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Crean AM, Small GR, Saleem Z, Maharajh G, Ruel M, Chow BJW. Application of Cardiovascular Computed Tomography to the Assessment of Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 205:481-492. [PMID: 37683571 DOI: 10.1016/j.amjcard.2023.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy is a common inherited cardiac condition in which regional myocardial thickening and scarring can lead to a range of symptoms including breathlessness, dizziness, chest pain, and collapse with loss of consciousness. It is vital to be able to understand the mechanisms behind these epiphenomena and to be able to distinguish, for example, between syncope because of arrhythmia versus syncope because of mechanical outflow tract obstruction. Therefore, we require a technique that can characterize anatomy, physiology, and myocardial substrate. Traditionally, this role has been the preserve of cardiac magnetic resonance (CMR) imaging. This review makes the case for cardiac computed tomography (CT) as an alternative imaging method. We review the use of functional CT to identify the components of outflow tract obstruction (and obstruction at other levels, which may be simultaneous), and as an aid to interventional and surgical planning. We demonstrate the added value of multiplanar isotropic reformats in this condition, particularly in cases where the diagnosis may be more challenging or where complications (such as early apical aneurysm) may be difficult to recognize with 2-dimensional techniques. In conclusion, our aim is to convince readers that cardiac CT is a highly valuable and versatile tool, which deserves wider usage and greater recognition in those caring for patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Andrew M Crean
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Gary R Small
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zain Saleem
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gyaandeo Maharajh
- Division of Cardiovascular Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
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Abdelkarim A, Roy SK, Kinninger A, Salek A, Baranski O, Andreini D, Pontone G, Conte E, O’Rourke R, Hamilton-Craig C, Budoff MJ. Evaluation of Image Quality for High Heart Rates for Coronary Computed Tomographic Angiography with Advancement in CT Technology: The CONVERGE Registry. J Cardiovasc Dev Dis 2023; 10:404. [PMID: 37754833 PMCID: PMC10532141 DOI: 10.3390/jcdd10090404] [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: 04/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE This study aims to evaluate image quality in patients with heart rates above or equal to 70 beats per minute (bpm), performed on a 16 cm scanner (256-slice General Electric Revolution) in comparison to a CT scanner with only 4 cm of coverage (64 slice Volume CT). BACKGROUND Recent advancements in image acquisition, such as whole-heart coverage in a single rotation and post-processing methods in coronary computed tomographic angiography (CCTA), include motion-correction algorithms, such as SnapShot Freeze (SSF), which improve temporal resolution and allow for the assessment of coronary artery disease (CAD) with lower motion scores and better image qualities. Studies from the comprehensive evaluation of high temporal- and spatial-resolution cardiac CT using a wide coverage system (CONVERGE) registry (a multicenter registry at four centers) have shown the 16 cm CT scanner having a better image quality in comparison to the 4 cm scanner. However, these studies failed to include patients with undesirable or high heart rates due to well-documented poor image acquisition on prior generations of CCTA scanners. METHODS A prospective, observational, multicenter cohort study comparing image quality, quantitively and qualitatively, on scans performed on a 16 cm CCTA in comparison to a cohort of images captured on a 4 cm CCTA at four centers. Participants were recruited based on broad inclusion criteria, and each patient in the 16 cm CCTA arm of the study received a CCTA scan using a 256-slice, whole-heart, single-beat scanner. These patients were then matched by age, gender, and heart rate to patients who underwent CCTA scans on a 4 cm CT scanner. Image quality was graded based on the signal-to-noise ratio, contrast-to-noise ratio, and on a Likert scale of 0-4: 0, very poor-4, excellent. RESULTS 104 patients were evaluated for this study. The mean heart rate was 75 ± 7 in the 4 cm scanner and 75 ± 7 in the 16 cm one (p = 0.426). The signal-to-noise and contrast-to-noise ratios were higher in the 16 cm scanner (p = 0.0001). In addition, more scans were evaluated as having an excellent quality on the 16 cm scanner than on the 4 cm scanner (p < 0.0001) based on a 4-point Likert scale. CONCLUSIONS The 16 cm scanner has a superior image quality for fast heart rates compared to the 4 cm scanner. This study shows that there is a significantly higher frequency of excellent and good studies showing better contrast-to-noise and signal-to-noise ratios with the 16 cm scanner compared to the 4 cm scanner.
