseases, congenital heart diseases, peri-procedural electrophysiology applications, and the functional evaluation of ischemia. This breadth requires a robust and diverse training curriculum to ensure graduates of CCT training programs meet minimum competency standards for independent CCT interpretation. This statement from the Society of Cardiovascular Computed Tomography aims to supplement existing societal training guidelines by providing a curriculum and competency framework to inform the development of a comprehensive, integrated training experience for cardiology and radiology trainees in CCT.
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Affiliation(s)
- Andrew D Choi
- Division of Cardiology & Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA.
| | | | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Center for Structural Heart Disease, Detroit, MI, USA
| | - Suhny Abbara
- Division of Cardiothoracic Imaging, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health of South Florida, Miami, FL and Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Center for Structural Heart Disease, Detroit, MI, USA
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Irfan Zeb
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
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10
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Choi AD, Thomas DM, Lee J, Abbara S, Cury RC, Leipsic JA, Maroules C, Nagpal P, Steigner ML, Wang DD, Williams MC, Zeb I, Villines TC, Blankstein R. 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography: A Statement from the Society of Cardiovascular Computed Tomography. JACC Cardiovasc Imaging 2021; 14:272-287. [PMID: 33168479 DOI: 10.1016/j.jcmg.2020.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular computed tomography (CCT) is a well-validated non-invasive imaging tool with an ever-expanding array of applications beyond the assessment of coronary artery disease. These include the evaluation of structural heart diseases, congenital heart diseases, peri-procedural electrophysiology applications, and the functional evaluation of ischemia. This breadth requires a robust and diverse training curriculum to ensure graduates of CCT training programs meet minimum competency standards for independent CCT interpretation. This statement from the Society of Cardiovascular Computed Tomography aims to supplement existing societal training guidelines by providing a curriculum and competency framework to inform the development of a comprehensive, integrated training experience for cardiology and radiology trainees in CCT.
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Affiliation(s)
- Andrew D Choi
- Division of Cardiology & Department of Radiology, The George Washington University School of Medicine, Washington, DC.
| | | | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan
| | - Suhny Abbara
- Division of Cardiothoracic Imaging, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health of South Florida, Miami, Florida and Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Radiology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Irfan Zeb
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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11
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Prasad Reddy KV, Singhal M, Vijayvergiya R, Sood A, Khandelwal N. Role of DECT in coronary artery disease: a comparative study with ICA and SPECT. ACTA ACUST UNITED AC 2020; 26:420-428. [PMID: 32755875 DOI: 10.5152/dir.2020.18569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Earlier imaging techniques for coronary artery disease (CAD) focused primarily on either morphological or functional assessment of CAD. However, dual-energy computed tomography (DECT) can be used to assess myocardial blood supply both morphologically and functionally. We aimed to evaluate the diagnostic accuracy of DECT in detecting morphological and functional components of CAD, using invasive coronary angiography (ICA) and single photon emission computed tomography (SPECT) as reference standards. METHODS Twenty-five patients with known or suspicious CAD and scheduled for ICA were investigated by DECT and SPECT. DECT was performed during the resting state using retrospective electrocardiography (ECG) gating. CT coronary angiography and perfusion images were generated from the same raw data. All patients were evaluated for significant stenosis (≥50%) on both ICA and DECT coronary angiography, and for myocardial perfusion defects on SPECT and DECT perfusion. Comparison was done between ICA and DECT coronary angiography for detection of significant stenosis and between SPECT and DECT perfusion for detecting myocardial perfusion defects. RESULTS Using ICA as reference standard, sensitivity, specificity, and accuracy of DECT coronary angiography in detecting ≥50% stenosis of coronary artery lumen were 81.6%, 97.8%, and 95.0%, respectively, by segment-based analysis and 92.1%, 96.1%, and 93.7%, respectively, by vessel-based analysis. Using SPECT as the reference standard, the sensitivity, specificity, and accuracy of DECT perfusion in detecting myocardial perfusion defects were 70.4%, 86.4%, and 80.6%, respectively, on per-segment analysis and 90.7%, 66.6%, and 84.7%, respectively, on per-territorial basis. CONCLUSION DECT accurately detected coronary artery stenosis and myocardial ischemia using ICA and SPECT as reference standards. In the same scan, DECT can accurately provide integrative imaging of coronary artery morphology and myocardial perfusion.
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Affiliation(s)
- Kamireddy V Prasad Reddy
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Training and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Training and Research, Chandigarh, India
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Ramsey BC, Field AE, Thomas DM, Pickett CA, Leon AJ, Rubal BJ. Assessment of Semi-automated Computed Tomographic Measures of Segmental Perfusion Defects in a Swine Model ( Sus scrofa) of Intermediate Coronary Lesions. Comp Med 2020; 70:258-265. [PMID: 32354378 DOI: 10.30802/aalas-cm-19-000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Computed tomographic myocardial perfusion (CTP) imaging is a tool that shows promise in emergent settings for defining the hemodynamic significance of coronary artery disease. In this study, we examined the accuracy with which the transmural perfusion ratio (TPR) derived through semiautomated CTP analysis reflected segmental perfusion defects associated with intermediate coronary artery lesions in swine. Lesions (diameter stenosis, 65% ± 11%) of the left anterior descending coronary artery (LAD) were created in 10 anesthetized female swine (weight, 47.5 ± 1.9 kg) by using a pneumatic occlusion device implanted on the LAD. Occluder inflation pressures were adjusted to maintain fractional flow reserve (FFR, 74.3 ± 1.7) during adenosine infusion (140ug/kg/min). Static CTP imaging using a stress-rest protocol and segmental TPR derived from semiautomated CT perfusion software was compared with microsphere-derived TPR (mTPR) by using a 16-segment model and polar mapping. Intermediate LAD stenosis was verified through multiplanar coronary CT angiography. Receiver operating characteristic analysis identified an optimal threshold for segmental perfusion defects for intermediate lesions (TPR threshold, ≤0.80); however, the area under the receiver operating characteristic curve was 0.58, and the overall accuracy was 63%. At this threshold, the sensitivity and specificity were 65% and 61%, and the positive and negative predictive values were 61% and 65%, respectively. Although CTP-TPR illustrated segmental perfusion defects with intermediate lesions, the disparity between CTP-TPR and mTPR measures of segmental perfusion suggests that further advances in analysis software may be necessary to improve the localization of segmental defects for intermediated lesions.
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Affiliation(s)
- Bryan C Ramsey
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Amy E Field
- US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Dustin M Thomas
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | | | - Alisa J Leon
- US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Bernard J Rubal
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas;,
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Association of regional myocardial conduction velocity with the distribution of hypoattenuation on contrast-enhanced perfusion computed tomography in patients with postinfarct ventricular tachycardia. Heart Rhythm 2018; 16:588-594. [PMID: 30935494 DOI: 10.1016/j.hrthm.2018.10.029] [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: 08/23/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging has been shown to be beneficial for identification of the ventricular tachycardia (VT) substrate before catheter ablation. Contrast-enhanced perfusion multidetector computed tomography (CEP-MDCT) is more generalizable to clinical practice, and wall thickness and regional hypoenhancement on CEP-MDCT can identify potential substrate sites, albeit with decreased specificity. OBJECTIVE The purpose of this study was to evaluate the association between wall thickness and attenuation on CEP-MDCT with local conduction velocity (CV) and electrogram abnormalities in patients with postinfarct VT. METHODS Fourteen patients with postinfarct VT underwent preprocedural CEP-MDCT followed by endocardial electroanatomic mapping (EAM) and ablation. Myocardial attenuation and wall thickness were calculated from 3-dimensional MDCT images using ADAS-VT software (Galgo Medical). EAM was registered with 3-dimensional MDCT images using the CartoMERGE module of CARTO3 software (Biosense Webster). Local CV was calculated by averaging the velocity between each point and 5 adjacent points with concordant wavefront direction. RESULTS A total of 3689 points were included. In multivariable regression analysis clustered by patient, local CV was positively associated with myocardial attenuation, bipolar voltage, unipolar voltage, and wall thickness. Each 10-HU drop in full-thickness attenuation correlated to 2.6% decrease in CV (P <.001) and 5.5% decrease in bipolar voltage amplitude (P <.001), after adjusting for wall thickness. CONCLUSION Myocardial attenuation distribution on CEP-MDCT is associated with regional CV and electrogram amplitude. Regions with low CV identified with low attenuation on CEP-MDCT may serve as important VT substrates in postinfarct patients.
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