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Affiliation(s)
- Ayman Abdelkarim
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Sion K. Roy
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - April Kinninger
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Azadeh Salek
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Olivia Baranski
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy (G.P.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20126 Milan, Italy
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy (G.P.)
| | - Rachael O’Rourke
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, 4032 QLD, Australia (C.H.-C.)
| | - Christian Hamilton-Craig
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, 4032 QLD, Australia (C.H.-C.)
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute, Torrance, CA 90502, USA; (A.A.); (O.B.)
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Madaj P, Li D, Nakanishi R, Andreini D, Pontone G, Conte E, O'Rourke R, Hamilton-Craig C, Nimmagadda M, Kim N, Fatima B, Dailing C, Shaikh K, Shekar C, Lee JH, Budoff MJ. Radiation Doses in Patients Undergoing Computed Tomographic Coronary Artery Calcium Evaluation With a 64-Slice Scanner Versus a 256-Slice Scanner. Tex Heart Inst J 2022; 49:478371. [PMID: 35244722 DOI: 10.14503/thij-18-6793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Computed tomographic coronary artery calcium scanning enables cardiovascular risk stratification; however, exposing patients to high radiation levels is an ongoing concern. New-generation computed tomographic systems use lower radiation doses than older systems do. To quantify comparative doses of radiation exposure, we prospectively acquired images from 220 patients with use of a 64-slice GE LightSpeed VCT scanner (control group, n=110) and a 256-slice GE Revolution scanner (study group, n=110). The groups were matched for age, sex, and body mass index; statistical analysis included t tests and linear regression. The mean dose-length product was 21% lower in the study group than in the control group (60.2 ± 27 vs 75.9 ± 22.6 mGy·cm; P <0.001) and also in each body mass index subgroup. Similarly, the mean effective radiation dose was 21% lower in the study group (0.84 ± 0.38 vs 1.06 ± 0.32 mSv) and lower in each weight subgroup. After adjustment for sex, women in the study group had a lower dose-length product (50.4 ± 23.4 vs 64.7 ± 27.6 mGy·cm) than men did and received a lower effective dose (0.7 ± 0.32 vs 0.9 ± 0.38 mSv) (P=0.009). As body mass index and waist circumference increased, so did doses for both scanners. Our study group was exposed to radiation doses lower than the previously determined standard of 1 mSv, even after adjustment for body mass index and waist circumference. In 256-slice scanning for coronary artery calcium, radiation doses are now similar to those in lung cancer screening and mammography.
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Affiliation(s)
- Paul Madaj
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Dong Li
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Rine Nakanishi
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California.,Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Edoardo Conte
- Department of Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Rachael O'Rourke
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Cardiology, University of Queensland, Brisbane, Australia
| | | | - Manojna Nimmagadda
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Nicholas Kim
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Badiha Fatima
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Christopher Dailing
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Kashif Shaikh
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Chandana Shekar
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ju Hwan Lee
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Matthew J Budoff
- Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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Kligerman S, Hsiao A. Optimizing the diagnosis and assessment of chronic thromboembolic pulmonary hypertension with advancing imaging modalities. Pulm Circ 2021; 11:20458940211007375. [PMID: 34104420 PMCID: PMC8150458 DOI: 10.1177/20458940211007375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023] Open
Abstract
Imaging is key to nearly all aspects of chronic thromboembolic pulmonary hypertension including management for screening, assessing eligibility for pulmonary endarterectomy, and post-operative follow-up. While ventilation/perfusion scintigraphy, the gold standard technique for chronic thromboembolic pulmonary hypertension screening, can have excellent sensitivity, it can be confounded by other etiologies of pulmonary malperfusion, and does not provide structural information to guide operability assessment. Conventional computed tomography pulmonary angiography has high specificity, though findings of chronic thromboembolic pulmonary hypertension can be visually subtle and unrecognized. In addition, computed tomography pulmonary angiography can provide morphologic information to aid in pre-operative workup and assessment of other structural abnormalities. Advances in computed tomography imaging techniques, including dual-energy computed tomography and spectral-detector computed tomography, allow for improved sensitivity and specificity in detecting chronic thromboembolic pulmonary hypertension, comparable to that of ventilation/perfusion scans. Furthermore, these advanced computed tomography techniques, compared with conventional computed tomography, provide additional physiologic data from perfused blood volume maps and improved resolution to better visualize distal chronic thromboembolic pulmonary hypertension, an important consideration for balloon pulmonary angioplasty for inoperable patients. Electrocardiogram-synchronized techniques in electrocardiogram-gated computed tomography can also show further information regarding right ventricular function and structure. While the standard of care in the workup of chronic thromboembolic pulmonary hypertension includes a ventilation/perfusion scan, computed tomography pulmonary angiography, direct catheter angiography, echocardiogram, and coronary angiogram, in the future an electrocardiogram-gated dual-energy computed tomography angiography scan may enable a "one-stop" imaging study to guide diagnosis, operability assessment, and treatment decisions with less radiation exposure and cost than traditional chronic thromboembolic pulmonary hypertension imaging modalities.
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Affiliation(s)
- Seth Kligerman
- Cardiothoracic Imaging, University of California San Diego, La Jolla, CA, USA
| | - Albert Hsiao
- Cardiothoracic Imaging, University of California San Diego, La Jolla, CA, USA
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Cherukuri L, Birudaraju D, Kinninger A, Chaganti BT, Pidikiti S, Pozon RG, Pozon ACG, Lakshmanan S, Dahal S, Hamal S, Flores F, Christopher D, Andreini D, Pontone G, Conte E, Nakanishi R, O’Rourke R, Hamilton-Craig C, Nasir K, Roy SK, Mao SS, Budoff MJ. Use of Advanced CT Technology to Evaluate Left Atrial Indices in Patients with a High Heart Rate or with Heart Rate Variability: The Converge Registry. J Nucl Med Technol 2020; 49:65-69. [DOI: 10.2967/jnmt.120.253781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022] Open
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Meyer E, Labani A, Schaeffer M, Jeung MY, Ludes C, Meyer A, Roy C, Leyendecker P, Ohana M. Wide-volume versus helical acquisition in unenhanced chest CT: prospective intra-patient comparison of diagnostic accuracy and radiation dose in an ultra-low-dose setting. Eur Radiol 2019; 29:6858-6866. [PMID: 31175414 DOI: 10.1007/s00330-019-06278-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/15/2019] [Accepted: 05/17/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Diagnostic performance and potential radiation dose reduction of wide-area detector CT sequential acquisition ("wide-volume" acquisition (WV)) in unenhanced chest examination are unknown. This study aims to assess the image quality, the diagnostic performance, and the radiation dose reduction of WV mode compared with the classical helical acquisition for lung parenchyma analysis in an ultra-low-dose (ULD) protocol. METHODS After Institutional Review Board Approval and written informed consent, 64 patients (72% men; 67.6 ± 9.7 years old; BMI 26.1 ± 5.3 kg/m2) referred for a clinically indicated unenhanced chest CT were prospectively included. All patients underwent, in addition to a standard helical acquisition (120 kV, automatic tube current modulation), two ULD acquisitions (135 kV, fixed tube current at 10 mA): one in helical mode and one in WV mode. Image noise, subjective image quality (5-level Likert scale), and diagnostic performance for the detection of 9 predetermined parenchymal abnormalities were assessed by two radiologists and compared using the chi-square or Fisher non-parametric tests. RESULTS Subjective image quality (4.2 ± 0.7 versus 4.2 ± 0.8, p = 0.56), image noise (41.7 ± 8 versus 40.9 ± 8.7, p = 0.3), and diagnostic performance were equivalent between ULD WV and ULD helical. Radiation dose was significantly lower for the ULD WV acquisition (mean dose-length product 14.1 ± 1.3 mGy cm versus 15.8 ± 1.3, p < 0.0001). CONCLUSION An additional 11% dose reduction is achieved with the WV mode in ULD chest CT with fixed tube current, with equivalent image quality and diagnostic performance when compared with the helical acquisition. KEY POINTS • Image quality and diagnostic performance of ultra-low-dose unenhanced chest CT are identical between wide-volume mode and the reference helical acquisition. • Wide-volume mode allows an additional radiation dose reduction of 11% (mean dose-length product 14.1 ± 1.3 mGy cm versus 15.8 ± 1.3, p < 0.0001).
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Affiliation(s)
- Elsa Meyer
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Aissam Labani
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Mickaël Schaeffer
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Mi-Young Jeung
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Claire Ludes
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Alain Meyer
- Physiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Catherine Roy
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Pierre Leyendecker
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France. .,ICube Laboratory, 300 Boulevard Sébastien Brandt, 67400, Illkirch Graffenstaden, France.
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